What is a Hernia?
A hernia is a weakness or hole in the strong layer of the abdominal wall, called the fascia. This layer, along with the muscles of your abdominal wall keeps your internal fat and organs on the inside, and protects them.
Where do hernias occur?
Hernias commonly occur in the groin (called an inguinal hernia), by the belly button (called an umbilical hernia in medical terms), or elsewhere in the abdomen. Hernias can occur over time due to predisposition, other medical conditions, or can occur after an incision from another surgery doesn’t fully heal or breaks down over time. This results in a bulge which may cause discomfort.
Are hernias dangerous?
For the most part hernias are not dangerous, and not an emergency.
The exception to this is if bowel or another important organ gets stuck in the hernia and is pinched to the point that blood flow is interrupted, or the bowel is blocked. This is a medical emergency and requires urgent treatment by a surgeon. Common signs of such an emergency are a painful and hard lump that won’t go back in, inability to pass gas or stool accompanied by bloating, crampy abdominal pain, nausea, and vomiting. If this occurs you should go to your nearest emergency department.
Thankfully, these situations are rare.
Does my hernia need repair?
There are many reasons to consider hernia repair. These include:
pain
incarceration of obstruction - if you have had to visit the emergency department due to your hernia being stuck out
activity limitation
hernia growth over time
frequent international travel
Groin hernia repair is not an urgent surgery. This has been carefully studied in trials.
In one large trial comparing observation with surgical repair, there were less than 0.01 hernia emergencies per patient year.
What happens to groin hernias over time?
Over time, men with groin hernias tend to pursue surgical repair, even if they chose to monitor their hernia at first.
In one study, 23% of men with minimal symptoms who began by simply monitoring their hernia at first chose surgical repair by 2 years, and nearly 32% chose surgical repair by 4 years.
In longer term studies, the rate of men choosing hernia repair approaches 65% over time, usually due to an increase in symptoms.
What to expect when having hernia surgery
Most hernia surgery is day surgery, meaning you come to the hospital for your procedure and sleep in your own bed that night. For smaller and more common hernias in the groin or by the belly button, hernia repair usually takes 1-2 hours. The procedure can be completed under a general anesthetic, or can often be performed under various other forms of anesthesia such as a spinal anesthetic or even local anesthetic if a general anesthetic is not deemed safe due to other health conditions.
In most cases the surgeon will make an incision overtop of the area of the hernia, identify the weakness, patch the weakness with a medical mesh by suturing it in place, and then suture the tissues closed. Sometimes the hernia is so small that it can be repaired with permanent sutures alone, but studies have shown that even smaller hernias are less likely to come back Local anesthetic (freezing) is usually injected around the area of the repair to aid with pain control, and you are sent home with instructions for what medication to take to help control your pain after surgery.
Risks of Inguinal Hernia Surgery
Groin hernia repair (inguinal hernia repair) with mesh is a safe and common procedure. However, just as whenever you get in your car to drive you could be in an unexpected accident, there are small risks of serious events that can occur during or around the time of surgery. These risks include but aren’t limited to:
· A bad or allergic reaction to the medications used for your anesthetic.
· Heart or lung problems like stroke, heart attack, or pneumonia.
· Blood clots in the blood vessels of the legs or in the lungs.
· Serious bleeding requiring us to give you blood (1% or less).
· Infection at the skin cuts or deeper inside.
· Infection of the mesh used for your repair. This can usually be treated with antibiotics, but if the infection can’t be cleared you could require another surgery to remove the mesh.
· Risk of the hernia coming back despite our repair. This risk is low, typically ranging around 3-4%
· Injury to the blood vessels running to the testicle or the tube carrying sperm
· Build up of blood (hematoma) or fluid (seroma) in the space the hernia used to occupy where the surgery was. In serious cases this could require drainage, and can sometimes become infected, but usually goes away on its own.
· Injury to one of the nerves in the groin area leading to chronic pain symptoms.
· Studies show that after groin surgery up to 10% (1 in 10) of patients have longer lasting discomfort in the groin area, longer than the usual 1 month of post surgery discomfort that most patients experience.
· Small risk of chronic pain in the groin which can be so severe that it affects the ability to work and prevents you from doing your regular activities and has a major negative impact on your quality of life. If this occurs we will involve our pain medicine colleagues for treatments that target work to interrupt the pain signals from nerves in this area. In the worst of cases sometimes further surgery to remove the mesh is pursued.
This procedure is usually conducted as a day surgery, and you will go home later the same day. You will be provided with instructions for post-operative pain control. You should call your surgeon’s office a few days after surgery to request a post-operative check-up appointment. Your surgeon will usually want to see you 4-6 weeks after your surgery.
Risks of Umbilical Hernia Repair
Umbilical (belly button) hernia repair with mesh is a safe and common procedure. However, just as whenever you get in your car to drive you could be in an unexpected accident, there are small risks of serious events that can occur during or around the time of surgery. These risks include but aren’t limited to:
· A bad or allergic reaction to the medications used for your anesthetic.
· Heart or lung problems like stroke, heart attack, or pneumonia.
· Blood clots in the blood vessels of the legs or in the lungs.
· Serious bleeding requiring us to give you blood (1% or less).
· Infection at the skin cuts or deeper inside.
· Infection of the mesh used for your repair. This can usually be treated with antibiotics, but if the infection can’t be cleared you could require another surgery to remove the mesh.
· Risk of the hernia coming back despite our repair. This is not very common, but may occur 2-5% of the time.
· Injury to the bowel or blood vessels.
· Build up of blood (hematoma) or fluid (seroma) in the space the hernia used to occupy. In serious cases this could require drainage, and can sometimes become infected.
· If a mesh is used there is a small risk that despite sewing the mesh in place it can move or be dislodged, come in contact with bowel where it can get stuck to bowel and possibly cause bowel blockage, or could wear its way into the bowel over time if it is in contact with the bowel. For these reasons we try our best to avoid putting mesh in a position where it might be in contact with the bowel.
This procedure is usually conducted as a day surgery, and you will go home later the same day. You will be provided with instructions for post-operative pain control. You should call your surgeon’s office within 7 days after your surgery to request a follow up (post-operative check-up) appointment to be scheduled about 4 weeks after surgery.