Hernias and Your Options for Repair

A hernia is when something bulges through a space that should not exist. The confusing thing is that there are MANY types of hernias and not all hernias cause problems for patients.

Examples of hernias include:

• Umbilical (“belly-button" hernias)
• Groin hernias (inguinal or femoral hernias)
• Incisional hernias (a hernia through an area of prior surgery)

In the example of an umbilical hernia, usually, that patient is born with a small “hole” in their abdominal wall. That hole may grow over time based on factors that are not exactly clear to us. In the past, associations about their origin have been made with “straining.” This includes patients who suffer from chronic cough, constipation or even bodybuilders who lift weights regularly. There may also be a genetic component when considering the likelihood of developing a hernia.

Patients can check themselves at home for the presence of a hernia or be evaluated by their primary care provider at a routine check-up. Patients with umbilical hernia will notice a bulge around the area of their “belly-button.” These bulges may or may not be able to be pushed back into the abdomen by a physician. We call this act of pushing back in a bulge “reducing” the hernia. Patients might also notice that reducing the hernia causes some discomfort.

In the case of groin hernias such as inguinal or femoral hernias, the patient may notice a similar bulge in/around the crease of their groin. Males may notice such a bulge within their scrotum. What may be tricky about groin hernias is that a bulge is not always obvious, and patients may have significant pain from these hernias anyway. Pain can limit daily living by inhibiting work-related activities and physical fitness and even cause dependence on pain medication. Patients with chronic and debilitating groin pain should be evaluated by a hernia specialist even without the presence of a bulge. Sometimes, ultrasound or CAT scans can be used to detect small hernias not felt during physical examination.

Incisional hernias are more common than most patients and medical providers realize. Approximately 1 out of every 5 patients who undergo abdominal surgery through a classic “midline” incision will go on to develop a hernia. The risk is even higher if patients are smokers, overweight, or on certain medications such as steroids. Patients with incisional hernias will note a bulge in the region of a prior scar.

These hernias can often be difficult to treat because such surgery is re-operative, and the surgeon must dissect through scar tissue. Such hernias are also best approached by a hernia specialist.

In general, all patients who are fit to undergo surgery should have their hernias repaired. This, of course, can be approached on a case-by-case basis depending on any risk factors patients have. The medical studies that have been done thus far demonstrate that even hernias currently not causing symptoms have a high probability of eventually doing so.

Importantly, hernias that either cause no or minimal symptoms can be repaired on an “elective” basis (meaning there is no urgency to undergo surgery). This is not the case if patients suddenly note the onset of severe pain arising from a bulge/hernia. Symptoms may also include nausea or vomiting if the hernia involves any part of the intestine. Such symptoms require emergency medical attention and will likely require immediate repair.

In discussing the types of repair options available to patients, surgeons generally characterize them as “open” or laparoscopic repairs. “Open” means that the surgery is done through a single incision while laparoscopic refers to the surgery being done through small “key-hole” incisions with the use of a small camera. Both types of surgery can be excellent options depending on the patient and their hernia characteristics. The benefits of a laparoscopic approach can sometimes be a quicker return to work and regular activity, improved cosmetic outcome, and less post-operative pain.

In most cases, surgeons generally use “mesh” to repair the hernia. Meshes come in all different types of shapes, size and can be made of different materials. Some are permanent and some are absorbed by the body over time.

The mesh allows us to provide a tension-free repair of the hernia and reduce recurrence. In the example of a groin hernia, the introduction of mesh allowed surgeons to reduce the recurrence rate (hernia coming back), from 50 percent to less than 1 percent. Hernia meshes used by surgeons for hernia repair are 100 percent safe and approved by the medical governing regulatory bodies.

In summary, as a surgeon who conducts these types of surgeries, I encourage you to be your best advocate. Be knowledgeable about your body and examine yourself for hernias when you have a moment. When visiting with your primary care provider, raise any concerns you might have or make an appointment with a hernia surgeon. Most general surgeons repair hernias, but only some are experienced in both open and laparoscopic techniques. I had the good fortune of training with some of the best hernia surgeons in the country and observing their techniques. I gained experience in repairing everything from the simplest and smallest hernias to the more complex and larger incisional hernias. In my medical career, I have seen many times how hernia surgery can allow patients to return to an active, happier and healthy life.