WHAT IS A HERNIA?

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Hernias are very common. Each year roughly 5 million Americans experience a hernia, and over one million hernia repair surgeries are performed. Understanding what is actually happening in the body and your treatment options can help you make decisions for your hernia care.

A hernia occurs when internal organs or tissue break through a layer of muscle or tissues that are meant to contain them.  This occurs as a result of a weak spot forming in the containing muscle or tissue, which can be caused by a number of common factors. 

People who have a hernia typically notice swelling or a bulge at the site of the hernia. Hernias can develop in a number of different regions of the body, including the belly area, groin, chest, and sites of previous surgical incisions. 

A hernia is the medical term used to describe an abnormal opening in the abdominal cavity and is generally applied to two scenarios.  

1. A hole or defect in an area where there should be intact strong tissue, such as the muscles and fascia of the abdominal wall.  
2. An unusually wide opening where there is normally supposed to be a narrow opening, such as in the diaphragm or the pelvis.

The normal pressure inside the abdomen is higher than what is seen in the chest or outside the body, so hernia defects, when present, allow things like a loop of bowel or a piece of omentum (the fatty apron which hangs down from the midportion of the colon) to protrude or “herniate” from inside to locations outside the abdominal cavity. When that occurs the hernia is experienced as a lump under the skin.

There's a variety of reasons for a hernia to occur. In fact, hernias can even be present at birth if there was abnormal development of the abdominal wall. Hernias can also develop over time in areas of weakness or from excessively high pressures. Some of following conditions are frequently associated with hernias:

• Pregnancy
• Lifting excess weight
• Straining for bowel movement or urination
• Obesity
• Chronic coughing
• Trauma to abdomen

The cause and location of the hernia will determine how the hernia is categorized and how to proceed when treating the condition.

The only effective treatment for abdominal hernias is surgery, and healthy patients can typically expect good outcomes. The good news is that we perform the surgery robotically which avoids large incisions and causes minimal pain. We either repair the hernia by suturing your own body's layers or more commonly by inserting a piece of  absorbable or synthetic mesh.  This reinforces the repair and reduces the risk of the hernia returning.

Details of the hernia repair will depend on the type of hernia being treated and the severity of the condition. Because these factors are so individual to each patient and to each hernia, specific questions are best answered during an in-office consultation.  At that time, questions regarding the length of the procedure, recovery time frame, and post-surgical instructions can be addressed.

What is done during a hernia surgery?

Under general anesthesia, we use small incisions to push back anything protruding into the hernia. After we return it to its proper position in the abdominal cavity, we close  the hole in the  layers of the abdominal wall , and the closure is then  often reinforced with a mesh to keep the hernia from coming back. 

An umbilical hernia, or belly button hernia is the abnormal widening of the opening in the muscles directly underneath the patient’s navel or belly button. It can be present from birth or can develop over time as a patient ages. An “outie” belly button is usually just an untreated umbilical hernia. Small umbilical hernias typically are filled with a small amount of fat that originates in the abdominal cavity. If allowed to become larger over time, eventually a part of the intestines can protrude through the umbilical opening in the abdominal muscles. When seen in infants or young children, these hernias are usually not harmful and are just monitored because a majority will close down on their own. If not closed down by the age of 5, surgery is the only real treatment because the hernia will typically not go away and can get bigger over time.

The hernia will create a bulge or swelling felt at the base or immediately next to the belly button. As it grows, the hernia will cause the belly button to “pop out” similar to what can be seen in a pregnant woman. The bulge may appear to grow when straining or coughing and may appear to get smaller when the abdominal wall is relaxed and the patient is lying down on their back.  

If you believe that you have an umbilical hernia, contact the office and discuss the symptoms and signs with the doctor. Again, any umbilical hernia after the age of 5 should be fixed unless you have major medical issues. 

For most older children and adults affected by an umbilical hernia, surgery will likely be required.. If the hernia is very small, a simple incision and suture off the hole may be enough. For larger hernias, a robotic procedure will be used to return the contents within the umbilical hernia back into the abdominal cavity. The hole in the abdominal wall will be repaired, and that repair will be reinforced with a mesh to prevent the hernia from coming back. It is best to undergo surgery when the hernia is smaller.

An incisional hernia occurs after there has been a previous abdominal surgery and you develop a weakness.  Incisional hernias can occur soon after surgery or can appear months or even years later. 

Anyone who has undergone surgery on their abdomen can develop an incisional hernia, however individuals can be at a greater risk if they:

• Have had an infection after the surgery
• Are overweight or obese
• Smoking
• Have had lung problems after surgery
• Used steroid medications
• Are older
• Have more than one surgery using the same incision

All hernias carry with them the chance of intestinal strangulation. This is when the intestine become stuck and twisted within the hernia and the blood flow then gets cut off. If the intestines become strangulated, the pain will be severe and vomiting is often present because the strangulated intestines get kinked or blocked. Strangulated hernias are a surgical emergency, because if left untreated the intestine may die and the situation can become life-threatening for the patient. It is best to have a surgeon address the hernia when it is first noticed to prevent such things from occurring.

Unless medically contraindicated, all incisional hernias should be repaired because they will grow over time. The pain from a hernia will limit physical activity.   This procedure is performed either robotically and partially open depending on the size, location and complexity. 

An inguinal hernia occurs in the lower part of the abdomen where a hole or defect occurs in the muscles of the groin.  The result of an inguinal hernia is pain and/or swelling experienced in the groin region.  Typically, over time the bulging in the groin area can grow and the swelling under the skin can extend into the scrotum in males and alongside the labia in females. The pain and fullness of inguinal hernias often continues for a few weeks or months and does not improve with rest or physical therapy.

Typically, inguinal hernias present with:

• A bulge or obvious swelling beneath the skin of the groin area. This may disappear when the person lies down and is often tender.
• Difficulty moving and performing certain activities.
• Discomfort or pain when using groin muscles.
• Heavy feeling in the abdomen or groin with straining.

If you think you may have an inguinal hernia call our offices and schedule an appointment. If the bulge is persistent, do not wait, call today. Additionally, if you are experiencing pain accompanied by nausea or vomiting, you may have a “strangulated” hernia and it is important to seek medical attention urgently. If left untreated a strangulated hernia can cause life-threatening complications.

Surgery is traditionally recommended for all inguinal hernias. This helps to avoid complications, including when the intestines become lodged and stuck within the hernia. This can cut off the blood supply to the intestine and if that condition is not urgently addressed the intestine could die. 

We perform robotic surgery which can take 30 mins to 1 hour to repair inguinal hernia. During the procedure, several small incisions (typically 3) are made in the skin.   The hernia can then be clearly seen and adequately repaired from the inside.  The small incisions and minimal disruption of the abdominal wall muscles speeds recovery and makes future development of additional hernias less likely. There is little pain after surgery. You can shower right away.  We only ask that you perform n o heavy lifting for one month.