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Hernia Repair

By

Sarah Lewis, PharmD

What is a hernia repair?

A hernia repair is the surgical correction of a hernia. A hernia is a condition in which an organ or other structure protrudes through a weak part of tissue or muscle. In some cases, a hernia can create a visible lump or bulge in the skin. A hernia repair returns the organ or structure to its proper place and fixes the weakened area of muscle or tissue.

A hernia repair is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options available. Consider getting a second opinion about all of your treatment choices before having a hernia repair.

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Types of hernia repair

The types of hernia repair procedures include:

  • Mesh repairs use a mesh plug to cover and strengthen the weakened area of muscle or tissue.

  • Suture repairs use stitches to strengthen the tissues around the weakened area.

Why is a hernia repair performed?

Your doctor may recommend a hernia repair to treat hernias causing pain or other symptoms. Hernias occur in any area of your abdominal (belly) wall. However, the most common sites are in the groin (inguinal hernia), at the naval (umbilical hernia), or at a previous surgical incision site.

Nonsurgical treatment, or watchful waiting, may be an option for adults with hernias that are not causing symptoms. Without surgery, however, the hernia will grow larger over time. Sometimes, it can become trapped (incarcerated) outside your abdominal wall. This can cut off the blood supply to the hernia, resulting in a strangulated hernia. This requires urgent surgical repair. Symptoms of an incarcerated hernia include nausea, vomiting, pain, and color changes in the bulging area.

Surgery is the only way to repair a hernia. Your doctor may consider a hernia repair if watchful waiting is not an option for you. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on hernia surgery.

Your doctor may recommend surgical repair of the following hernias:

  • Congenital diaphragmatic hernia is a birth defect in which abdominal organs protrude up into the chest cavity.

  • Femoral hernia is the protrusion of abdominal fat or part of the intestines through the abdominal muscles into the upper thigh area.

  • Hiatal hernia is the protrusion of a portion of the stomach through an opening in the diaphragm called the hiatus. Hiatal hernia is also called a hiatus hernia.

  • Incisional hernia is a hernia that develops through a previous surgical incision. This can occur anywhere on the abdomen or back.

  • Inguinal hernia is the protrusion of abdominal fat or part of the intestines through the abdominal muscles into the groin area (also called the inguinal canal). Inguinal hernia is the most common type of hernia.

  • Umbilical hernia is the protrusion of part of the intestines or abdominal lining through the abdominal wall around the belly button. It most often occurs in infants ages six months and younger.

Who performs a hernia repair?

General surgeons and pediatric surgeons repair hernias. General surgeons specialize in the surgical treatment of diseases of the abdomen, including appendicitis, hernia, and gallbladder, stomach and intestinal diseases. Pediatric surgeons specialize in the surgical care of diseases, injuries and deformities in premature and newborn infants, children, and adolescents.

How is a hernia repair performed?

Your surgeon will make an incision and put the displaced tissue or organs back into proper place. Stitches are used to strengthen the tissues around the weakened area. A more common technique involves inserting a mesh patch to cover and strengthen the weakened area of muscle or tissue.

Surgical approaches to hernia repair

Hernia repair surgery is performed in a hospital using one of the following approaches:

  • Minimally invasive surgery is performed by inserting special instruments and a laparoscope through small incisions in your abdomen (belly). A laparoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your doctor as he or she performs the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less damage to tissues and organs. Your doctor will make small incisions instead of a larger one used in open surgery. Your doctor threads surgical tools around structures and organs instead of cutting through or displacing them as in open surgery.

  • Open surgery uses a large incision in your abdomen. The length of the incision will depend on the size of the hernia. An open surgery incision allows your doctor to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery because it causes more trauma to tissues. Open surgery requires a larger incision and involves more cutting and displacement of muscle and other tissues. Despite the potential for damage, open surgery may be a safer or more effective method for certain patients.

Your doctor will determine which type of surgery is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different hernia repair procedures and ask why your doctor will use a particular type of procedure for you.
Types of anesthesia that may be used

Your surgeon will perform a hernia repair using either regional anesthesia or general anesthesia.

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a special type of sleep. During general anesthesia, you are unaware of the procedure and will not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. This type of anesthesia involves an injection or a continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

  • Regional anesthesia is also known as a nerve block, an epidural, or spinal anesthesia. Regional anesthesia involves injecting an anesthetic around certain nerves in the spine so you do not feel anything below the waist. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your hernia repair

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control your breathing during general anesthesia.

  • A team member may also insert a tube through your nose to keep your stomach empty and a catheter into your bladder to collect urine and monitor kidney function. You will not feel or remember this or the surgical procedure.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a hernia repair?

As with all surgeries, hernia repair involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or recovery.

General risks of surgery

The general risks of surgical procedures include:

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis (DVT). A DVT that develops in the leg or pelvis can travel to your lungs causing a