A hernia occurs when tissue bulges out through an opening or weakness in the muscular wall. Hernias can develop in any part of the abdomen, but the groin, navel, or the site of a previous surgery are the most frequent locations. Symptoms include a bulge, mild pain or pressure, and numbness, especially with coughing or straining.
Hernias do not resolve without an operation, which is recommended for many patients with asymptomatic hernias and all patients with symptomatic, painful hernias. Patients having hernia surgery at Cayuga Medical Center most often have minimally invasive robotic surgery on the da Vinci Robotic System or laparoscopic surgery, rather than traditional open surgery.
Both robotic and laparoscopic surgeries use small, half-inch incisions resulting in less blood loss, pain, and a faster recovery than open surgery that may require a 5-inch incision. Cayuga Medical Center’s da Vinci robotic system gives surgeons a 3D high-definition magnified view of the surgical area where small surgical instruments are used. The robotic technology provides the surgeon with a greater range of motion to perform a hernia repair than either open or laparoscopic surgery.
Who is most at risk for a hernia?
Men have a 35% lifetime risk of developing hernias, while women have a 5% lifetime risk. In males, groin hernias are the most common type. An opening in the abdominal wall for the testicular artery, vein, and reproductive canals can provide a pathway for a groin hernia to develop. In females, the equivalent anatomical structures are present, but smaller, reducing the risk women face for developing hernias.
Are hernias dangerous?
Most hernias aren’t serious health threats, but they can lead to life-threatening issues. If an intra-abdominal organ such as the intestine gets stuck, the bowel may become obstructed. You may develop bloating, nausea, and vomiting if this occurs. If the blood supply to the intestine gets cut off, this is called strangulation, which is a surgical emergency. Incarceration occurs when part of the small intestine protrudes into the groin area and cannot be pushed back in. Fortunately, the risk of incarceration or strangulation is low for non-painful hernias.
How are hernias treated?
If your symptoms are minimal, then watchful waiting may be an option and has a low risk of complications such as incarceration or strangulation. However, long-term studies on watchful waiting show that most patients eventually develop pain and opt for surgery. Patients with large or painful hernias are at risk for post-operative issues such as recurrence or chronic pain. Currently, guidelines recommend an elective hernia repair for healthy patients with asymptomatic or minimally symptomatic hernias.
There are two main surgical approaches to a hernia surgery: open, or minimally invasive robotic-assisted or laparoscopic surgeries. For open surgery hernia repairs, an incision is made near the site and the hernia. The surgeon pushes the herniated tissue back into place and reinforces the barrier it pushed through with surgical mesh.
For robotic-assisted and laparoscopic surgeries, usually three small incisions are made for surgical instruments and camera. The abdomen is inflated with carbon dioxide to provide a better view of the surgical site and space for manipulating instruments and repairing the herniated site with mesh.
Why is mesh used?
Surgery is the only treatment that can permanently repair a hernia and mesh is used in about 90 percent of those surgeries, according to the U.S. Food and Drug Administration. Many studies show surgical mesh strengthens the hernia repair and reduces the rate of a recurrence with an equal risk of postoperative pain as a non-mesh repair. Surgical mesh is made from synthetic materials and is usually non-absorbable.
Returning to activity after surgery
Resume normal activities as soon as possible after surgery. Walking on the day of surgery increases blood flow and prevents blood clot formation. Restrictions on lifting weight and strenuous activity are normally necessary for 1-2 weeks after surgery. Then, a patient may slowly increase activity as tolerated without restrictions and return to work or school as they feel able. This may range from a few days to a few weeks.
Post-surgery concerns
Some patients have post-surgical pain and should discuss pain management options with their surgeons. Most patients do well with only over-the-counter pain medications. Patients may resume a regular diet after surgery. Avoid straining with bowel movements by increasing the fiber in your diet or with fiber supplements. Be sure you are drinking 8-10 glasses of water each day. Patients are shown how to care for the surgical wound as it heals over 4-6 weeks. The scar will become softer and continue to fade over the next year.
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Dr. Micah Katz received his medical degree from the University of Wisconsin School of Medicine and Public Health in Madison, WI. He did his general surgery training and residency at the University of Utah in Salt Lake City where he was also a fellow in the Center for Global Surgery. His fellowship research focused on expanding surgical capacity in Northern Ghana. His areas of special clinical experience include robotic-assisted surgery, gastroesophageal reflux/heartburn surgery, hernia surgery, and colorectal surgery. Dr. Katz sees patients for Cayuga Surgical Specialists in Ithaca (607) 273-3161 and at Schuyler Hospital (607) 210-1968.
