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Hernia Center

Smiling Man Looking at Phone, Don't suffer with hernia pain

The treatment of hernias can be extremely complex and may require the skill and expertise of a surgeon and staff with experience. Our many years of experience in hernia repair allows our center to repair different types of hernias using a variety of techniques. Each hernia is different, and our surgeons will discuss your hernia with you and tailor treatment to your particular needs.

Hernia Repair

A hernia is a weakness or actual defect in the abdominal wall. Hernias typically occur in the abdomen or groin where there are naturally weak areas (such as the belly button, canals in the groin). Sometimes hernias are present at birth. Hernias can also occur after someone strains an area where the muscles are weak, after high impact injuries, after normal wear-and-tear, or hernias can be a consequence of weakness at surgical incision sites in the abdominal wall. When hernia defects form, the inner lining of the abdominal wall bulges outward, forming a sac. Abdominal contents such as fluid, fat, or internal organs like the intestine can go into the sac. The bulge may or may not be visible. Pain and/or discomfort may or may not be present.

When contents freely move in and out of the defect, the hernia is considered reducible. If contents get trapped within the defect and cannot reduce (the bulge will no longer flatten), the hernia is considered incarcerated. If the blood supply of trapped contents is cut off, the hernia is considered strangulated, and its contents may die, resulting in severe pain and a surgical emergency.

The techniques and types of hernias we repair include:

Inquinal and femoral (groin)

Inguinal and femoral hernias are weaknesses or defects that occur in the groin, which is actually the lowest part of the abdominal wall. They occur in both males and females, though more likely in males. These can sometimes be obvious to a patient by being associated with pain and/or a bulge, and other times may only be apparent to an examining physician.

Surgery is needed to repair the defect in the abdominal wall. No two hernias are alike: depending on your unique situation (ie, prior surgery or mesh, nature of hernia), your surgeon will recommend either an open or a laparoscopic approach. In a laparoscopic approach, mesh is placed behind the defect (like patching a tire) using three small incisions. In an open approach, mesh is placed behind and/or in front of the defect using a single incision in the groin. In either approach, the operation typically takes 1-2 hours and patients usually go home the same day.

Umbilical

An umbilical hernia is a weakness or defect at the navel. This part of the abdominal wall is a naturally vulnerable due to presence of the umbilical cord while in the womb. When this part of the abdominal wall fails to fuse properly, a hernia can result. In other situations, this vulnerable area can come apart with strenuous activity, weight gain, or pregnancy. These can sometimes be obvious to a patient by being associated with pain and/or a bulge, and other times may only be apparent to an examining physician.

Surgery is needed to repair the defect in the abdominal wall. No two hernias are alike: depending on your unique situation (ie, prior surgery or mesh, nature of hernia, weight of patient), an open or laparoscopic approach will be recommended. An open approach uses a single incision at the belly button. A laparoscopic approach uses multiple small incisions and a camera. Tiny defects might not require mesh, but most umbilical hernias will require a mesh patch to be placed behind the defect (like patching a tire). In most cases, the operation lasts 1-2 hours. With small hernias done by an open approach, patients go home the same day. With larger hernias done by a laparoscopic approach, an overnight stay is usually required.

Ventral, Spigelian, Incisional

A ventral hernia is a weakness of the abdominal wall that occurs in the absence of prior surgical incisions. A Spigelian hernia is a weakness that occurs between the rectus and oblique muscles in the semilunar line, either on the left or the right side. An incisional hernia is a weakness of the abdominal wall that occurs at a prior surgical incision site. All of these situations are managed in similar fashion. Like other hernias, these can sometimes be obvious to a patient by being associated with pain and/or a bulge, and other times may only be apparent to an examining physician.

Surgery is needed to repair the defect in the abdominal wall. No two hernias are alike: depending on your unique situation (ie, prior surgery or mesh, nature of hernia, weight of patient), your surgeon will recommend either an open or a laparoscopic approach. In either approach, most ventral, Spigelian and incisional hernias will require mesh, which is placed behind the defect (like patching a tire). An open approach uses a single incision at the site of the hernia. A laparoscopic approach uses multiple small incisions and a camera. In most cases, the operation lasts 1-2 hours. With small hernias done by an open approach, patients go home the same day. With larger hernias done by a laparoscopic approach, an overnight stay is usually required.

Hiatal

Hiatal hernias are weaknesses in the diaphragm that allow portions of the stomach to move up into the chest. In most cases, these are associated with esophageal reflux. Small hiatal hernias which are not bothering patients are usually managed without surgery. Surgery is recommended to manage larger hernias, hernias causing symptoms not adequately treated with medication, hernias in which the stomach is twisted or angulated, or hernias in which stomach erosions cause slow bleeding. In most cases, hiatal hernia repair can be performed laparoscopically using five small incisions. However, sometimes an open approach is required.

At surgery, the weakness in the diaphragm is tightened up with sutures, but it cannot be closed because the esophagus and aorta must also pass through this opening (the “esophageal hiatus”). In some cases, reinforcing mesh is used. One thing that helps with associated reflux and also to prevent recurrence is the addition of a fundoplication or “wrap”, whereby part of the stomach is wrapped around the lowest part of the esophagus. This is also commonly performed during hiatal hernia repair. The operation typically lasts 1-2 hours. With a laparoscopic approach, patients usually stay 1-2 nights in the hospital.

Flank

A flank hernia is a weakness in the part of the abdominal wall between our hip and side of the rib cage. These most often result from surgery, especially kidney surgery, orthopedic surgery involving the hip, and some types of spine surgery. Flank hernias are very challenging to repair due to the bony anatomy, and are extremely prone to recurrence, so expert care is required.

Surgery is needed to repair the defect in the abdominal wall. Mesh must be placed behind the defect, and often anchored into the hip bone and sutured to/around ribs for security. Depending on the situation, a laparoscopic or open approach will be recommended. These operations take 2-4 hours to perform and usually require 1-2 nights in the hospital.

Complex

Hernias that have recurred after previous repair(s), that occur in patients with risky medical or surgical issues, that have become so large that contents won’t fit back into the belly, that occur in the presence of obesity, smoking, diabetes and/or immunosuppression, or that occur in the presence of active or recent infection, are considered complex hernias, and these cases demand expert care. Careful planning with imaging, review of previous surgery, and risk reduction planning is essential in these cases. Our surgeons will explain why it is vital to address correctable risk factors like smoking, uncontrolled diabetes, and obesity.

In most patients, surgery will be appropriate; but in some cases, surgery will be considered too risky and not recommended. Since each successive operation carries significantly greater risk of major complications, and is much more likely to fail, our surgeons will outline a preoperative plan to minimize risk factors and optimize your chances for a successful outcome.

Depending on your situation, surgery will be recommended as laparoscopic, open, or a combination of the two (hybrid). Mesh is required in almost all complex hernia repairs. Advanced techniques, such as retrorectus repair (placement of mesh in between the visceral sac and the rectus muscles), and component separation (releasing one of the oblique muscles laterally in order to allow the muscles to come together in the midline) might be required.

In some cases, assistance from a plastic surgeon is required for complicated skin and soft tissue problems. These operations take at least 3-4 hours, and hospital stays can range from 3-7 days. We utilize enhanced recovery pathways which not only shorten the length of stay in the hospital, but also minimize risk of complications and optimize recovery and outcome.

Incarcerated or Strangulated

When herniated content is stuck or “won’t go back in” it is considered incarcerated. An incarcerated hernia can sometimes become an urgent or emergent situation. You should definitely call you doctor and be evaluated quickly to make sure your hernia is not considered strangulated.

When herniated content is so stuck that its blood supply is compromised, tissue death begins to occur and this hernia is now considered strangulated. A strangulated hernia is an emergency condition and surgery is required. If you suspect you have this problem, you should proceed immediately to the emergency room and notify your doctor or your surgeon of the situation.

Sports Hernias

Treatment

Hernias will not heal on their own and therefore, with few exceptions, are generally treated with surgery. Depending on the situation, surgery may best be performed laparoscopically or via traditional open incision. The goal of surgery is to put the abdominal contents back into the belly and repair/reinforce the defect in the abdominal wall or groin. Most hernias occurring for the first time, in patients with no risky concurrent medical or surgical problems, are considered traditional and are usually managed with straightforward outpatient surgery.

Hernias that have recurred after previous repair(s), that occur in patients with risky medical or surgical issues, that have become so large that contents won’t fit back into the belly, that occur in the presence of obesity, smoking, diabetes and/or immunosuppression, or that occur in the presence of active or recent infection, are considered complex hernias, and these cases demand expert care. Careful planning and technical considerations are mandatory. Previous surgery (and mesh if present) causes adhesions and scar tissue. Advanced surgical techniques such as retrorectus repair (placing mesh behind the abdominal muscles) and component separation (releasing one of the three muscles on the sides to allow the muscles to meet in the midline), even coordination with a plastic surgeon for optimal tissue coverage, may be necessary.

In almost all cases, the standard of care and mainstay of hernia surgery involves placement of a mesh patch to reinforce and repair the hernia defect. The field of biomaterials available for hernia surgery is vast and your surgeon will review with you the options and recommendations based on experience and evidence. No two hernias and no two patients are alike. Your surgeon will formulate a plan for your specific situation and, if surgery is considered, will review preoperative preparation, surgical approach, operative technique, biomaterials, risks, benefits, and alternatives to surgery with you.

Resources

For more information on hernias, visit the U.S. Library of Medicine.

Make an Appointment

To make an appointment, or to speak with someone on our staff, please call 919-784-4160.

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