Understanding Hernia

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What is Hernia?

A hernia can occur in the abdominal cavity when the muscle layer that covers and supports the intestines is ruptured or weakened, causing part of the intestine or tissue to protrude through the muscle layer.

What does it look like?

A hernia most often appears as a lump or bulge and may cause some discomfort when pressed upon. However, sometimes, this small balloon-like sac may not be noticeable and may be asymptomatic.

Where does it occur?

Hernias can present themselves in the groin area (inguinal/femoral), near or around the belly button area (umbilical), or they can also occur at the incision site of a previous procedure you had done (incisional).

SYMPTOMS

Most of the time, you may feel pain or pressure in the region of the hernia when you cough, sneeze, or strain that muscle area by lifting heavy objects. The pain may strike you immediately as a sharp stabbing pain, or it may resemble a dull ache that lasts for a few hours after the activity. Another sign of a hernia is a visible bulge located within your abdominal wall. Looking at your body in a mirror with a side-view may help to distinguish these bulges.

TYPES OF HERNIAS

  • Inguinal hernias appear in the groin area. Inguinal hernias are more commonly found in men in the groin or scrotum.
  • Femoral hernias are more common in women and appear in the groin, upper thigh, or in the skin near the vaginal opening.
  • Ventral Hernias appear as bulges in the abdomen, not near the umbilical area. It can occur as incisional (at a past incision site) due to scar tissue or weak muscles around the site, mid-line above the belly button (epigastric), or anywhere else where there may be weak muscle sites in the abdominal cavity (primary abdominal).
  • Umbilical hernias occur near the belly button when fatty tissue or a part of the intestine bulges through the muscle, pushing the belly button outward due to an increased pressure near the navel.

TREATMENT OPTIONS

The only way to treat hernias is by having an operation. They will not disappear on their own over time, and they will most likely only worsen as more time passes.

For inguinal and femoral hernias, there are a couple of options for treatment depending on the location and size of the hernia.

  • One option is often referred to as an open hernia repair in which a three to four-inch incision is made near the hernia, and a mesh screen is put in to strengthen the muscular wall or the muscle tissue is sutured/sewn if needed. The patient is most often placed under general anesthesia or a local anesthetic and sedation may be used.
  • Most inguinal hernia repairs use the mesh screen to close the muscle tear. After the hernia sac is removed during the operation, the mesh is placed over the site of the sac removal and sewn into the strong muscle tissue around it. Mesh repairs reduce the risk that the hernia will return again.
  • For sutured repairs, after the hernia sac is removed, the edges of the muscle are sewn together without any mesh being placed in the space. This method is often used for strangulated hernias that were less than 3cm.
  • Another option is for the hernia to be treated laparoscopically. This is when the hernia is repaired using instruments that go through a smaller incision in the abdomen and the doctors use telescopes. This route tends to have a lower rate of wound infection compared to open hernia repair, but may not be ideal if the hernia is too large and cannot be treated with this method.
  • Several small punctures are made around the abdominal space for ports (hollow tubes) to be placed in the openings. This allows the abdomen to be inflated with carbon dioxide to make it easier to view the internal organs. Surgical instruments and a light are placed into the ports and the hernia is repaired with those tools using either the mesh or the suture method mentioned above.
  • Laparoscopic procedures may have a longer operation time and may cost more financially, but you also have less scar tissue and have the potential of a quicker recovery when compared to an open hernia repair.
  • Both Ventral hernias and Umbilical hernias are treated the exact same way as inguinal/femoral hernias. You have the option of an open hernia repair (mesh or suture), or a laparoscopic hernia repair. With umbilical hernias, the umbilicus is fixed back to the muscle if it is separated during an open hernia repair. Mesh is the most common repair option for umbilical hernias because it reduces the likelihood of it recurring.

PROCEDURE PREPARATION

  • Doctors will do preliminary blood work and conduct a urinalysis prior to your procedure so your levels can be recorded and monitored during your operation.
  • You will also discuss any current medications and previous medical history with your doctor and your anesthesiologist, if one is necessary.
  • Do not shave the surgical site as the surgical team with use sterilized equipment to trim the hair near the incision site.
  • On the day of your procedure, do not eat or drink for a minimum of 6 hours before your operation.
  • Wear loose fitting clothing and slip-on shoes that do not require you to do any bending over.
  • Be sure to bring a list of current medications with you if your doctor does not already have those on file.
  • If undergoing general anesthesia, and IV line will be started to get the fluids and medication into your system prior to your procedure. A breathing tube may be placed in your throat if the doctor deems it necessary for your operation.

RECOVERY

  • In the recovery room, your heart rate, breathing rate, and oxygen levels will be monitored until you have been cleared to be discharged from the surgery center or hospital.
  • Patients normally return home the same day of their procedure if there are no complications.
  • Recovery is often a quick process, and the patient can resume normal daily activities without further discomfort over the next 2-3 weeks.
  • Patients who have had laparoscopic procedures done often return to work or school within 1-2 weeks following the procedure.
  • No matter what type of procedure you had done, no heavy lifting (heavier than 10lbs) or strenuous activity should be done for 4-6 weeks minimum.
  • It is also very important to keep the wound site(s) clean and sterile.
  • Do not wear tight clothing around those areas and keep the skin covered and protected with regularly
    changed bandages.

Book an appointment with our hernia care team here.

Resources:
1. American College of Surgeons
2. Society of American Gastrointestinal and Endoscopic Surgeons

 

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