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 that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of a hernia repair
Complications of a hernia repair can be serious and include:
Nerve damage, which can lead to tingling or numbness in the groin and upper thigh
Organ, blood vessel, or bowel damage
Pain lasting longer than three months
Recurrence of hernia
Testicular pain or swelling
Urinary retention or inability to urinate
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor or radiologist if you are nursing or if there is any possibility that you may be pregnant
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if have any allergies
How do I prepare for my hernia repair?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for a hernia repair by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include an ultrasound of the hernia, chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing weight before the surgery through a healthy diet and exercise plan. This is important in reducing your risk of recurrence.
Not eating or drinking just prior to surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of the procedure because you can choke on stomach contents during deep anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. For a hernia repair, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
What kind of hernia do I have?
Why do I need a hernia repair? Are there any other options for treating my condition?
Which type of hernia repair procedure will I need?
How long will the surgery take? When will I go home?
What kind of restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery?
How will you manage my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my hernia repair?
Knowing what to expect can help make your road to recovery after a hernia repair as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may be able to go home on the same day if you are recovering well. You may need to stay in the hospital longer if you cannot urinate on your own or you are having nausea and vomiting. In addition, a hospital stay of one day may be required for infants or if your hernia was incarcerated.
Recovery after surgery is a gradual process. Recovery time varies depending on the specific procedure, type of anesthesia, your general health, age, and other factors. Full recovery times range from two to six weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor and care team will manage your pain so you are comfortable and can get the rest you need. Contact your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a hernia repair. Call your doctor if you have questions or concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bloating, swelling or pain in your abdomen or belly
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or pass gas
No bowel movements for three days after surgery
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
Tingling or numbness in the groin
Worsening pain or swelling of a testicle
How might a hernia repair affect my everyday life?
A hernia repair may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. For example, a hernia repair may help you resume your daily activities without pain. However, it will not prevent hernias from coming back. You can make changes in everyday life that may help prevent or delay recurrence of hernias, such as:
Avoiding constipation and chronic straining
Avoiding sudden strains, pulls or twists of your abdomen
Drinking plenty of fluids
Eating a high-fiber diet
Getting regular exercise
Maintaining a healthy weight
Practicing abdominal exercises only as directed by your healthcare provider
Taking fiber supplements as directed by your healthcare provider
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- Could That Lump Be A Hernia? The Nemours Foundation. http://kidshealth.org/parent/system/surgical/hernia.html#.
- Hernia. BetterMedicine. http://www.bettermedicine.com/article/hernia.
- Inguinal/Femoral Hernia. American College of Surgeons. http://www.facs.org/public_info/operation/hernrep.pdf.
- Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62.http://ccjm.org/content/73/Suppl_1/S62.full.pdf.