What is a hernia?
Basically, a hernia is a hole in the strength layer that holds everything inside of you. If you develop a hole, things from the inside can push out. This feels like a bulge. Fat is often the first thing pushing through the hernia defect (hole). Hernias do not get better and do not go away. In time, they usually become larger and other structures can push through the defect, most often intestines. There is some risk that the intestines will get outside of that defect and become stuck, with the possibility that they can then rupture. This is very serious and would require emergency surgery to repair. Sometimes hernias can be very painful especially with activity. This can start to limit your normal activities and the ability to do sports and exercise.
Hernias can develop in several different locations. Most are in the abdominal wall and they are often named by location. Groin hernias are some of the most common hernias, also called inguinal hernias. They are further designated as indirect and direct hernias, depending on the specific anatomic defect. Essentially, these 2 hernias are repaired similarly. Other hernias include femoral hernias (a bulge near the groin on the medial upper thigh), umbilical hernias (through the umbilicus, or belly button), incisional hernias (through a prior surgical incision on the abdominal wall), ventral hernias (essentially any non-inguinal abdominal wall hernia, but usually referring to anterior hernias not involving prior incisions, the umbilicus, or groin areas), spigelian hernias (lateral lower abdominal wall hernias through a special type of defect) and other even more rare hernias.
Hernias can be reducible, meaning the intestines push through the defect and can slip back inside either manually or when laying down (the bulge disappears). Or, they can be incarcerated, meaning the intestines do not slip back inside. Sometimes, incarcerated hernias can be very painful and can start to cause damage to the intestines (strangulated hernia). This hernia might be very hard and tender and you might experience abdominal pain and nausea or vomiting as well. You should be seen immediately in the Emergency Room if this happens.
Why did I get a hernia?
In many cases, they just happen. Inguinal hernias are more common in men because of a defect sometimes left behind from infancy due to the passage of the testicle into the scrotum. Women get hernias here too probably due to natural weakness of the structures in this area. Hernias sometimes run in families and it is felt that obesity and certain other factors might increase the risk for developing a hernia. Poor wound healing is known to increase the risk of developing incisional hernias. People that engage in a lot of very strenuous activity might be at some increased risk for hernia development.
There are some people who can actually remember a specific activity (usually lifting something) which might have “caused” the hernia. They often describe the sensation of a “pop” and the presence of an intermittent bulge from that point forward. All of this being said, many hernias just become noticeable one day and have no direct causal event.
What should I do about my hernia?
That is a really good question. Most hernias should probably be fixed in active healthy people. Especially those hernias at higher risk for complications (such as femoral hernias) which should almost always be fixed. That being said, we know that some people do fine for years without having their hernia repaired. It is often difficult to predict which hernias will cause problems. In general, if you have a hernia, you should consult with a surgeon to discuss the options and the risks.
So, I’ve decided to have my hernia repaired. Tell me about hernia surgery.
Most hernias are repaired using some type of mesh patch. We have learned that patching hernias reduces the recurrence rate significantly and while hernia surgery is usually pretty straight forward, surgery for a recurrent (or even re-recurrent) hernia becomes much more complicated and has higher risk. So, anything that we can safely do to reduce the risk of recurrence is important.
Depending on the type of hernia and on your underlying medical problems, surgery might be done with a general anesthesia or with local anesthesia with sedation, or sometimes with spinal anesthesia.
The surgical technique can vary as well depending on a number of factors.There are open techniques as well as laparoscopic techniques, all with their own risk/benefit profile. The decision as to which specific technique is chosen will depend on many things: the type of hernia, whether it is primary or recurrent, unilateral or bilateral (for inguinal hernias), your underlying health status, and surgeon preference, among other things. For example, the laparoscopic technique is a very nice way to fix bilateral inguinal hernias at the same operation.
Surgery is usually done as an outpatient. You would require some time off of work in most cases and there would be some activity restrictions for a period of time. Much of this depends on the type of hernia repaired and on the specific surgery.
You should have a much more thorough discussion about the specifics of the recommended repair, risks of surgery, and recovery expectation with your surgeon.
What is the next step?
So, if you think you have a hernia, you should discuss it with your doctor and consider a surgical evaluation to review the options. Feel free to call our office at Albuquerque Surgical Consultants and we would be happy to schedule a time for you to come in for a consultation.