Hernia Repair Surgery

A hernia is a hole or defect in the strong, protective layer of abdominal tissue encircling the organs, known as the fascia. Hernias typically develop as a result of significant and continued pressure on the abdomen caused by violent coughing or sneezing, exertion, pregnancy and/or obesity. These issues may be exacerbated by weakness in the abdomen due to previous surgeries, and even heredity.

Why We Treat Hernias

A hernia does not improve on its own. In fact, it is a progressive condition, that if left untreated will only worsen and enlarge, making for a more complex repair. Typically, only symptomatic hernias are treated – those that have a visible or palpable bulge or those that cause pain or discomfort. Asymptomatic hernias, those with no outward symptoms, can be left alone if they do not represent a significant risk. The most important reason for treating a hernia is the possibility of incarceration, which involves intestinal contents becoming stuck in the hernia defect. Strangulation occurs when blood is cut off to the incarcerated intestinal tissue. This is an emergency situation, requiring an immediate trip to hospital and urgent surgery.

Types of Hernias

There are several types of hernias. Some of the most common include:

• Inguinal or groin hernias – these hernias occur in the groin area and may involve the testicles. These are the most common hernias and affect men in much greater proportion than women.
• Femoral or upper thigh hernias present with bulging and/or pain on the upper inside of the thigh. Women are more prone to femoral hernias than are men. Because of the very high risk of strangulation – some estimate upwards of 20% – these hernias should be repaired immediately.
• Umbilical hernias occur in the natural abdominal weak spot that is the navel. Many cases of umbilical hernias occur in children, but occur in adults as well. A telltale sign of an umbilical hernia is a protruding navel or bulge in the vicinity.
• Incisional hernias occur as a result of unnatural perforation of the abdomen most often due to surgery. Significant trauma such as a knife wound can also create an inherent defect in the abdomen that can lead to an incisional hernia.
• There are many more hernias that occur throughout the abdomen. Treatment for most hernias involve the placement of surgical mesh to reinforce the repair.

How We Treat Hernias

Because our bodies do not repair hernias on their own, the only effective form of treatment is surgery. Surgical repair for hernias is one of the most common general surgery procedures in the world. Hernias can be repaired either in an open manner, with a single incision; or in a minimally invasive, or laparoscopic technique.

The hernia is accessed either from the front of (open surgery) or from behind (minimally invasive surgery) the abdominal wall. Once the defect is found and the intestinal contents have been reduced into the abdomen, the hole is covered with a thin, strong surgical mesh. This mesh is a permanent implant and represents a foundation upon which new tissue can grow and strengthen the repair. This is known as a tension-free repair because we do not use sutures to mechanically close the defect.

By using the tension-free mesh repair, we reduce the risk of recurrence of the hernia by upwards of 90%. Further, today’s mesh is lighter and stronger than ever before, reducing complications and minimising the chance of chronic pain.

Modern hernia surgeons now employ a hybrid laparoscopic technique where the hernia defect is stitched closed and then reinforced with mesh as well.

Elective hernia repair is most often performed as a day surgery. The procedure lasts approximately 45 minutes to an hour, during which time patients undergoing laparoscopic hernia repair are under general anaesthetic. An open repair only requires local or regional anaesthetic.

Recovery after Hernia Repair

After a hernia repair, patients must minimise strain and pressure on the abdomen for approximately six weeks. The goal is to allow the surgical mesh to integrate into the body and strengthen the repair. Patients may experience discomfort and swelling in the area of the procedure for up to several weeks after surgery. Only a very small number of patients with experience discomfort beyond that time.

Due to some patients taking pain medications during recovery, patients should not drive for up to a week after surgery. While every patient’s threshold for pain will vary, most patients report that the discomfort is well managed with non-narcotic medication such as paracetamol/ ibuprofen.

Patients typically return to work within a week of surgery, and most return to gym / exercise activity between 6-to-8 weeks after the procedure. During the recovery time, there are no dietary restrictions, however patients should take care not to lift anything weighing more than a briefcase. It is advised that, for the first week after surgery, the patient has assistance in performing general household duties.

Mr. Ahmed will advise patients on the progress of their recovery and their suitability for returning to certain activities during their follow-up visit, which occurs approximately one-two weeks after surgery.

Considerations Before and After Hernia Surgery

For some hernia patients, watchful waiting – not having surgery – is a viable option. However, a discussion with Mr. Ahmed is the best way to weigh the risks of surgery with the risks of doing nothing. Elderly patients typically have a lower risk of strangulation and a higher risk of surgical complication, and may opt not to have surgery if their lifestyle is not impeded by the hernia. Younger patients are typically very good candidates for hernia surgery, and in most cases, surgical repair is recommended as it only gets worse over time.

Some patients will have bilateral hernias – hernias on both sides of the abdomen. This is most common with inguinal hernias. Prior to, and during, surgery, Mr. Ahmed will check the opposing side of the abdomen for any hernia defect and repair as appropriate. Typically, if a bilateral hernia is present the laparoscopic approach is most appropriate.

Recurrence of a hernia is becoming rarer as surgical mesh and hernia repair techniques improve. However, recurrence is an ever-present possibility. Typically, recurrent hernias are treated with the laparoscopic approach, even if the primary procedure was performed in an open manner.

While there has been some controversy associated with surgical mesh, most patients who undergo a mesh-based hernia repair should not have any adverse effects. Further, the risk of recurrence due to a tension (non-mesh, suture based) repair typically outweighs any risk of using mesh.

Patients who wait to have their hernia repaired risk incarceration or strangulation of intestinal contents. If not treated immediately, this can lead to necrosis (death) of intestinal tissue – usually of the large intestine. If intestinal involvement is significant enough, colon surgery and resection may be required, which dramatically increases the risks of surgery.

As with any surgical procedure, hernia surgery involves certain inherent risks including pain, blood loss, recurrence of the hernia, and infection.

Most importantly, employing a highly-skilled surgeon such as Mr. Ahmed that specialises in the repair of hernias, offers the greatest chance of an excellent outcome and minimises the risks associated with surgery.