Hernias


A hernia, also called a "rupture" is from a weakness or a tear in the abdominal wall. It has two parts. There is a hole (defect) and something protruding through the hole. If the hole is present but nothing goes through, it is not a hernia. The more common places to develop hernias are in the inguinal area (groin) and the umbilicus (belly button). The defect may be present from birth (congenital) or develop over time (acquired). Hernias, however, can happen anywhere.

Inguinal Hernias

In the groin there are two main types of hernia. The indirect inguinal hernia, the most common type, occurs through a natural hole in the abdominal wall where the blood supply and nerves to the testicle exit the abdomen to enter the scrotum. The direct inguinal hernia is similar but the hernia protrudes through a weakness in the abdominal wall muscles.

Repair of inguinal hernias has two basic parts. First, the part of the body that is being pushed out (the hernia sac) must be pushed back in (reduced). Then the hole needs to be closed. This can be done in a number of different ways.

Open Repair – An incision is made in the groin over the area where the bulge occurs. The sac is reduced and then a piece of mesh is then placed into the hole, like a cork in a bottle, to prevent anything from going through the hole. A second piece of mesh may also be placed over this repair to strengthen the surrounding tissues to prevent another hernia from forming. All the stitches are placed under the skin.

Laparoscopic Repair – An incision is made in the umbilicus and a needle is inserted into the abdomen and the abdomen is distended with carbon dioxide gas. Then a tube is placed in the abdomen and a camera is inserted into the abdomen. Other tubes are then placed in the abdomen. The inner lining of the abdominal cavity is then separated from the rest of the abdominal wall and the hernia is reduced. A piece of mesh is then placed under the muscle to cover the hole (hernia defect). The CO2 is removed and the tubes are taken out. All of the stitches are placed under the skin.

Your doctor will discuss with you the advantages of open and laparoscopic hernia and will recommend the best repair for you.

Inguinal hernia repairs are usually done as an outpatient. The patient comes to the hospital the day of surgery, has surgery done, which usually takes about an hour, and after a brief recovery, is able to go home the same day. Patients are walking around the following day and are back to most activities within two weeks.

Bleeding and infection can occur after hernia repair. The risk is about 1%. The chance that the hernia can come back (recurrence) is about 1.5%. Most recurrences occur within the first year. Hernias can occur on the opposite side in approximately 10 -15% of patients.

Umbilical Hernia

Umbilical hernias appear as a swelling or bulge at the belly button. The may or not be reducible and they may or not be painful. They may be present from birth (congenital) or develop over time. Often umbilical hernias in children will go away without the need for surgery. If the hernia persists through the age of 5 it will more than likely not go away and will require repair.

Repair of an umbilical hernia is usually done through an incision underneath the belly button. The belly button is then elevated off the hernia sac and the sac is then pushed back in (reduced). The hole is then closed with stitches. Larger hernias may require placement of a mesh (plastic screen) to help support the repair. The belly button is then stitched to the repair and the stitches are placed under the skin to close the incision.

Umbilical hernia repairs are usually done as an outpatient. The patient comes to the hospital the day of surgery, has surgery done, which usually takes about an hour, and after a brief recovery, is able to go home the same day. Patients are walking around the following day and are back to most activities within two weeks.

Bleeding and infection can occur after hernia repair. The risk is about 1%. The chance that the hernia can come back (recurrence) is about 1.5%. Most recurrences occur within the first year.

Incisional Hernia

When an incision is made in the abdominal wall it heals with a scar. Scar is never as strong as normal tissue. With excessive straining and / or coughing a hernia can occur in an old incision. These can occur months or years after the incision has healed. Incisional hernias are usually identified by either pain or swelling in a previous incision.

Repair of an incisional hernia is usually done through the same incision. The incision is opened and the excess scar tissue is removed. The hernia sac is then freed up from the surrounding tissue pushed back into the abdomen (reduced). The defect is then closed with stitches. Often incisional hernias require placement of a mesh (plastic screen) to help support the repair. This is sutured down to the repair. Occasionally a plastic tube may be placed to drain any fluid from the area where the hernia was repaired.

Incisional hernia repairs are often done as an outpatient. The patient comes to the hospital the day of surgery, has surgery done, which usually takes about an hour, and after a brief recovery, is able to go home the same day. Patients are walking around the following day and are back to most activities within two weeks.

Bleeding and infection can occur after hernia repair. The risk is about 1%. There is a chance that the hernia can come back (recurrence). Most recurrences occur within the first year.

The content on this site is intended for informational purposes only and is not intended as medical advice.