Surgical Repair of Hernias

What is a Hernia? What is an Inguinal Hernia?

  • A hernia develops when the muscular layers of the abdominal wall weaken, resulting in a bulge or tear.
  • This allows a small sac containing tissue, and frequently intestine, to protrude through the opening in the muscles of the abdominal wall. The inner lining of the abdominal cavity, called the peritoneum, protrudes to form the sac.
  • While any part of the abdominal wall can develop a hernia, the most common site is the groin. A hernia in the groin region is called an inguinal (ing’gwi-nal) hernia (inguinal is another word for groin). Inguinal hernias account for 80 percent of all hernias. In an inguinal hernia, the sac protrudes into the groin, and may extend into the scrotum in men.
  • Although most common in men, inguinal hernias can also occur in women.
  • You may be born with a hernia (congenital) or develop one over time.

How do I know if I have a hernia?

  • The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and at the site of a previous abdominal operation (incisional).
  • It is generally easy to recognize a hernia. You may notice a bulge under the skin, particularly while straining abdominal muscles. You may feel pain while lifting heavy objects, coughing, straining during urination or bowel movements, or during prolonged standing or sitting.
  • The pain may be sharp and immediate, or a dull ache that gets worse toward the end of the day.
  • Severe, continuous pain, redness, and tenderness are signs that the hernia may be incarcerated or strangulated. These symptoms are cause for concern and should prompt immediate contact of your physician or surgeon, as urgent surgical attention is required.

How are hernias repaired?

  • Hernias do not go away on their own; while sometimes providing a decrease in discomfort, trusses provide no benefit for patients with hernias.
  • For young children, or in very small hernias, the edges of the muscle defect are simply reapproximated.
  • However, the most commonly used method to repair inguinal hernias is the tension-free mesh technique. In this type of repair, an incision is made overlying the hernia, and the hernia contents are reduced back into the abdominal cavity; the hernia sac is frequently excised. A piece of mesh, made of woven polypropylene, is then place to overlap the entire region. This provides a tensionless repair, allowing a faster recovery with less discomfort, and has a risk for recurrence of approximately 2%. Incisional hernias in the abdominal wall also are generally repaired with a mesh technique.

What preparation is required for hernia surgery?

  • Most inguinal hernia repairs are performed on an outpatient basis, so you should be able to go home on the same day of the operation. Some, but not all, incisional hernia repair surgeries are also done on an outpatient basis. The procedure is reviewed with you during the preoperative visit, along with its risks, to allow you to provide written consent for surgery.
  • We see our patients preoperatively a day or so before surgery, and depending upon your age and other medical conditions, preoperative test may include blood work, an EKG, or a chest X-Ray.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery; if you are on Coumadin or Plavix, it is very important to review instructions regarding these medications with your surgeon. Diet medications or St. John’s Wort should not be used for two weeks prior to surgery.
  • You should not eat or drink anything after midnight the night before the operation. If your surgeon has stated they are permissible, you may take your routine medications with a sip of water the morning of surgery.
  • You should arrange to have a friend or relative drive you home after surgery and, ideally, someone should stay with you on the first night.
  • You should shower the morning of the operation, and wear loose-fitting clothing and slip-on shoes.

Further information about laparoscopic cholecystectomy can be found on a PDF file here on our web site.