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Hernias come in all shapes and sizes

What is a hernia?

A hernia is a bulge of tissue through a weak area, usually through the abdominal wall.  Imagine your belly as a wall that acts to keep your intestinal tract inside of you.  If there is a weakness in the wall, then under the right circumstances, your internal organs can bulge out.  This bulging is referred to as a hernia.  Sometimes you can see the bulge as a lump that can be either painless or very painful.  If the intestines are involved you can have severe symptoms that range from nausea, difficulty with bowel movements, or vomiting.

What causes hernias?

All hernias are caused by a weakness in a wall that allows tissue or an organ to bulge through it.  We are born with areas of natural weakness in the abdominal wall with the most common hernias occurring at the belly button.  They are called umbilical hernias.  Other common places are in the groin, which we call inguinal hernias.   Another cause of hernias are from weaknesses in the abdominal wall as a result from surgical incisions that don’t heal back to their full strength.  We call these incisional hernias.

What are the risk factors for getting a hernia?

A combination of age, constipation, straining, coughing, and lifting heavy objects can cause these weaknesses to get larger, and as a result in the formation of a hernia.

When should I get surgery for a hernia?

There is one situation where you simply MUST get your hernia repaired: If you have intense pain that does not go away, nausea, vomiting, or difficulty having a bowel movement, a piece of intestine may be trapped in the hernia.  We call this incarceration.  If this occurs, you must get the hernia repaired immediately as this is a medical emergency.  The consequences of not repairing these hernias are that the entrapped intestine will lose its blood supply and begin to die.

Most commonly though, patients will have hernias that are painless and can be fixed electively.  If you have regular mild discomfort, intermittent pain that gets better with rest, or simply a bulge that is noticeable, you can choose when or if you would like to have the hernia repaired.

What does hernia surgery involve?

Currently, there are three basic ways to repair a hernia.  First, a hernia can be repaired by an "open" approach in other words with a single incision that is about the length of the hernia.  This can be anywhere from two inches to the entire length of the abdomen.  Second, a hernia can be repaired laparoscopically which involves multiple small incisions and a camera to repair the hernia. Finally, a hernia can be fixed robotically.  Robotic surgery is one of the most recent techniques to be developed in surgery.  Similar to laparoscopic surgery, multiple small incisions are used, but instead of the surgeon using the surgical instruments by hand, robotic arms are attached to the instruments, and the surgeon operates the robot from a console.  Laparoscopic and robotic surgery are two kinds of minimally invasive surgery.

In many cases, the hernia is repaired with mesh, also called a patch.  This is a synthetic screen that is implanted onto the abdominal wall muscle.  Mesh has been proven to decrease the chance of hernias recurring after repair and is considered the standard of care for most hernias.

Which surgery option is the best?

There is no single best option for hernia repair as every patient is different and every surgeon is different.  Each surgeon has spent years perfecting his or her method of giving you the best result possible.  Your surgeon will take into account your medical conditions, the size and location of your hernia and many other factors.  The surgeon will work with you, in a joint effort, to determine which method will be best for you.  In some cases, your surgeon may feel the open approach is best; in others, the laparoscopic or robotic.

What is the recovery like after hernia surgery?

Hernia surgery is typically done on an outpatient basis.  This means you will go home the same day of your surgery.  You can expect several days of pain, regardless of the method used to repair the hernia.  You should expect to walk immediately after surgery, and can resume normal activities as pain permits.  Most surgeons will limit the amount of weight you should lift, in most cases no more than 10-15 pounds.  This restriction will last anywhere from 2 to 6 weeks, depending on the severity of the hernia, and how physically demanding your normal work and home activities are.

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