Why You Shouldn’t (Or Could) Wait To Have Hernia Surgery

March 22, 2018

In an effort to give you the most comprehensive answers to common questions and topics, we have updated this blog post which was originally published in 2012. In this update, we will explore the nuances of hernia surgery –  about when a patient can reasonably wait to have hernia surgery and alternately when they should have it as soon as possible. Of course, every situation is unique and a consultation with qualified surgeons such as those at ASA is the best first course of action.

There are many types of hernia – inguinal, femoral, incisional, umbilical, hiatal and more – each with their own set of complexities. The one commonality between them is that many of these hernias can start as very minor, causing minimal pain and discomfort. The fact that hernias can seem so benign offers a false sense of security. The thinking is that since there is little or no pain, the hernia is fine and doesn’t need repair.

In actual fact, the very presence of a hernia requires surgery – and the sooner the better. By their nature, hernias tend to get worse and this worsening can be very rapid depending on a multitude of circumstances. Let’s explore potential complications of an untreated hernia.

  • The most urgent complication of any form hernia is known as incarceration or strangulation of the herniated abdominal contents. This is an emergency situation that requires a visit to the ER and immediate surgery to reduce the hernia contents. Incarceration occurs when the abdominal contents cannot be pushed back through the hernia. Strangulation occurs when the incarcerated contents lose blood flow and tissue begins to die. If left untreated, this condition can be very serious, even fatal. Luckily, strangulation is a less common complication of a hernia– However, patients with a femoral hernia have a very high likelihood of strangulation.
  • Related to the point above, strangulated or incarcerated hernias are an emergent situation that requires immediate surgery. Statistics show that emergency hernia surgery has the potential for greater complications than a surgery performed on an elective basis.
  • When patients comes into see us suspecting a hernia, it is likely that they have either noticed a bulge in their abdomen or have pain or discomfort – which can be mild or significant. Unfortunately, these persist until the hernia is corrected by surgical means. Losing some weight to reduce the pressure on the abdomen can help, but typically does not do much for a symptomatic hernia.
  • Lastly, but not least, is that hernias are a progressive condition. We know that they cannot be repaired without surgery, but they certainly can get worse over time. As the pressure from the abdominal contents push on the hernia, it tends to expand. This can happen over the course of weeks, months or even years – we simply don’t know. However, a larger hernia is not only more difficult to repair but requires more mesh to cover the defect and ultimately can create more complications.

Who Is a Good Candidate for Surgery?

  • Younger, healthy patients are typically recommended for surgery because the risks of the procedure are quite low. Further, younger patients tend to have stronger muscle structures in the abdomen, which can increase the chance of incarceration or strangulation if the hernia is not repaired.
  • Patients with smaller hernias may also benefit from surgical intervention sooner rather than later as these are more likely to strangulate than larger hernias.
  • Patients with femoral hernias, more often found in women than men, should have surgery urgently as this type of hernia tends to strangulate at a much higher rate than other abdominal hernias.
  • Lastly, those who are experiencing a significant amount of pain or discomfort from the hernia may wish to have it repaired for lifestyle reasons.

Who is a Good Candidate for Watchful Waiting?

  • Older patients typically have a weaker abdominal muscle structure allowing the herniated contents of the abdomen to retract easily. This reduces the risk of strangulation or incarceration.
  • Patients with larger hernias may also opt to wait to have them repaired as large hernias tend to have a lower incidence of strangulation or incarceration.
  • Those with a high degree of surgical risk, usually due to poor general health, may not be candidates for elective hernia surgery until their health improves.
  • Lastly, patients who do not have significant symptoms that impede their lifestyle– typically those who found their hernias incidentally – may opt not to have a hernia repaired if the likelihood of strangulation or incarceration is low.

Ultimately, in most cases it may not be worth waiting to have a hernia surgery performed unless there is a solid medical reason to the contrary. Addressing and correcting a hernia sooner rather than later can avoid further problems, both in the short term and in the longer-term as well.

To learn more about the surgical option that is best for your hernia problem, you can contact our office to schedule a consultation.

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Advanced Surgical Associates is one of the first exclusively surgical groups practicing in Union County New Jersey. And that is just the first of many firsts for ASA. For over 40 years, we have pioneered breakthrough surgical patient care in North Jersey in both general and weight loss surgery. ASA also offers gastric bypass, gastric sleeve and gastric banding to those suffering from obesity in New Jersey.
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