Hernia surgery

Also known as: Surgery, hernia, Repair, hernia, hernia treatment, herniorrhaphy, hernioplasty

Surgery overview
A hernia is a bulge of intestine, another organ, or fat through the muscles of the belly. A hernia can occur when there is weakness in the muscle wall that allows part of an internal organ to push through.

There are several different types of hernias, named after their location in the body. The most common are inguinal and umbilical, although a hernia can occur in almost any area of the body. Different, common hernias include:

Hernias don't just go away on their own (except for umbilical hernias in babies, which may close on their own). Only surgery can repair a hernia. Hernia repair is one of the most common surgeries done in the United States and is typically performed by a general surgeon.

Why is it done?
In adults, if the hernia is very small or does not cause symptoms it may not require immediate surgical repair. Some people are able to delay surgery for months or years, or may never undergo surgery to repair the hernia. But, over time, hernias tend to get larger as the muscle around it weakens and more tissue bulges through. Many doctors recommend surgery to prevent strangulation, a serious problem that occurs when a loop of intestine or other tissue becomes trapped tightly in a hernia and is cut off from its blood supply. Strangulation requires immediate surgery, although the condition is rare in adults.

In a child, surgery is always recommended because of the increased risk of strangulation.

How it is done
The weak spot in the muscle wall—where the hernia bulges through—traditionally has been repaired by sewing the edges of healthy muscle tissue together (herniorrhaphy). This is appropriate for smaller hernias that have been present since birth (indirect hernias) and for healthy tissues, where it is possible to use stitches without adding stress on the tissue. But the surgical approach varies depending on the area of muscle wall to be repaired and the surgeon's preference.

Mesh patches of synthetic material are now being widely used to repair hernias (hernioplasty). This is especially true for hernias that recur and for large hernias. Patches are sewn over the weakened area in the abdominal wall after the hernia is pushed back into place. The patch decreases the tension on the weakened abdominal wall, reducing the risk that a hernia will recur.

Surgeons can access the hernia using traditional surgical techniques (open surgery), or minimally invasive techniques (laparoscopic surgery).

  • Open hernia repair surgery. During open surgery, the surgeon repairs the hernia through an incision in the abdominal wall.
  • Laparoscopic (minimally invasive) hernia repair. During laparoscopic hernia repair, the surgeon will use several small incisions rather than one large one. With this technique, a thin, lighted scope, called a laparoscope, is inserted through one incision, while instruments to repair the hernia are inserted through other small incisions.

Benefits of minimally invasive procedures may include less pain and faster recovery. There might be increased risks as well and not all surgeries can be done as minimally invasive. Patients should always discuss their surgical options and associated risks with their surgeon before undergoing any type of surgery.

What to think about
If your hernia does not bother you, you may not need to have surgery. In some cases, hernias that are small and painless may never need to be repaired.

Talk with your doctor before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias and sometimes can do more harm than good.

A surgeon's experience plays an important role in the risk of a hernia recurring. If you are thinking about having hernia surgery, ask the surgeon how many of these surgeries he or she has performed and about his or her recurrence rates. Recurrence rates tend to be higher for surgeries that do not use mesh (a synthetic patch).

Some people with other medical conditions may choose not to have surgery or may not be able to have hernia surgery.

  • People with major health problems, such as uncontrolled diabetes, may need to bring these conditions under control before having hernia surgery.
  • Conditions that cause coughing or straining to pass stools or urine (such as lung diseases or prostate problems) may need to be corrected before surgery so that the hernia is less likely to recur after repair.

Learn more
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