Including minimally invasive laparoscopic hernia repair, open hernia surgery for complex incisional hernias.
A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. A hernia usually develops between your chest and hips. In many cases, it causes no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin. The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.
The most common symptom of inguinal, incisional, umbilical and ventral hernias is a painful lump or bulge underneath the skin where the hernia occurs. This can be in the groin or in the abdomen and is caused by intestine or other soft tissue pushing through a weakness or gap in the abdominal wall. Usually, the protrusion is more pronounced when standing, especially when coughing or straining, and it may get smaller or go away when lying down or relaxing.
Symptoms of abdominal or groin hernias include:
Hiatal hernias occur when the stomach pushes up into the chest through a small opening in the diaphragm—the muscle that separates the abdomen from the chest—and often do not cause any symptoms aside from mild heartburn.
Hernias become a medical emergency if the intestine—or esophagus, in the case of hiatal hernias—becomes trapped or incarcerated, cutting off its own blood supply. When blood supply is cut off, a condition known as strangulation, tissue can quickly die or become necrotic and cause a life-threatening infection that requires immediate surgical removal of the affected intestine.
Symptoms of a hernia in need of emergency treatment include:
If you have any of these symptoms, go to your A&E department immediately.
Every patient is evaluated individually, and treatment plans are specifically designed to address your needs and situation. We offer the following methods for hernia repair.
Laparoscopic, or minimally invasive, procedures use multiple small incisions no more than 1 centimeter in length to access the hernia. The abdomen is then inflated with carbon dioxide to provide room for the surgeon to work, and the hernia is repaired with a small, flexible device called a laparoscope.
Mesh is sometimes required to secure and reinforce the hernia. This procedure requires a hernia specialist comfortable with minimally invasive techniques and typically produces less scarring and postoperative pain, reduced risk of wound infection, shorter postoperative hospital stay length and a faster return to normal activities.
With a skilled surgeon, the risks of complications or recurrence are approximately the same as an open procedure. However, not all patients will be candidates for minimally invasive procedures, including patients with large hernias or adhesions from prior abdominal surgery.
Open procedures use a single incision to open the abdomen and access the hernia, after which the hernia is repaired using mesh. Open procedures are ideally suited for patients with large or multiple hernias. Patients who have had prior abdominal surgery are also good candidates for open procedures, as scar tissue in the abdomen forms adhesions that can make minimally invasive operations difficult or even dangerous.
Abdominal wall reconstruction repairs defects in the abdominal walls while reducing abdominal tension and providing structural support. This may require a component separation to be performed so that the muscle edges of the hernia gap can be brought back together again.
Mesh is often used to help strengthen the hernia repair and reduce the risk of recurrence. Dr Antonios Athanasiou uses specialized mesh that is designed to improve the outcomes of the hernia repair. As each case is different, your surgery may not require the use of mesh.
Recovery time after surgery depends on the type of hernia you have and the type of procedure required. Patients who undergo minimally invasive surgery are usually able to go home the same day and are able to walk the night of the surgery. Some patients, especially those who have had abdominal wall reconstructions or component separations, may have to stay in the hospital for a few days.
Discomfort is typically handled with over-the-counter medication, although some patients may require a combination of over-the-counter and opioid-based medication.
All patients need a follow-up appointment two weeks after surgery to ensure that their pain is well controlled and there are no infections. Patients with more complex procedures may have complex bandages or negative pressure dressings that need evaluation, and we need to ensure that any surgical drains are performing properly to avoid infection. Depending on the patient’s progress, a second follow-up appointment may be necessary.
After surgery, most patients will be asked to avoid lifting anything heavier than 15 pounds for the first two weeks, though more complicated patients may have differing limitations. Different patients will have individual restrictions, but in general, you should be as active as your provider permits.
Advances in technology and medical knowledge have lowered the risk of complications after hernia surgery substantially, and our experts use the latest practices and equipment to provide the safest procedures possible.
However, there is still a chance of recurrence or infection after surgery. Obesity and smoking increase these risks substantially, and many hernia experts will require patients to lose weight and commit to smoking cessation before surgery, unless tissue is incarcerated or strangulated.
Additionally, activities that increase intra-abdominal pressure at the hernia repair site should be avoided, as even a persistent cough or constipation can increase the risk of recurrence.
Chronic pain is also a risk. Although most pain will go away with conservative management, in rare cases, further surgery may be necessary to alleviate the pain.
A healthy lifestyle with regular exercise and regular checkups with your primary care provider will also help reduce the risks involved with any surgery.
