Hernia Surgery
About Hernia Repairs...
A hernia occurs when a small sac containing tissue protrudes through an
opening in the muscles of the abdominal wall. The technical name for the
operation that repairs a hernia is herniorrhaphy.
As routine as a hernia repair is (over half a million operations were
done in the US last year), no two people undergoing a herniorrhaphy are alike.
The reasons for and the outcome of any operation depend on the patient’s
overall health, age, the severity and size of the hernia, and the strength of
the abdominal tissues.
What
Are Hernias?
A hernia develops when the
outer layers of the abdominal wall weaken, bulge, or actually rip. The hole in
this outer layer allows the inner lining of the cavity to protrude and to form a
sac. Any part of the abdominal wall can develop a hernia. However, the most
common site is the groin.
A hernia in the groin area is called an inguinal
hernia. Inguinal hernias
account for 80 percent of all hernias. In an inguinal hernia, the sac protrudes
into the groin toward --and sometimes into--the scrotum. Although most common in
men, groin hernias can also occur in women.
Femoral hernias are an unusual type of groin hernias that can be
seen as a bulge at the top of the thigh.
Another type of hernia develops through the navel, and it is called an
umbilical hernia.
A hernia that pushes through a surgical incision or operation site is
called an incisional hernia.
Who
Gets Hernias?
Most inguinal hernias in adults result from strain on the abdominal
muscles, which have been weakened by age or by congenital factors. The types of
activity associated with the appearance of an inguinal hernia include:
·
Lifting
heavy objects
·
Sudden
twists, pulls, or muscle strains
·
Marked
gains in weight
·
Chronic
constipation
·
Repeated
attacks of coughing
A hernia is called reducible if the protruding sac of tissue can be
pushed back into place inside the abdomen. If the hernia cannot be pushed back,
it is called irreducible, or incarcerated.
The symptoms of inguinal hernias vary. Sometimes the onset is gradual,
with no symptoms other than the development of a bulge. Other times, the hernia
will occur suddenly with a feeling that something has "given way."
This feeling can be accompanied by pain or discomfort. Signs and symptoms of
inguinal hernias can include:
·
Visible
bulges in the scrotum, groin, or abdominal wall
·
A
feeling of weakness or pressure in the groin
·
A
burning feeling at the bulge
·
A
gurgling feeling
In some cases, an irreducible hernia gets so pinched that the blood
supply is cut off and the tissue swells. Rapidly worsening pain or a tender lump
is a signal that the hernia has strangulated. When strangulation occurs, the
tissue can die quickly and become infected. Within hours this condition can lead
to a life-threatening medical emergency that requires immediate operation.
Preparing
for the Operation
Unless the hernia is strangulated, hernia repair typically is an elective
operation. Each patient must decide whether or not to proceed with the repair.
However, one must realize that ( I ) the hernia is not going to heal by itself,
(2) pain may increase in the area of the hernia, and (3) the size of the hernia
will usually increase over time.
Prior to admission to the hospital, standard tests to measure blood
counts and electrolyte levels, as well as a urinalysis are frequently done.
Additional studies may be required depending on the patient’s condition and
age.
Prior to the operation, an intravenous catheter is placed in the back of
the hand or forearm for sedative medications.
In addition, the area of the incision will be shaved. Preoperative
preparation generally takes less than two hours. Local, spinal, or general
anesthetic may be used depending on the surgeon's preference, patient’s age,
general health, and the procedure's degree of difficulty.
Outpatient
Surgery
Unless there is cause for concern, hernia repair can be done on an
outpatient basis. On the day of the operation, one should wear loose-fitting,
simple clothing to the hospital, such as a sweat suit and slip-on shoes. That
way, upon discharge, getting dressed will be easy. Patients should not eat on
the morning of the operation. A friend or relative should drive the patient home
after the operation and, ideally, someone should stay with the patient the first
night, particularly if the bedroom is on the second floor because stairs may be
difficult to climb.
Types
of Procedures
Today, surgeons use a variety of techniques to repair hernias.
The
Conventional Method. In this case, an incision is made over the site of
the hernia. The protruding tissue is returned to the abdominal cavity, and the
sac that has formed is removed. The surgeon repairs the hole or weakness in the
abdominal wall by sewing strong surrounding muscle over the defect. This is the
most common method of hernia repair.
The
Laparoscopic Method. A
laparoscope is a long metal tube with a lens and a tiny light source on one end
and a telescopic eyepiece on the other, which is connected to a TV monitor. The
scope is used to view the hernia in the abdominal wall while the surgeon repairs
the hernia. Surgical instruments are inserted into other tiny openings and can
be used to push the intestine and hernia sac back into place. A patch of inert
mesh typically is used to reinforce the abdominal wall and is held in place with
surgical staples. A general anesthetic is usually required. This method may
allow the patient to recover faster and with less discomfort than the
conventional method. This method is new, still being evaluated, and is not an
option for every patient.
Tension-free
Mesh Technique. For this
technique, an incision is made at the site of the hernia and a piece of mesh is
inserted to cover the area of the abdominal wall defect without sewing together
the surrounding muscles. Recovery is swift, and the likelihood of the hernia
recurring is small. The mesh is safe and generally well-accepted by the body's
natural tissues.
Complications
Are Few
As with any operation, infection and bleeding can occur. Most of the
time, however, these problems are easily handled, without the need for a
hospital stay. A slight chance also exists that the intestine or bladder can be
injured during the operation. The formation of scar tissue is another
possibility. Any infection associated with the operation will be treated with
antibiotics but otherwise such drugs are not typically used or required.
Recovery
While hernia repair is not considered "major" surgery, the
amount of pain varies from patient to patient. It also depends on the location
and type of hernia that was repaired and the technique that was used for the
repair. Generally, after a conventional hernia repair, one will have some
difficulty walking the first few hours after the operation, and climbing stairs
the first couple of days. Bathing will require care so as not to wet the
incision site. Sexual activity is usually too uncomfortable to enjoy the first
week or two. Heavy lifting, jogging, or doing strenuous exercise are to be
avoided for the first four to six weeks. Driving
a car may be difficult and unwise for a few weeks. Depending upon your
occupation, you can expect a recovery period lasting from one to six weeks.
After Your Groin Hernia Repair Instructions
