Hernia Procedures
What Is a Hernia?
How Does a Hernia Develop?
Hernia Repair Surgery
Traditional Hernia Repair
Laparoscopic TAPP Repair
Laparoscopic TEPP Repair
After Hernia Surgery
Laparoscopic Repair of Hernias
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What Is a Hernia?
A hernia (or “rupture”) is a weakness or defect in the wall of the abdomen. This weakness may be present at birth. Or, it can be caused by the wear and tear of daily living. If left untreated, a hernia can get worse with time and physical stress.
When a Bulge Forms
A weak area in the abdominal wall allows the contents of the abdomen to push outward. This often causes a noticeable bulge under the skin. The bulge may get bigger when you stand and go away when you lie down. You may also feel pressure or discomfort when lifting, coughing, urinating, or doing other activities.
Types of Hernias
The type of hernia you have depends on its location. Most hernias form in the groin at or near the internal ring. This is the entrance to a canal between the abdomen and groin. Hernias can also occur in the abdomen, thigh, or genitals.
- An incisional hernia occurs at the site of a previous surgical incision.
- An umbilical hernia occurs at the navel.
- An indirect inguinal hernia occurs in the groin at the internal ring.
- A direct inguinal hernia occurs in the groin near the internal ring.
- A femoral hernia occurs just below the groin.
- An epigastric hernia occurs in the upper abdomen at the midline.
Surgery: The Best Treatment
A hernia will not heal on its own. Surgery is needed to repair the defect in the abdominal wall. If not treated, a hernia can get larger. It can also lead to serious medical complications. The good news is that hernia surgery can be done quickly and safely. In most cases, you can go home the same day as your surgery.
The wall weakens or tears.
The intestine pushes into the sac.
The intestine may become trapped.
The intestine may become strangulated.
How a Hernia Develops
Although a hernia bulge may appear suddenly, hernias often take years to develop. They grow larger as pressure inside the body presses the intestines or other tissues out through a weak area. With time, these tissues can bulge out beneath the skin.
Stages of Hernia Development
The wall weakens or tears: The abdominal lining bulges out through a weak area and begins to form a hernia sac. The sac may contain fat, intestine, or other tissues. At this point, the hernia may or may not cause a visible bulge.
The intestine pushes into the sac: As the intestine pushes further into the sac, it forms a visible bulge. The bulge may flatten when you lie down or push against it. This is called a reducible hernia and does not cause any immediate danger.
The intestine may become trapped: The sac containing the intestine may become trapped by muscle (incarcerated). If this happens, you won't be able to flatten the bulge. You may also have pain. Prompt treatment may be needed.
The intestine may become strangulated: If the intestine is tightly trapped, it becomes strangulated. The strangulated area loses blood supply and may die. This can cause severe pain and block the intestine. Emergency surgery is needed.
Hernia Repair Surgery
A hernia (or “rupture”) is a weakness or defect in the wall of the abdomen. A hernia will not heal on its own. Surgery is needed to repair the defect in the abdominal wall. If not treated, a hernia can get larger. It can also lead to serious medical complications. Fortunately, hernia surgery can be done quickly and safely. Below is an overview of hernia repair surgery.
Preparing for Surgery
Your doctor will talk with you about preparing for surgery. Follow all the instructions you're given and be sure to:
- Tell your doctor about any medications, supplements, or herbs you take. This includes both prescription and over-the-counter items.
- Stop taking aspirin, ibuprofen, and naproxen as directed.
- Arrange for an adult family member or friend to give you a ride home after surgery.
- Stop smoking. Smoking affects blood flow and can slow healing.
- Gently wash the surgical area the night before surgery.
- Don't eat or drink after midnight, the night before your surgery.
The Day of Surgery
Arrive at the hospital or surgical center at your scheduled time. You'll be asked to change into a patient gown. You'll then be given an IV to provide fluids and medication. Shortly before surgery, an anesthesiologist will talk with you. He or she will explain the types of anesthesia used to prevent pain during surgery. You will have one or more of the following:
- Monitored sedation to make you relaxed and sleepy.
- Local anesthesia to numb the surgical site.
- Regional anesthesia to numb specific areas of your body.
- General anesthesia to let you sleep during surgery.
Fixing the Weakness
Surgery treats a hernia by repairing the weakness in the abdominal wall. Most hernias are treated using “tension-free” repairs. This is surgery that uses special mesh materials to repair the weak area. The mesh covers the weak area like a patch. The mesh is made of strong, flexible plastic that stays in the body. Over time, nearby tissues grow into the mesh to strengthen the repair.
After Surgery
When the procedure is over, you’ll be taken to the recovery area to rest. Your blood pressure and heart rate will be monitored. You’ll also have a bandage over the surgical site. To help reduce discomfort, you’ll be given pain medications. You may also be given breathing exercises to keep your lungs clear. Later, you’ll be asked to get up and walk. This helps prevent blood clots in the legs. You can go home when your doctor says you’re ready.
Risks and Possible Complications of Hernia Surgery
- Bleeding
- Infection
- Anesthesia risks
- Mesh complications
- Inability to urinate
- Numbness or pain in the groin or leg
- Risk the hernia will recur
- Damage to the testicles or testicular function
- Bowel or bladder injury
Having Hernia Surgery: Traditional Repair
Surgery treats a hernia by repairing the weakness in the abdominal wall. An incision is made so the surgeon has a direct view of the hernia. The repair is then done through this incision (open surgery). To repair the defect, muscle and connective tissue may be sewn (sutured) together to make a "traditional repair." Follow your doctor's advice on how to get ready for the procedure. You can usually go home the same day as your surgery. In some cases, though, you may need to stay in the hospital overnight.
Getting Ready for Surgery
Your doctor will talk with you about preparing for surgery. Follow all the instructions you're given and be sure to:
- Tell your doctor about any medications, supplements, or herbs you take. This includes both prescription and over-the-counter items.
- Stop taking aspirin, ibuprofen, and naproxen as directed.
- Arrange for an adult family member or friend to give you a ride home after surgery.
- Stop smoking. Smoking affects blood flow and can slow healing.
- Gently wash the surgical area the night before surgery.
- Don't eat or drink after midnight, the night before your surgery.
The Day of Surgery
Arrive at the hospital or surgical center at your scheduled time. You'll be asked to change into a patient gown. You'll then be given an IV to provide fluids and medication. Shortly before surgery, an anesthesiologist will talk with you. He or she will explain the types of anesthesia used to prevent pain during surgery. You will have one or more of the following:
- Monitored sedation to make you relaxed and sleepy.
- Local anesthesia to numb the surgical site.
- Regional anesthesia to numb specific areas ofyour body.
- General anesthesia to let you sleep during surgery.
Risks and Complications
Hernia surgery is safe, but does have risks including:
- Bleeding
- Infection
- Anesthesia risks
- Mesh complications
- Inability to urinate
- Numbness or pain in the groin or leg
- Risk the hernia will recur
- Damage to the testicles or testicular function
- Bowel or bladder injury
During the Surgery
To make a traditional repair, an incision is made over the hernia. The muscle tissue surrounding the weak area is then sewn together to repair the defect. The incision is closed with stitches, staples, surgical tape, or special glue. This method can be used to repair any type of hernia.
After Surgery
When the procedure is over, you'll be taken to the recovery area to rest. Your blood pressure and heart rate will be monitored. You'll also have a bandage over the surgical site. To help reduce discomfort, you'll be given pain medications. You may also be given breathing exercises to keep your lungs clear. Later, you'll be asked to get up and walk. This helps prevent blood clots in the legs. You can go home when your doctor says you're ready.
Having Laparoscopic Hernia Repair: TAPP
Typical operative setup and cannula site selection for a transabdominal preperitoneal (TAPP) laparoscopic inguinal herniorrhapy.
Copyright © 2006 Lippincott Williams & Wilkins
Once you know you have a hernia, you and your doctor can discuss laparoscopic surgery to repair it. Laparoscopic surgery is done with a laparoscope, a tiny “telescope” attached to a camera. It allows your surgeon a close-up view of your hernia using only small incisions. Because large incisions are not required, recovery from laparoscopic surgery is often faster and less painful than after open surgery. The surgery usually takes 45 min – 1 hour. You can likely go home the same day.
Preparing for Surgery
- Schedule lab tests: You may have blood tests, an ECG (electrocardiogram), and a chest x-ray. These tests help ensure that your heart and lungs are healthy enough for surgery.
- Ask about medications: Before surgery, you may be told to stop taking some medications, such as aspirin, ibuprofen, or herbal remedies.
- Quit smoking: To avoid straining your hernia from “smoker's cough” and to promote good blood flow for healing, ask your doctor for help quitting smoking.
- Avoid heavy lifting: Avoid putting strain on your hernia. Don't do any heavy lifting before your surgery.
- Keep your stomach empty: Don't eat or drink anything (not even water) after midnight the night before surgery. Your surgery may be canceled if you eat or drink before surgery. If you take any regular medications and have been told to continue them, take them with small sips of water.
- Arrange for help after surgery: Plan to have someone drive you home afterward. You'll want to take it easy after surgery, too, so you may need extra help at home.
Just Before Surgery
- You'll be asked to sign consent forms.
- Your doctor or anesthesiologist will talk with you about the anesthesia you'll be given during surgery.
During the Procedure
- You'll be given general or regional anesthesia. This keeps you free from pain during surgery.
- You will have 3 small incisions. The laparoscope and other instruments are inserted through these incisions. The laparoscope has a tiny video camera that sends clear images to a video monitor.
- Your surgeon is using the transabdominal (TAPP) approach during surgery. This means that the instruments are extended into your abdomen past the peritoneum.
- Carbon dioxide gas is injected into your abdomen through an incision near your navel. The gas inflates your abdomen, allowing your surgeon to work.
Placing the Patch
The surgeon repairs the hernia, then places strong mesh directly over the weak spot in your abdominal wall. The mesh acts just as a patch would on a tire wall. The mesh is secured with surgical staples, tacks, clips, or sutures. These stay in place permanently. Neither the mesh nor the staples are harmful to your body. Other reinforcement methods besides mesh may be used. After the mesh is applied, the gas is released from your abdomen.
Risks and Possible Complications
- Bleeding
- Infection
- Numbness or pain in the groin or leg
- Urinary retention (inability to urinate)
- Bowel or bladder injury
- Recurrent hernias
- Deterioration of testes
- Risks of anesthesia
Having Laparoscopic Hernia Repair: TEPP
Once you know you have a hernia, you and your doctor can discuss laparoscopic surgery to repair it. Laparoscopic surgery is done with a laparoscope, a tiny “telescope” attached to a camera. It allows your surgeon a close-up view of your hernia using only small incisions. Because large incisions are not required, recovery from laparoscopic surgery is often faster and less painful than after open surgery. The surgery usually takes 1 – 2 hours. You can likely go home the same day.
Preparing for Surgery
- Schedule lab tests: You may have blood tests, an ECG (electrocardiogram), and a chest x-ray. These tests help ensure that your heart and lungs are healthy enough for surgery.
- Ask about medications: Before surgery, you may be told to stop taking some medications, such as aspirin, ibuprofen, or herbal remedies.
- Quit smoking: To avoid straining your hernia from “smoker's cough” and to promote good blood flow for healing, ask your doctor for help quitting smoking.
- Avoid heavy lifting: Avoid putting strain on your hernia. Don't do any heavy lifting before your surgery.
- Keep your stomach empty: Don't eat or drink anything (not even water) after midnight the night before surgery. Your surgery may be canceled if you eat or drink before surgery. If you take any regular medications and have been told to continue them, take them with small sips of water.
- Arrange for help after surgery: Plan to have someone drive you home afterward. You'll want to take it easy after surgery, too, so you may need extra help at home.
Just Before Surgery
- You'll be asked to sign consent forms.
- Your doctor or anesthesiologist will talk with you about the anesthesia you'll be given during surgery.
During the Procedure
- You'll be given general or regional anesthesia. This keeps you free from pain during surgery.
- You will have 3 – 4 small incisions. The laparoscope and other instruments are inserted through these incisions. The laparoscope has a tiny video camera that sends clear images to a video monitor.
- Your surgeon will be using the extraperitoneal (TEPP) approach to the surgery. This means that the laparoscope and other instruments are used under your skin, but outside the peritoneum.
- Carbon dioxide gas is injected into your abdomen through an incision near your navel. The gas inflates your abdomen, allowing your surgeon to work.
Placing the Patch
The surgeon repairs the hernia, then places strong mesh directly over the weak spot in your abdominal wall. The mesh acts just as a patch would on a tire wall. The mesh is secured with surgical staples, tacks, clips, or sutures. These stay in place permanently. Neither the mesh nor the staples are harmful to your body. Other reinforcement methods besides mesh may be used. After the mesh is applied, the gas is released from your abdomen.
Risks and Possible Complications
- Bleeding
- Infection
- Numbness or pain in the groin or leg
- Urinary retention (inability to urinate)
- Bowel or bladder injury
- Recurrent hernias
- Deterioration of testes
- Risks of anesthesia
After Hernia Surgery
You can usually go home the same day as surgery. To speed healing, take an active role in your recovery. The tips below can help:
An ice pack helps reduce swelling.
Reducing Swelling
Early on, it’s common for the area around your incision to be swollen, bruised, and sore. To reduce swelling, put an ice pack or bag of frozen peas in a thin towel. Place the towel on the swollen area 3–5 times a day for 15–20 minutes at a time.
Managing Pain
Take any prescribed pain medications as directed. Be aware that some pain medications can cause constipation. So your doctor may also suggest a laxative or stool softener.
Returning to Normal
You can return to your normal routine as soon as you feel able. Just take it easy and follow these guidelines:
- Take short walks to improve circulation.
- Avoid heavy lifting for at least a week.
- Ask your doctor about driving and returning to work.
- You can begin having sex again when you feel ready.
Following Up
Be sure to keep all follow-up appointments with your doctor. These ensure you’re healing well. During visits, your stitches, staples, or bandage may be removed.
Call your doctor if you have any of the following:
- A large amount of swelling or bruising (some testicular swelling and bruising is normal)
- Fever over 101° F
- Bleeding
- Increasing pain, redness, or drainage
- Trouble urinating