Hernia Surgery in Mobile, AL
A hernia is a hole in the fascia of the abdomen through which the contents of the abdominal cavity, most often the intestines, protrude. Hernias can be small or large, painless or painful, and can appear virtually anywhere in the abdomen. Over a million hernia repair surgeries are performed in the United States every year, making it the most common surgical procedure for a general surgeon.
Types of Hernia
- Inguinal (groin) hernias, which are the most common type and occur in men far more often than women
- Femoral (upper thigh) hernias which are most commonly found in women, but may occur in men as well
- Incisional (surgical) hernias which may form due to a previous surgical incision
- Umbilical (belly button) hernias which are often present from birth or occur because of the weak nature of the umbilicus
Causes of Hernias
Hernias develop as a result of the weakening of the fascial layer in the abdomen, either because of genetic predisposition or because the fascial layer weakens with strain or age. Some of the most common causes of a hernia are:
- Obesity, which adds additional pressure on the abdominal wall
- Heavy lifting
- Straining in the bathroom
- Persistent cough from allergies, asthma or smoking
- Previous abdominal surgery
Symptoms of a Hernia
The size of a hernia does not necessarily correlate to the severity of symptoms. In fact, smaller hernias can often hurt more than larger hernias. The two main symptoms are bulging in the abdomen and pain, burning or discomfort in the area.
In rare cases, the protruding intestinal contents can become trapped in the hernia – this is call incarceration. The telltale signs are a bulge that does not go away when pushed or lying down, and enhanced pain, sometimes severe. This may lead to the strangulation of the hernia, which involves the partial or complete cutting off of blood flow to the incarcerated portion of intestine. This is an emergency situation requiring immediate surgery. The most common symptoms of an incarcerated or strangulated hernia are:
- Severe pain
- Nausea and vomiting
- Inability to pass gas or stool
- Sometimes an inflamed, tender and red bulge at or near the hernia site
Diagnosis of a Hernia
Most hernias are diagnosed with a simple physical evaluation and are often found during routine physicals. Most hernias present with a bulge somewhere in the abdomen, depending on the type of hernia.
On occasion, if a hernia is suspected but cannot be found with a physical examination, imaging technology such as ultrasound, MRI or CT scan can be used to help with the diagnosis.
Treatment for a Hernia
Unfortunately, hernias do not go away on their own and require a surgical procedure to correct them. Many patients will never know they have a hernia, or their hernia is asymptomatic, so will never have it repaired. For those who have a higher risk of strangulation and/or significant symptoms, surgery is usually advised.
Surgery to repair a hernia is relatively straightforward. Today, hernia repairs are usually performed using a thin, synthetic surgical mesh placed over the hole to create a tension free repair. The technique to lay the mesh varies based on a surgeon’s preferred method. We perform most of our surgical repairs using laparoscopy due to the shorter recovery time and lower incidence of chronic pain. The mesh is placed over the defect from within the abdomen. Most patients are in and out of the surgery center on the same day, back to work within a few days and back to normal activity within 2-3 weeks, depending on type of activity and work.
Open surgery involves an incision on the outer wall of the abdomen using a scalpel. Various techniques allow the mesh to be affixed from the outside or the inside of the defect, again depending on the surgeon’s preference. Open surgery can use mesh or suturing alone to repair the defect.
Risks and considerations of a Hernia Repair
- The patient may develop chronic pain – this involves is some degree of pain longer than 3 months post-op. While this is a relatively uncommon complication (our experience <10%), it is probably the most controversial and least well-known of all. Luckily, for most patients, conservative management of the pain is enough to allow it to resolve on its own over time
- The hernia may recur (return). This is more common in tension (sutured repairs)
- The hernia mesh may may become infected and require removal
- There is a risk of blood loss
- Hernia surgery requires anesthesia
The surgeon’s experience in repairing hernias, as well as their case volume, is one of the most accurate determinants of the ultimate success of the procedure. As with any surgery, heightened experience allows a surgeon to better identify and mitigate the potential risks of surgery.