A hernia is a defect or hole in the abdominal wall that holds all of the organs inside the body. Hernias can cause a significant amount of pain. Intestines and other abdominal organs can protrude through these defects leading to incarceration (bowels stuck outside the abdominal wall). It is usually recommended that hernias be repaired.
Umbilical hernias are hernias that occur at the umbilicus or belly button. These hernias can be present from birth or occur at any time during a person’s lifetime. Sometimes, they are so small a person may not even realize that they have a hernia. If the hernia causes pain, it probably should be repaired. Small umbilical hernias can be repaired through a small incision near the umbilicus. Larger umbilical hernias may require mesh and a slightly larger incision. Very large umbilical hernias can be repaired laparoscopically also known as a laparoscopic hernia repair. A number of small incisions are made and the hernia is repaired with the assistance of a special camera known as a laparoscope and mesh.
When most people think of hernias, they think of groin hernias. These are generally divided into two groups known as inguinal hernias and femoral hernias. Inguinal hernias are more common in men because they occur where the spermatic cord and its vessels leave the inside of the abdomen and enter the scrotum. These hernias can be present from birth and grow larger over time. Hernias present from birth often occur on both sides. These hernias most often are noticed as bulges in the groin that can go down into the scrotum. The size of the bulge can vary throughout the day although some people may notice the bulge all of the time. Other inguinal hernias are caused by wear and tear and are seen as bulges mostly in the groin.
Femoral hernias occur in the femoral canal where the vessels that supply the leg start. These hernias present as bulges in the lower groin. They seem to be more common in women but can be found in men as well. These hernias are more likely to present as an emergency or incarcerated (stuck out).
Groin Hernia Surgery
Groin Hernias can be repaired in a number of ways but most can be described as laparoscopic or open. An open repair involves an incision right over the groin with mesh placement to prevent hernia recurrence. A laparoscopic inguinal (or femoral) hernia repair is accomplished with three small incisions on the abdominal wall. A piece of mesh is placed over the entire area where a hernia can occur with the assistance of a special camera called a laparoscope. The advantages of a laparoscopic hernia repair as compared to an open repair are smaller incisions, same incisions for a bilateral (both sides) repair, decreased pain in most people with an earlier return to regular activities other than heavy lifting. Open repairs are still a good option in many people and this decision is usually made at the time of consultation in the office.
Ventral and Incisional Hernias
Ventral hernias occur along the abdominal wall. Many of these hernias more specifically known as incisional hernias occur following a previous surgery. These hernias can become quite large and are very painful and troublesome to many people. They can usually be felt in the office although some are better seen on studies like a CT scan. These hernias can also occur at sites where a colostomy or ileostomy used to be. Sometimes, the hernia can occur while the ileostomy or colostomy is still in place. These are known as parastomal hernias. In addition, there are some other hernias of the abdominal wall including spigelian hernias, which occur at the edge of the rectus muscles of the abdomen (six-pack) muscles.
Ventral Hernia Repair
Ventral hernias can be repaired by either an open or a laparoscopic technique. An open technique involves an incision directly over the area of the hernia, dissection of the hernia sac, and reduction of the hernia and its contents back into the abdomen. Once this has been accomplished, a mesh is placed to prevent recurrence of the hernia and adds strength to the repair. A laparoscopic ventral hernia repair is performed by multiple small incisions with the assistance of a special camera known as a laparoscope. The hernia is viewed from the inside. The intestine that might be stuck inside the hernia is carefully released along with other scarring that may be present from previous surgeries. A mesh is then secured to the abdominal wall from the inside of the abdomen. Advantages of a laparoscopic ventral hernia repair include smaller incisions and decreased infection of the incision. Additional advantages are ability to see any other small hernias that may be present and an ability to release other scarring that may lead to blockage of the intestines. Open repairs are still a good option for many patients and this type of repair may still be recommended.
- No food or drink after midnight the night before surgery.
- Please stop taking aspirin or any other blood thinners at least 5 days prior to surgery. Please check with your primary care physician before discontinuing any prescription drugs.
- Lab work may be required prior to your surgery. This will be scheduled for you.
- Clearance may be required from your primary care physician or a cardiologist prior to any operation. Please bring any notes with you to the office or on the day of surgery that pertain to this matter.
- Please check with your primary care physician or with anesthesia as to which of your prescription medications should be taken on the day of surgery.
- Please have a ride home arranged for the day of surgery (not a bus or taxi).
- Resume a regular diet as tolerated.
- No heavy lifting (greater than 15 lbs.) for 4 to 6 weeks after either a laparoscopic or open hernia repair.
- Exercise and regular activities may be resumed as tolerated other than heavy lifting and only if they can be accomplished without significant pulling or discomfort.
- Driving is not permitted while on narcotic pain medication (Vicodin) or while the brake cannot be applied without significant pain or effort. Driving is not recommended for several days after surgery.
- Constipation can be a common problem after surgery. Milk of magnesia is available over the counter and can be helpful for this problem.
- Ice should be applied to the affected groin after both laparoscopic and open repairs for the evening after surgery to prevent swelling.
- Scrotal support for the first two weeks following hernia repairs will also decrease swelling and discomfort.
- Expect a large amount of bruising following hernia repairs. The bruising may be significantly lower than the area of the incisions. The bruising will improve after approximately two weeks.
- Incisions will have both an outer and inner dressing. The outer dressing may be removed the day after surgery. The inner dressings will resemble band-aids otherwise known as steri-strips. These should remain in place and will fall off in a few days. A patient may shower once the outer dressing has been removed. No baths or swimming for two weeks.
- Fevers, redness or drainage from the incisions is reasons to call the office, as they may be signs of infection. Please feel free to call with other questions as well.
- A follow-up appointment should be made 2 weeks after surgery.
Ventral Hernia Repairs
- No eating or drinking after midnight the night before surgery.
- Please discontinue aspirin or any other blood thinners at least 5 days prior to surgery. Please check with your primary care physician before discontinuing any prescription medications.
- Lab work may be required prior to surgery. This will be scheduled for you.
- Clearance from your primary care physician or a cardiologist may be required prior to surgery. Please bring any notes to this effect to the office or on the day of surgery.
- Please check with anesthesia or your primary care physician as to which of your prescription medications to take on the day of surgery.
- Resume a regular diet as tolerated.
- No heavy lifting (greater than 15 lbs) for 4 to 6 weeks.
- Resume other activities as tolerated with the exception of heavy lifting.
- Driving is not permitted while taking narcotic pain medication (Vicodin) or as long as the brake cannot be effectively applied without significant pain in the case of an emergency. Driving is not recommended for several days following surgery.
- Incisions will have both an outer and inner dressing. The outer dressing can be removed the day after surgery. The inner dressings will resemble band-aids and are otherwise known as steri-strips. These should remain in place and they will fall off in a few days. A patient may shower once the outer dressing has been removed.
- All sutures are underneath the skin and will dissolve on their own. Occasionally, patients may notice a thread or a knot outside the skin. This will dissolve on its own or can be removed in the office.
- Patients with an open repair may have a drain. This drain should be emptied at least every 24 hours with the amount of drainage recorded on a piece of paper. If the drain suddenly stops draining, please contact the office.
- Patients with a laparoscopic repair should keep a pressure dressing directly over the hernia site for several days. This will prevent a collection of fluid from forming where the hernia used to be.
- Most patients will receive an abdominal binder. This elastic device may provide some support and comfort and protect the repair to some extent as well. It should be worn when out of bed for approximately two weeks after surgery.
- Fevers, drainage or redness from incisions or severe pain is reasons to contact the office as they may be signs of infection.
- A follow-up appointment should be scheduled 2 weeks after surgery. Patients with a drain should schedule their follow-up one week after surgery.