Hernia repair is one of the most common surgical procedures at Holland Hospital. More than 300 hernia operations are performed each year, most often on an outpatient basis. Hernias are rarely dangerous, but they do require treatment in most cases. Following are answers to some commonly asked questions.
Q. What is a hernia?
A. A hernia appears as a bulge under the skin when part of an internal organ, often the intestine, protrudes through a weak area in the muscular wall, usually of the abdomen. According to the National Center for Health Statistics, about five million Americans have an abdominal hernia.
There are a number of different types of hernias, including:
Q. What causes hernias?
A. Individuals may be predisposed to hernias as a result of weak abdominal muscles or a defect in the abdominal wall from birth. Hernias can be caused or aggravated by obesity, lifting heavy objects, repetitive twisting and straining (as with certain sports), constipation, a persistent cough or pregnancy.
Q. What are the symptoms?
A. A bulge may appear under the skin and grow larger when the individual stands up, lifts heavy objects, strains, coughs or sneezes. It may diminish when the individual lies down or applies gentle pressure. Hernias are often painless, especially when small. However, they may cause a burning sensation, a feeling of heaviness or tugging, or pain that can be sharp and immediate or a dull ache.
Generally, a health care provider can diagnose a hernia by touch. If there is no obvious bulge, an imaging test such as ultrasound or CT scan can be helpful.
Q. Are hernias dangerous?
A. Although not usually harmful, hernias should not be ignored. With the exception of umbilical hernias in infants, they will not go away on their own. Hernias can become dangerous if a portion of the intestine becomes trapped and its blood supply is cut off (called “strangulation”), causing severe pain and nausea. In this case, cautions the American Medical Society, immediate surgical repair is needed.
Q. How are hernias treated?
A. Your doctor may suggest “watchful waiting” if the hernia is small and causes no pain. However, most hernias eventually require surgical treatment.* With conventional surgery, the surgeon makes an incision, pushes the protrusion back into place and repairs the abdominal wall. Often, especially in adults, the abdominal wall repair is reinforced with mesh. There are several advantages to mesh, usually a synthetic material woven into a screen, including a lower recurrence rate and a quicker return to normal activity.
Sometimes the mesh is placed laparoscopically using several small incisions rather than one large one. A laparoscope (a small instrument with a lens or camera on the end) is used to position the mesh internally to strengthen the weak area in the muscles. This can have the advantage of less postoperative pain and a quicker recovery. A thorough examination by your surgeon can determine if the laparoscopic procedure is right for you.*
* Society of American Gastrointestinal and Endoscopic Surgeons, www.sages.org.