Hernias usually don’t get better on their own
Minimally invasive surgical procedures offer quicker recovery and less down time
By William Symons, MD, FACS, Director, Hernia Center
Hernias are common and can occur when the abdomen or groin muscles are weak due to aging or repeated strains. The weakened muscles allow an organ or body part to protrude (bulge) through the wall of the muscle, causing pain. However, some people don’t experience severe symptoms and a doctor or a significant other discovers the hernia.
Hernias can occur in people whose work requires heavy lifting, those who struggle with obesity, those with a chronic cough or chronic constipation, and in women who have had multiple pregnancies.
There are many different types of hernias, but the most common are inguinal hernias, umbilical hernias and incisional hernias.
Treating hernias in the groin
The quicker a hernia is treated; the less difficult treatment becomes. This is because the fascia (a band of connective tissue under the skin attaching muscles and organs) hole gets larger over time and the organs inside the peritoneal cavity (the space between the abdominal wall and the internal organs) starts to bulge out through the wall.
Even if a patient isn’t experiencing pain, it’s important to treat the hernia. An untreated hernia can potentially cause a piece of bowel to get stuck in the hernia defect resulting in an incarcerated hernia — meaning the bulge is no longer able to be pushed back in. If the bowel loses blood flow, it becomes a strangulated hernia that can cause the tissue to die – this leads to serious complications.
There are several ways we approach hernia treatment.
Sometimes we choose to delay hernia repair or to forgo surgery in patients who are much older, very sick with dementia or have bad hearts and may not recover well after anesthesia. In these patients, we routinely watch the hernia to make sure it doesn’t become a serious medical problem. But for patients who are active and healthy and have pain that interferes with normal activities – which most hernias do – we recommend a repair.
Open repair surgery
During open surgery, the surgeon makes a small incision over the groin, cutting through the muscle layers and repairing the fascia. The tear in the fascia is repaired with either stitches (sutures repair) or a piece of mesh which helps strengthen the abdominal wall.
When hernia repair occurs without a piece of mesh, a surgeon uses sutures (Canadian method) to repair the tissue. This method creates tension on the fascia. Studies have shown this approach can cause more pain initially because of the added tension and a greater chance of a recurrence.
Because the Canadian method has resulted in pain and recurrent hernia, surgeons began using mesh which offered a bridge between the two pieces of fascia, eliminating much of the tension. By relieving the tension, we’re able to reduce pain and the chance of recurrent hernia.
Unfortunately, sometimes during an open surgery where the mesh is placed, it can still cause pain.
To help patients recover quicker and experience less acute and chronic pain, a laparoscopic approach is offered. During this procedure, the surgeon makes small cuts in the lower belly and places the mesh using a thin tube with a camera on the end (laparoscope). This approach allows the surgeon to visualize the nerves from the inside and precisely place the mesh away from the nerves and the farthest away from the bowel. Most patients are back to work within four days.
Technology to repair hernias has evolved over the years — from the Shouldice technique (using your tissue and sutures) to tension-free (using mesh) and today with the robotic option. During a robotic-assisted repair, the surgeon uses a device with a camera to control robotic arms that hold tiny surgical tools. The robotic arms can bend and turn in more ways than human hands, allowing for better precision. Today, we can do more outpatient procedures with smaller incisions and less recovery time.
Lifestyle changes are recommended for ventral hernias (hernias in the upper abdomen) caused by rapid weight gain or when a hernia occurs after surgery because of a weakened surgical area. Patients with a body mass index (BMI) between 30 and 40 work with a nutritionist to first address weight issues before hernia surgery is performed.
Because there is such a variety of technology and evidence-based approaches to hernia repair, a surgeon who specializes in hernia repair can recommend the best approach based on your needs. At the Stamford Health Hernia Center, our surgeons follow evidence-based practices using the latest technology and treatments. We perform thousands of hernia repairs each year and always recommend the best plan based on the condition and needs of each patient.