Ask the Doctors Hernia Surgery

Ask the Doctors: Hernias and Hernia Repair Surgery

A hernia occurs when part of an organ or soft tissue bulges through a weak spot in muscle, most often in the abdomen. Hernias are a common medical issue that can occur in all ages and sexes. While patients may be familiar with the basics of hernias, it’s also important to understand their different causes, their impact on health and how they are most effectively treated. Hernia repairs are common, with over one million surgeries performed each year in the United States. Sara Holden, MD, is an expert in the surgical repair of hernias using innovative techniques like minimally invasive surgery.

Hernias and Hernia Repair Surgery: Frequently Asked Questions

What is a hernia?

A hernia occurs when part of an internal organ or soft tissue pushes through a weakened area or rupture in the surrounding muscle, intruding into a place where it should not be. Hernias are a very common problem often caused by a combination of muscle weakness and straining. They can affect adults, children and newborns for different reasons, and they can have varying symptoms or levels of severity.

What can cause a hernia?

A hernia is caused by the intrusion of intestines or other soft tissue through weakened or over-strained muscles, usually in the abdominal wall. Certain factors can make muscles more vulnerable to hernias, and these elements may compound to increase the likelihood a hernia will occur.

Common contributing factors to hernias include:

  • Obesity
  • Age
  • Family history
  • Congenital defects
  • Pregnancy
  • Chronic coughing
  • Injury
  • Previous surgeries
  • Straining from constipation

What types of hernias exist?

Most hernias occur in the abdominal wall and involve intestines pushing through from the abdominal cavity, causing a visible lump and pain in the affected area. While this is the most common form of a hernia, other types exist and may involve non-intestinal tissue or different muscle regions in the body. The main types of hernias are:

  • Inguinal Hernia: These occur when the intestines or soft tissue push through the abdominal muscles to the inguinal, or groin, area. This hernia may occur through a tear in the abdominal wall or at the inguinal canal, a passageway or round ligament present in the abdomen. It is typically visible as a small bulge in the groin. Inguinal hernias are the most common kind of hernia.
  • Umbilical Hernia: These hernias are most frequent among newborns, but they can also happen to adults. Umbilical hernias occur when part of the intestine or soft tissue squeezes through the muscle at the belly button or navel, where the umbilical cord was present at birth.
  • Ventral or Epigastric Hernia: If the hernia is located above the belly button or navel area, it is considered ventral or epigastric. These are similar to umbilical hernias in their development, resulting from a protrusion of intestine or soft tissue through the abdominal muscle.
  • Femoral Hernia: These hernias occur when part of the intestine or soft tissue pushes through the femoral canal, intruding in the groin area near the upper thigh. This type of hernia most often affects older females.
  • Hiatal Hernia: Most common in pregnant people and those older than 50, a hiatal hernia happens when part of the stomach pushes up into the diaphragm, which is a flat muscle separating the internal cavities of the chest and abdomen. This hernia can cause sensations similar to gastroesophageal reflux disease, or GERD, with symptoms of burning pains in the chest normally associated to eating or lying down.
  • Incisional Hernia: These are caused by weakness in abdominal muscles following a surgery, such as a cesarean section. After a surgical incision through the muscles of the stomach or abdomen, a hernia may protrude through the scars from that operation. Such a hernia can happen months or years after the surgery.
Photo from https://www.surgicalaffiliatesnj.com/hernias

What are the symptoms of a hernia?

Hernia symptoms can vary depending on the type of hernia, its severity and the general health condition of the patient. For most hernias, a patient will see or feel a bulge where the hernia occurred. This may disappear or become more pronounced depending on activity, and the bump may be maneuverable by touch. Common hernia symptoms include:

  • A lump or bulge in the area where the hernia occurred – usually the abdomen or groin – which can increase in size over time.
  • Pain in the affected area, which may increase when coughing, lifting heavy objects, bending over or otherwise straining nearby muscles. Pelvic pain or acute pain without activity is also possible.
  • Pressure, heavy or dull aching sensations in the abdomen.
  • Burning or aching near the lump.
  • Inguinal hernias may cause pain and swelling near the testicles.
  • Hiatal hernias may produce heartburn, indigestion, regurgitation, difficulty swallowing, and chest pain or discomfort.

Why do you need hernia surgery? Do all hernias need surgery?

A hernia will not go away without treatment, and it can require surgery to avoid health complications or increasing severity of the rupture. Surgery is usually recommended for treating hernias. Inguinal, ventral, femoral and incisional hernias often require surgical treatment.

If a doctor recommends surgery for a patient’s hernia, a surgeon will help the patient decide the best type of surgery for the condition and severity of the hernia. Open, laparoscopic and robotic hernia repair options are available.

Hernias left untreated can increase in size or lead to complications, such as constriction on the blood flow of tissues pushed through the muscle wall. This condition, known as a strangulated hernia, can lead to tissue death and requires emergency surgery.

What types of surgery are available for hernia repair?

Three major types of surgery are available for repairing hernias:

  • Open Surgery: This is the traditional hernia repair surgery. A cut is made in the abdomen where the hernia is located. The surgeon moves the intrusive tissue back into its correct space and stitches closed the ruptured muscle. To maintain integrity of the muscle wall, they may implant medical mesh for structural support.
  • Laparoscopic Surgery: While similar to open surgery, laparoscopic surgery requires smaller incisions, each less than an inch, made in the abdomen or groin. The surgeon inserts a camera and small surgical tools through these cuts to repair the hernia.
  • Robotic Surgery: Like laparoscopic surgery, robotic surgery uses small incisions for repairing hernias. In robotic surgery, a surgeon operates through a console in the operating room, using handles that direct surgical instruments. Robotic surgery is a new and effective method for small hernia repair and reconstructing the abdominal wall.

As with all surgeries, each type of hernia repair has advantages and disadvantages. After examining a hernia and talking through these options, a surgeon will determine which type of procedure would be best for their patient’s condition.

How long does hernia surgery take?

Surgery time can vary based on the severity and location of the hernia and the type of surgery. The full surgical procedure will typically take somewhere between 30 minutes and two hours, with the addition of patient intake before the surgery and during recovery at the hospital.

How long does it take to heal from hernia surgery?

Minimally invasive hernia repair surgery uses smaller incisions than traditional open surgery, usually has a shorter recovery time and involves less pain than open surgery. Laparoscopic and robotic hernia surgeries are considered “minimally invasive.” Patients treated with these techniques usually have a shorter hospital stay and a faster recovery than those with traditional open surgery.

After minimally invasive hernia surgery, patients can usually go home the same day or after an overnight recovery period. After one or two weeks, the patient can engage in light activities, and higher strain activity can be resumed after four weeks. This is the same case with open surgery, but an overnight stay can be necessary for more invasive procedures, and the full recovery period often takes six weeks.

Why is my stomach bigger after hernia surgery?

It is normal to experience swelling, pain and bruising at any surgical site, including areas post-op for hernia repair. Swelling is due to the presence of fluid at the surgical area as the body goes through its healing process. Bloating may also occur in abdominal areas following a hernia procedure, or the addition of mesh may result in a slight expansion where it is placed. Such swelling or bloating should decrease during recovery as the body heals and adjusts to any medical devices, usually days or a few weeks later. Larger hernias and surgical areas will result in more swelling that may take a few months to subside.

Is hernia surgery painful?

Hernia repair surgery is an effective method for reducing the pain and complications associated with a hernia. While the intent of any surgery is to reduce the pain of the patient, there is a recovery period for the procedure, and hernia repair is no exception. The surgery itself is mediated to be painless through general, regional (spinal) or local anesthesia with sedation. There will likely be soreness in the treated area following surgery and during the recovery period.

What benefits does robotic hernia repair surgery have?

Robotic hernia repair is not just minimally invasive, promoting a shorter healing period and less scarring or soreness. It provides three-dimensional images for the surgeon to work with during the procedure, allowing higher visualization of the hernia and affected area and more precise, complex movements by the surgeon. Robotic hernia surgery has the lowest potential of tissue strain, shortest hospital stay time and least postoperative pain.

Can you fix a hernia without surgery? How?

In some mild cases, changes in lifestyle and medication may be sufficient to treat a hernia. Hernias that are less likely to require surgery include umbilical hernias, which often resolve soon after birth without medical attention, and some hiatal hernias, which can be treated with over-the-counter or prescription medicine and dietary changes. Some examples of non-surgical treatments include corsets or binders to apply gentle pressure to the hernia, but these will not fully heal the hernia.

Washington University Hernia Surgeons

The team of Washington University hernia surgeons, including Holden, are highly trained in the most advanced techniques for hernia repair. They see patients at the Center for Advanced Medicine, Barnes-Jewish West County Hospital and Christian Hospital. Minimally invasive and cardiothoracic surgeons provide expert laparoscopic surgical care for patients with hernias.

For more information about hernia surgery or to make an appointment with Holden at the Center for Advanced Medicine or Barnes-Jewish West County Hospital, please call 314-454-8877.

For more information or to make an appointment at Christian Hospital, visit the Christian Hospital website or call 314-747-9355.