Hernia Surgery


By Dr Bala Murali Krishna Mudiyam
Consultant in General Surgeon

Article Context

  1. Overview
  2. Procedure
  3. Complications of Hernia Surgery
  4. Care at Medicover
  5. Frequently Asked Questions

Overview:

A hernia is the protrusion of an organ or a covering of the organ through a defect in the wall of the cavity that normally contains it. The most common hernias develop in the abdomen, when the inside layers of the abdomen have weakened. This results in a bulge or tear. A hernia can also occur in the upper thigh, near your belly button or groin area. It can be quite painful, especially during coughing, lifting or performing any activity that puts pressure on the stomach.

Symptoms of hernia include fever, severe pain, nausea, vomiting, a red or purple bulge and inability to pass a stool.

Hernia is treated by a procedure called herniorrhaphy or hernioplasty.

Types of Hernia:

The most common types of hernia are:

  • Femoral: It occurs in the upper thigh region or the outer groin.
  • Incisional: At times, after abdominal surgery, this type of hernia may occur.
  • Ventral: Occurs in the general abdomen or ventral wall.
  • Hiatal: This type of hernia occurs when a piece of your stomach tissue sticks out through your diaphragm into the chest cavity. A hiatal hernia is common among individuals aged 50 years and above.

Procedure

Before the procedure

  • For the diagnosis of a hernia, a physical examination is usually enough.
  • During this examination, the doctor checks for a bulge in the affected area.
  • He/she asks the patient to stand, strain or cough as it makes the hernia more prominent and helps in the diagnosis.
  • The doctor also asks about the patient’s medical history and symptoms.
  • If the doctor cannot locate the bulge, imaging tests such as ultrsound, CT Scan or MRI may be needed for a more accurate diagnosis of hernia.
  • Preoperative assessments such as blood tests, blood pressure measurement and an ECG are required prior to the procedure.
  • A hernia surgery can be carried out under general anesthesia or epidural anesthesia.
  • Patients must have an empty stomach before the procedure.

During the procedure

The three main methods of hernia surgery are open, laparoscopic and robotic.

Open or Conventional approach:

  • An open hernia repair is normally performed under local anesthesia and intravenous sedation. However, it can also be done under general anesthesia.
  • An open or conventional hernia surgery is done through a three to four inch incision in the skin.
  • In order to reach the level of the hernia, the incision is extended through the subcutaneous fat and muscle.
  • The contents of the hernia are pushed back through the hole into its original position.
  • At this point, a piece of surgical mesh is placed through the hole to repair the defect. It is then secured with a suture.

Laparoscopic hernia surgery:

  • This procedure must be conducted under general anesthesia.
  • The hernia is repaired through three small incisions in the abdominal wall.
  • The operation is also displayed on a video screen. While performing the surgery, a small video camera is inserted through one of the incisions
  • The surgeon uses small instruments to operate through the other two incisions.
  • The surgical area is inflated with CO2 which enables a better view and provides more space for the procedure.
  • The hernia is repaired from behind the abdominal wall.
  • The hernia sac with its contents, is repositioned or pulled back.
  • There is no cutting of muscles or structures. This results in reduced trauma and inflammation, as well as a faster and less painful recovery.
  • A surgical mesh piece is placed over the hernia defect and secured with small surgical absorbable clips.
  • Finally, CO2 is released and the skin incisions are sutured.

Robotic hernia repair:

  • In this approach, the hernia is repaired similar to a laparoscopic hernia surgery.
  • There are three small incisions used. The operation is also shown on a video screen.
  • In laparoscopic surgery, the surgeon's hands grasp and move the instruments while performing the procedure literally next to the patient. Whereas, in robotic surgery, the devices are docked or attached to robotic arms.
  • The surgeon then sits next to the patient's bed at a console and controls the robotic instruments using small controls at the console.

Hernias have a high recurrence rate, hence surgeons frequently utilize surgical mesh to strengthen the hernia repair and minimize recurrence. The use of surgical mesh may reduce operative time, recuperation time and also improve surgery outcomes. Let's understand more about surgical mesh.

Surgical Mesh:

  • Surgical mesh is a type of medical device that is used to support weakened or damaged tissue. Most of the surgical mesh devices available are made of synthetic materials or animal tissue.
  • Surgical mesh is made of synthetic materials. It is available in both knitted and non-knitted sheet forms. The synthetic materials used can be absorbable, non-absorbable, or a combination of the two.
  • Animal-derived mesh is composed of animal tissue, such as intestine or skin, that has been treated and sterilized in order to be used as an implantable device. These meshes made from animals are absorbable. Majority of these tissue implants come from pigs (porcine) or cows (bovine).
  • Non-absorbable mesh is a permanent implant that will remain in the body indefinitely. It is used to strengthen the repaired hernia. On the other hand, the absorbable mesh degrades slowly and loses its strength. It is not meant to provide long-term support to the repair site. As the material degrades, new tissue growth is intended to provide strength to the repair.s

After the procedure

  • There may be swelling of genital areas and fluid accumulation in the groin after hernia surgery. Sometimes, this can feel firm like a lump. Rotate ice packs or bags of frozen peas to help with the swelling (up to 15 minutes per hour, for the first 3 days).
  • Keep the incision dry. Avoid excessive perspiration. Do not apply lotions, ointments, or creams.
  • You will also be provided a prescription strength pain medication to be used as needed.
  • Consume only clear liquids for the initial 24 hours. Slowly, you may advance your diet. Be sure to be mindful of constipation.

Complications

Surgery to repair an inguinal hernia is generally safe and complications are uncommon. Being aware of possible risks allows patients to report postoperative symptoms to their doctor as soon as they occur. Few such risks are:

  • Hernia recurrence
  • Bleeding
  • Wound infection
  • Painful scar
  • Injury to internal organs
  • Urinary retention

Care at Medicover

At Medicover, our expert laparoscopic surgeons provide minimally invasive surgeries that reduce discomfort to the patients. Our surgeons use advanced techniques that help with speedy recovery. The surgical procedures done by our team of doctors involve minimum amount of tissue damage, blood loss and risk of infection. Our team has expertise in providing complete care and safety to the patients by using the latest diagnostic and surgical techniques. We provide a multidisciplinary approach for taking care of every patient.

Frequently Asked Questions:

Open hernia surgery, in which a physician uses a lengthy incision to force the protruding organ back into place, usually necessitates a three-week recovery period. The recovery time for a laparoscopic hernia repair is closer to one to two weeks.

Open hernia surgery is frequently performed under local anesthesia or a regional anesthetic is injected into the spine, this means you will be awake throughout the treatment but the area being operated on, will be numbed. This will prevent you from feeling any pain. A general anesthetic may be administered at times.

Doctors advise sleeping on the side or back as other positions may harm your spine and put pressure on your hips.

Generally, if you are comfortable, you can walk after surgery. In another six to twelve weeks, non-impact exercises such as biking, swimming and planks for building core strength, can also be done. But, be sure to check with your doctor before starting any type of workouts after your surgery.

Obesity can increase the risk for developing recurrent hernias either at the site of the original hernia or other weakened areas. Being obese or overweight increases the strain and pressure on the abdominal muscles and makes them weaker and more prone to developing hernias.

Depending on the type and size of hernia, most routine hernia surgeries take 30 to 90 minutes. After surgery, the patient spends about 1-2 hours in the recovery room before being discharged.

Reports of 90-99% success rates are common.

Most patients believe that wearing a compression garment, which is a soft, surgical girdle-like garment that goes over your abdomen and compresses it, reduces swelling and promotes proper healing.

Avoid lifting anything that would make you strain. This may include heavy grocery bags, milk containers, a heavy briefcase, backpack, vacuum cleaner or even a child.

You will need to stay on a liquid or soft diet for approximately three weeks after surgery.

Splint your incision for a few weeks when you need to cough or sneeze. This means applying pressure to the incision using your hands, a rolled-up blanket, or a pillow. To reduce the pressure on your incision, sneeze with your mouth open.

Citations:

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999781/
  • https://www.fda.gov/medical-devices/implants-and-prosthetics/hernia-surgical-mesh-implants