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Hernia repairs are one of the most common surgeries, with more than 1 million performed each year in the United States. Repairing a hernia through surgery can help to strengthen the abdominal wall and solve uncomfortable symptoms that untreated hernias may cause. 

What is a hernia? 

In order to understand the ins and outs of hernia repair surgery, we must first understand what exactly a hernia is. Hernias occur when part of an organ protrudes through the muscle that sits in front of it. In a lot of cases, hernias occur in the abdominal wall, near a weakened area of the abdominal muscles. 

The most common type of hernia is the inguinal hernia, accounting for roughly 800,000 of the annual hernia repair surgeries performed in the U.S.  

Hernias are caused by a combination of pressure and muscle fatigue or weakness. When there is an increase in pressure pushing on an organ, it can easily push through an opened or weakened area of muscle. Common activities that cause hernias include: lifting heavy objects, diarrhea or constipation and persistent coughing or sneezing. Additional risk factors for hernias include obesity, poor nutrition and smoking. 

What are the different types of hernias? 

There are many different types of hernias. Some of the most common types include inguinal, femoral, ventral, umbilical, epigastric, incisional and hiatal.

Inguinal hernia

Inguinal hernias are the most common type, occurring in about 27% of men and 3% of women. This type of hernia involves a part of the intestine or bladder protruding through part of the lower abdominal wall. They are more common in men due to natural weakness in the groin area. Sometimes, inguinal hernias can slide in and out of the abdominal wall. Doctors can even move inguinal hernias back into place with a massage technique. Inguinal hernias usually occur on one side of the groin and are more common on the right side rather than the left. 

Femoral hernia

Femoral hernias occur when a part of the intestine pushes through a weak spot in the muscle of the inner thigh. This causes the intestinal tissue to enter the canal that holds the femoral artery, also known as the femoral canal. This type of hernia is deeper and much less common than an inguinal hernia. Femoral hernias are common in pregnant women. If left untreated, femoral hernias will not go away on their own. Although they are generally not dangerous, untreated femoral hernias can lead to severe complications that can become life-threatening. 

Ventral hernia

A ventral hernia is one that occurs through an opening in the muscles of the abdomen. Ventral hernias are visibly noticeable as a bulge in the abdomen. Ventral hernias can occur at birth or develop over time due to certain risk factors and they typically do not heal on their own. 

There are three types of ventral hernias: umbilical, epigastric and incisional. 

Umbilical: Umbilical hernias occur near the belly button. This type of hernia is commonly seen in babies who are born prematurely. When present at birth, umbilical hernias can heal on their own and usually go away by the time the child turns four. This type of hernia is more serious in adults than in babies. 

Epigastric: Epigastric hernias occur above the belly button area. If you have an epigastric hernia, then surgery will most likely be recommended since this type of hernia will not go away on its own and complications of leaving it untreated can be dangerous. 

Incisional: Incisional hernias result from intestines pushing through an area of the abdominal wall that was previously weakened from surgery. This type of hernia commonly occurs in people who have had abdominal surgery and are inactive following surgery. 

Hiatal hernia

Hiatal hernias involve an upper part of the stomach bulging into the chest through a hole in the diaphragm (a large flat muscle located below the lungs). Hiatal hernias are common in people over the age of 50 and the exact cause is still unknown. Symptoms of hiatal hernias include chest pain, heartburn and difficulty swallowing. 

How Serious are Hernias? 

Hernias themselves aren’t always very dangerous, however, when left untreated they can become more severe. With the exception of inguinal hernias that can sometimes be pushed back into place, most hernias are only treatable with surgery. 

You can wait to have surgery for your hernia if you aren’t experiencing symptoms but if you choose to wait, you’ll want to be monitored regularly by your doctor in case complications arise. In some situations, painless hernias never require surgery. 

Untreated hernias can become dangerous though. If left untreated, hernias can grow in size making them more difficult to repair when surgery is performed. Another dangerous complication of untreated hernias is strangulation. This occurs when the opening of the muscle closes around the protruding tissue and blood flow becomes cut off. This complication is life-threatening and warrants emergency surgery. 

For this reason, working closely with your health care provider to monitor your hernia is incredibly important.

Hernia symptoms

Signs of a hernia will vary depending on the type of hernia you have. If you suspect that you may have one, you should see your doctor as soon as possible. Your doctor can confirm whether or not you have a hernia by checking you for a lump in the area where the hernia may be. If your doctor is not certain, they can order an imaging scan such as a CT or MRI to confirm the diagnosis.

Common hernia symptoms include:

  • A bulge or lump near your pubic bone or abdomen. 
  • Burning or aching sensation at the bulging area.
  • Discomfort or pain that worsens with activity such as coughing or lifting.
  • Difficulty swallowing
  • Heartburn
  • Constipation

Risk factors

Some risk factors can make you more likely to develop a hernia. These include:

  • Being male
  • Older age
  • Pregnancy
  • Family history
  • Chronic cough
  • Chronic constipation
  • Premature birth or low birth weight

Hernia Repair Surgeries

There are three main types of hernia repair surgeries: open hernia repair, laparoscopic repair and shouldice hernia repair. 

Open hernia repair

In an open hernia repair, you may be under general anesthesia, local anesthesia or sedation. The surgeon will repair your hernia by making an incision along your groin and pushing the tissue back into your abdomen. They will then sew and reinforce the weakened muscle area to prevent the hernia from returning. Your surgeon might use stitches or a combination of stitches and mesh to reinforce the weakened muscle area. The incision will then be closed with sutures, staples or surgical glue. After surgery, you’ll be encouraged to move as quickly as possible to promote healing but it will take a few weeks before you can return to your normal activities. 

Laparoscopic hernia repair

Laparoscopic hernia repair surgery is a less invasive option in which the surgeon makes smaller incisions along the lower abdomen. They will then insert long, tube-like tools into the incisions to perform the surgery. One of the tools will have a small camera on the end, allowing the surgeon to see the inside of your abdomen on a large screen. This type of surgery is a less invasive procedure that allows for smaller incisions and less scarring. 

Shouldice hernia repair

Shouldice hernia repairs are a method that allows the surgeon to reinforce the weakened muscles without using mesh. Some people prefer this method so that they don’t have to forgo mesh placed into their abdomen. This is because it can be rejected by the body, cause infection and in some instances, migrate to another part of the body. 

When using the Shouldice repair method, the surgeon places tension on the muscle tissue around the hernia and then cuts through three separate layers of muscle and connective tissue. After placing the intestine and other misplaced tissues back where they belong, the layers are stitched back together in an overlapping fashion that reinforces the muscle without the use of mesh. 

Do I need hernia repair surgery?

There are some alternatives to hernia repair surgery. Some mild hernias can be monitored with the method of “watchful waiting.” This means delaying surgery and being mindful of the hernia by making sure that no complications arise. It is important to work closely with your primary care provider if you choose to delay surgery so that you can prevent complications from occurring and make sure that surgery is done if it becomes necessary. 

If your hernia is small and asymptomatic, you may never need surgery. However, if the hernia is causing discomfort and continuing to grow, surgery is incredibly important. Problematic hernias can worsen over time. If the hernia is actively growing then surgery will become more and more difficult as time goes on, leading to poorer outcomes. 

Talk with your primary care physician about the state of your hernia and your medical history to determine if you are a good candidate for hernia repair surgery. 

Post Surgery Considerations

Follow your physician’s care plan closely when recovering from hernia repair surgery. Most hernia repair surgeries will allow the patient to return home the same day of surgery. Although early movement is an important way to facilitate healing, you won’t be able to return to your normal activities for at least a few weeks after surgery. 

You’ll want to be mindful of any heavy lifting or strenuous activities to make sure that your hernia does not return. You can expect mild to moderate pain following surgery, which can be treated with over-the-counter pain medications. Keep your incision clean and dry, and monitor for any signs of infection.

Having a trusted provider is one of the best ways to ensure that your hernia repair surgery goes smoothly. At UCF Health, our general surgeon is well-versed in procedures like hernia repairs. We are here to help guide you through the process of preparing for and recovering from your hernia repair surgery. Schedule your visit today. 

Sources

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