Hernia repair

What is it?

A hernia repair is the surgical procedure to fix a hernia. This procedure is also known as herniorrhaphy.

A hernia occurs when part of an internal organ or body part protrudes into an area where it should not. The most common hernias occur in the abdominal area. A small portion of the intestine, or a piece of fat, pokes through a weak area in the muscular wall of the abdomen. This causes an abnormal bulge under the skin of the abdomen, usually near the groin or navel.

For most situations, there are two kinds of hernia repair:

• Traditional (open) hernia repair — The surgeon cuts open the skin. He or she fixes the hernia through an opening that is several inches long.
• Laparoscopic hernia repair — In this less-invasive procedure, the surgeon makes several small holes in the skin. He or she inserts a laparoscope and long-handled surgical instruments through these small holes. (A laparoscope is a telescope-like instrument with a camera on the end.)

For most people, a hernia repair does not require overnight hospitalization.

When is it necessary?

There are many different types of hernias. The most common occurs when a portion of the intestine or a bit of fat pokes through a weak area in the muscular abdominal wall. This causes an abnormal bulge under the skin. This bulge is usually near the groin or the navel.

Men are much more likely than women to develop groin hernias. Men have a small hole in the abdominal wall in the groin. This is where the cord to the testicle passes through. If this hole enlarges abnormally, it can lead to a hernia.

Hernias can cause pain or pressure. Or, they can appear as a painless lump.

Most hernias become larger over time and will not permanently resolve on their own. There is a small risk that part of the bowel could get trapped within the hernia. This can lead to a medical emergency. However, not all hernias need to be repaired.

You may choose to have surgery if:

• The hernia is causing discomfort or limiting your activities.
• The hernia is growing larger.
• You and your doctor are worried about the risk of the bowel getting trapped.

Preparation

Most hernias are diagnosed during an office visit with your doctor. Surgery is planned for a later time, at your convenience.

Your doctor will review your medical history and examine you. If there is any chance you might be pregnant, inform your doctor before surgery. Your doctor may order certain tests to make sure that you can undergo surgery safely. These tests may include blood tests or an electrocardiogram (EKG).

About one week before your hernia repair, your doctor may ask you to stop taking aspirin and other medications that could increase the risk of bleeding. You will be asked not to eat or drink anything beginning the night before surgery (except medicines). This will reduce the risk of vomiting during surgery.

On the day of your surgery, you should wear loose-fitting clothing. Ask your doctor if you should take your regular medications with a sip of water. You also should arrange for someone to drive you home after the surgery.

How it's done

Hernia repair can be done under different kinds of anesthesia. If you receive general anesthesia, you will be unconscious during the procedure. If you are given spinal, regional, or local anesthesia, you will remain awake. But the pain will be blocked in the area of surgery.

An intravenous line will be inserted into one of your veins to deliver fluids and medications. The procedure generally takes less than one or two hours to complete.

Traditional hernia repair — In a traditional repair, the surgeon makes an incision several inches long near the hernia. Once the surgeon can clearly see the herniated body part, he or she gently pushes it back into its proper place. Then the weakness or hole in the abdominal wall is repaired with stitches. Finally, the outer skin incision is closed with stitches.

Surgeons frequently use a synthetic mesh patch to repair hernias. These patches may reduce the tension on the repair. They may also reduce pain and make it less likely that your hernia will return. However, mesh patches may slightly increase the possibility of scarring or infection.

Laparoscopic hernia repair — In a laparoscopic repair, a harmless gas is injected into your abdomen to inflate it. This gives your surgeon more room to work and a better view.

Next, the laparoscope is inserted through a small incision at your navel. Other surgical instruments are inserted in several other small incisions in the abdomen. These may include tools for cutting and stapling. A camera on the laparoscope transmits images from your abdomen to a viewing screen. These images guide the surgeon in using the surgical instruments.

The surgeon gently pulls the herniated body part back into its proper place. He or she then positions a mesh patch over the weakness in your abdominal wall. The patch is secured in place with harmless staples, surgical clips, or stitches. At the end of the procedure, your abdomen is deflated. The small incisions are closed with sutures or surgical tape.

Traditional hernia repair can be done with the patient under local anesthesia. But laparoscopic repair requires general anesthesia. Traditional repairs of groin hernias have a longer track record of success. However, laparoscopic surgery causes less pain and often allows people to return to their usual activities more quickly.

After surgery, you will be monitored closely and given pain medication. Most people recover within a few hours and can go home the same day.

Follow-up

Most people can return to desk work, driving, and other light activities within a few days of surgery. If you work at a more physical job, you may need to wait for two weeks or more.

You will visit your doctor for follow-up some weeks after surgery. Your doctor will remove any stitches and check the healing of your incisions.

Ask your doctor about when you can resume specific activities such as sports, heavy labor, and lifting.

Risks

Hernia repair is generally very safe surgery. Nevertheless, there is always a small risk of complications. These include

• infection
• excessive bleeding
• blood clots
• injury to the intestine, testicle, or other nearby structures.

In children, hernia repair has long-term success in nearly all cases. In adults, the hernia returns in a small percentage of people. The rate can be higher in some special situations.

Additional info

American College of Surgeons (ACS)
https://www.facs.org/