For such a common problem, the hernia is often misunderstood. A hernia occurs when the strong layers of the abdominal wall have a tear or hole that allows tissues to protrude outward through the rupture. The tissue protruding is often some unimportant internal fat but occasionally it can be very important intestinal tissue that could become pinched, squeezed and then damaged, a process known as incarceration and then strangulation. And while strangulation does not happen often, it can be fatal, so doctors take hernias seriously and do not want them to ever reach that point.
We repair hernias when a person has symptoms of discomfort or painful protrusion, and certainly in the cases of painful incarceration, when tissues are truly stuck in the hernia defect. Most of the time, once a person notices the bulge, a doctor can diagnose the hernia by simple physical examination, and the repair can be scheduled as an elective procedure without a lot of drama. On the other hand, in the more unusual case in which there is intestine trapped, squeezed, and damaged within the hernia, that is a real emergency, and surgery typically occurs within hours of the person landing in the emergency room.
The good news is that the surgical solution for hernias continues to improve.
In the old days, all hernias were repaired by undergoing a surgical procedure with an open incision followed by dissection down to the level of the rupture, followed by placement of big stitches for the repair before closing the incision. This was painful, and the recovery could be months. Worse yet, the stitches alone were not very successful as a permanent solution to the hernia, and more than half of them recurred within 10 years. That lousy track record led to the innovation of surgical mesh, and by the 1980s and 90s it was clear that mesh dramatically improved the surgery, greatly reducing the chances of the hernia repair tearing apart later. Mesh became standard of care, and for good reason.
In the early 2000s, mesh got a black eye stemming from the use of mesh in the pelvic floor in females during suspensory type procedures. The mesh back then was stiff and rough, and it could rub against vulnerable soft tissues, creating erosion, uncomfortable drainage, pain, infection, and sometimes the need for more surgery. The only good thing that came from this dreadful problem was that it forced the mesh manufacturing companies to produce lighter weight materials that were softer, more pliable, and more compatible with human tissues. These are what we use today, and they work beautifully for hernia repair.
Combining this newer generation mesh with newer and less invasive surgical techniques has brought about a more favorable era of hernia repair in which a person undergoes less invasive surgery, has fewer complications, and a much shorter recovery time. Most hernias are repaired as outpatient procedures, otherwise known as same-day surgery.
Some of the terminology can be confusing, but think of the term “minimally invasive“ as an umbrella term that means if you are having a hernia repaired, you will wake up with a few small Band-Aids as opposed to a long, large, painful incision. That has been the real revolution of surgery in the last few decades. We commonly use the term “laparoscopic” to describe the camera technology that facilitates minimally invasive surgery. More recently, surgical device companies have produced large robot type devices that the surgeon controls with finger movements to perform the hernia repair, with similar camera technology and the same small Band-Aid type incisions.
One of the very challenging areas for surgeons repairing hernias is when the condition of obesity intersects with a recurrent hernia that was repaired years ago. Think of the abdominal wall musculature like a balloon for a moment, and imagine blowing more air into the balloon, expanding it, and watching the balloon wall become thinner. This means an increased risk of rupture and an increased risk of hernia. Additionally, the next repair becomes more difficult because the muscles are thinner and weakened, so it takes additional expertise to ensure that the subsequent repair will not also be a failure. Losing weight is a key part of a successful hernia repair strategy in these cases.
If you or a loved one has experienced a bulge in the groin or inguinal area, around the bellybutton, in a prior incisional scar, or anywhere else on the abdominal wall, talk to your doctor and see if this is a hernia which should be surgically repaired. Minimal invasive techniques are exceptionally effective at solving the problem before it becomes worse.
