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We use a variety of techniques to repair hernias, including advanced
laparoscopic surgeries for inguinal hernias, ventral and incisional hernias.
Laparoscopic techniques may allow for an earlier return to work/activities and
are generally associated with a decreased level of post-operative pain.
There are a variety of hernias and a variety of ways to repair them. The
common theme between all of them is that there is a weakness in the belly wall
that has allowed fat or bowel to pass through the hole. (Think of a tire
inner tube bulging through the side wall of tire.) This is a potentially
severe problem -- if the bowel looses it's blood supply, it dies and that is a
significantly complicated issue. That's why it's preferred to fix hernias
before they turn into a real problem
Another thing hernias share is the possibility of a recurrence, or that the
hernia may come back after a repair. Recurrences happen, but fortunately
they are very rare for most patients. To decrease your risk of a
recurrence, you should have stopped smoking
by at least a couple of weeks prior to surgery. Some hernia repairs
will not be performed if you are smoking at the time of surgery -- the risk
of infection and poor wound healing is too high. Smoking represents a
major risk factor for complications from surgery and if you smoke, you should
choose to decrease your operative risks. One more risk for recurrence is
weight, if you are considered obese (BMI >30,
use the calculator), you are at a
higher risk. If you gain weight after your hernia repair, you also
jeopardize the repair. Please review
these wellness options
to help you achieve and maintain a more healthy body weight.
Different types of hernias that we repair:
- Inguinal or groin hernias
- Femoral hernias
- Umbilical or "belly button" hernias
- Ventral (midline) hernias
- Incisional hernias (hernias that occur at sites of prior abdominal wall
incisions)
- Hiatal hernias
| Inguinal Hernias |
Inguinal hernias occur in both men and women and are generally
associated with a bulge or pain near the groin. These are repaired
using two options -- traditional open repair (using a "tension-free"
Lichtenstein repair) or laparoscopically. Laparoscopic repair is
the surgery of choice for recurrent inguinal hernias (those that have
already been fixed at least once) and bilateral inguinal hernias (both
sides). There are two types of inguinal hernias (direct and
indirect). It is difficult to tell which type you have until the
time of surgery, location is the most significant difference.
Laparoscopic repair is done under general
anesthesia through three small holes -- one at the belly button, one
just above the pelvic bone and one between the two. A catheter is
generally placed during the surgery and this may cause some post
operative pain when urinating, but this is uncommon and usually goes
away in day or two if it occurs. Surgery usually lasts 1-2 hours
depending on the complexity of the repair. A very large piece of
specially conformed mesh is placed. Typically a few absorbable
tacks are placed to hold the mesh in position until the end of surgery.
You go home the same day from the hospital, and most people would take
about 5-7 days off from work. Most people use narcotic pain pills
for a couple of days after surgery. You will be seen about 10-14
days after surgery in the office. You should limit your lifting to
less than 20 pounds for two weeks after surgery and refrain from
"super-human feats" for 4-6 weeks after surgery (pushing cars, boats,
moving very heavy appliances, etc). The risk of nerve injury
causing chronic pain is less with a laparoscopic repair versus an open
repair. However, this surgery does have a slightly greater risk of
blood vessel injury or injury to abdominal organs (bowel) -- THESE ARE
VERY RARE RISKS and our patients have not had these issues. The
recurrence rate for laparoscopic hernia repair is generally reported to
be between 2-5% for recurrent hernias and 1-2% for first-time repairs.
The additional benefit of laparoscopic inguinal hernia repair is that
both sides can be seen and both types of inguinal hernia and femoral
hernias can be looked for and repaired with the same incisions.
Traditional open inguinal hernia repair is usually done for those
people who have a first-time hernia on one side. It is done under
sedation or general anesthesia through an incision that is typically
less than two inches in size. If you are heavier, the incision
will have to be bigger. A piece of mesh is placed on the belly
wall after the hernia has been put back in the belly. This causes
scaring and is very successful. The chance of recurrence is
estimated to be less than 1% at 10 years (assuming non-smoker and
healthy initial body weight with no weight gain). Patients go home
the same day as surgery and generally take 1-2 weeks off from work.
Most patients will take a narcotic pain pill for 5-7 days after surgery.
A significant risk with this surgery, although it is extremely rare, is
nerve injury. There are a variety of nerves that travel in this
area and when the mesh scars into position, the body might drag some of
these nerves into the scar tissue and cause chronic pain. If this
does occur, it generally goes away without any particular intervention,
if it doesn't go away, there are a variety of options to interrupt the
nerve so it doesn't transmit pain; you'll experience numbness in this
area if the nerve is cut.
Both types of repair are well-tolerated and patients return to
routine activities readily.
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| Femoral Hernias |
Femoral hernias are a rare type of hernia that occurs when there is
a weakness near the large blood vessels that travel to the legs.
Bowel and fat can sometimes go into this area and get trapped.
This type of hernia has special repair options and is typically
approached like an inguinal hernia and has similar risks and recovery. |
| Ventral or Incisional Hernias |
These hernias occur in the abdominal wall or at sites of prior
surgeries. Generally these are fixed with laparoscopic (small
holes) technique and with the placement of mesh, usually done as an
outpatient surgery. |
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