New Jersey Hernia Surgery
Hernias are a very common condition around the world, and hernia repairs represent the most commonly performed general surgery procedure of all. It is estimated that almost 1 million hernia surgeries are performed every year in the United States alone, 800,000 of which are inguinal hernias.
A hernia is the general term for the protrusion of an internal organ through a muscle wall as a result of the weakening of its retaining barrier, called the fascia. As the organ pushes through this barrier, patients may experience anything from mild discomfort to significant pain. Hernias are unpredictable however because a severe hernia may present only minor pain and vice versa. That is why patients who suspect a hernia should visit their physician as soon as possible.
There are several different forms that hernias take including: inguinal (groin) hernias, femoral (lower groin / upper thigh) hernias, umbilical hernias and incisional hernias.
Surgical Options for a Hernia
The only way to repair a hernia is through surgical means. There are a few surgical treatment options available to patients suffering from hernias. Until about 25 years ago, the only options to repair a hernia was an open tension repair. Essentially, the healthy tissue on either side of the hernia is sutured together to close the gap. This method had both high complication and recurrence rates. More recently however, newer techniques have given patients additional options with fewer problems.
While hernia surgery has become routine, the choice to undergo surgery must be evaluated for its risks and benefits based on individual circumstances. Part of this decision will rest on the severity of the hernia and the surgical risk of the patient.
Types of Hernia Repair
A surgical hernia repair can be performed either in a minimally invasive or open manner. Which procedure is used depends on the case at hand including the patient’s particular health circumstance. In most cases, the patient will have a choice between open and minimally invasive surgery. However, if a hernia becomes strangulated, it will require an emergency operation and the decision will largely rest on the surgeon.
Open Hernia Surgery
Certain patients will benefit from an open procedure, especially if there are multiple hernias that are not easily reachable with traditional laparoscopic devices. Other reasons for choosing an open procedure include severe obesity, dense scar issue in the area of the procedure and a propensity for excessive bleeding. In some cases, open surgery also reduces the possibility of the recurrence of the hernia. Patients with recurrent hernias may benefit from an open procedure. Those who react poorly to general anesthesia may also opt for an open hernia repair that usually only requires local anesthetic.
On the other hand, open surgery requires a longer recovery time and patients will be less comfortable during recovery than those who have undergone minimally invasive surgery. There is a greater chance of certain complications such as chronic pain with an open hernia repair. There are rare occasions when a minimally invasive hernia surgery will have to be converted to an open surgery during the course of the procedure for patient safety or the effectiveness of the procedure.
Minimally Invasive Hernia Surgery
As minimally invasive techniques and devices are enhanced, an ever-greater proportion of hernia surgeries are being performed laparoscopically. During the procedure, two tiny incisions are made in the area of the hernia and a larger incision is made within the umbilicus. A surgical mesh is placed over the hernia and affixed to the abdominal wall.
Minimally invasive surgery has many benefits in the form of less pain and blood loss as well as a shorter hospital stays after surgery. However, minimally invasive surgery may not be appropriate for all hernia patients, especially those suffering from multiple hernias that cannot be reached with laparoscopic tools, obese patients or those with significant scarring from previous procedures in the area. Recurrent hernias are also typically treated using the open procedure.
Mesh or No Mesh?
There’s been a great deal of debate over whether surgical mesh should be used to repair a hernia. However, mesh remains the gold standard for hernia repair because it creates a stronger, longer-lasting solution that is less likely to allow for hernia recurrence when compared to a traditional tension or suture repair.
The debate around mesh centers on a biocompatibility of the mesh itself. Most meshes are synthetic while some are sourced from animal tissue. Whether the body has a greater tendency to reject this mesh, is up for debate.
Secondly, the way the mesh is adhered to the abdomen – by using staples or tacks – can cause irritation to surrounding nerves. Whether the risk is diminished by using surgical glue remains unanswered. However, complication rates for minimally invasive hernia repair has steadily decreased over the past couple decades
Risks of Hernia Repair Surgery
Hernia surgery performed laparoscopically will generally mean fewer complications and shorter hospital stay. However, both open and laparoscopic hernia repair come with some risk. To minimize risk, we suggest that healthy patients address their hernia sooner rather than later. A planned hernia repair carries a mortality risk no greater than the background population. As the complexity of the repair increases, so do the risks.
Typical risks of a hernia surgery include:
- Reaction to anesthesia (local for open and general for laparoscopic)
- Acute surgical pain
- Infection at the incision site(s)
- Chronic pain, possibly due to nerve irritation or reaction to mesh – Learn more about chronic pain after hernia repair
- Potential for adhesion, intestinal blockage, bleeding, fluid build-up (seroma) and perforation of neighboring organs
It is important to note that’s many of the complications in the last bullet point above were due to a defective mesh that was recalled in 2010. This mesh is no longer on the market. Feel free to visit the FDA’s website to learn more about this recall.
One very important the thing to note about hernia surgery is that a planned surgery is almost always less risky than emergency surgery for a strangulated hernia. Because of an interrupted blood flow to the organ during strangulation, it is possible that a strangulated hernia can cause part of the small intestine tissue to die. This will require the removal or resection of the affected part of the intestine. When this occurs, the risks of surgery increase drastically.
Do I Really Need Hernia Surgery?
Hernias are a progressive condition meaning that they will not improve or disappear on their own. Hernias can progress slowly or quickly; however they will not improve without surgical intervention. Surgeons at Advanced Surgical Associates are experts in the field of both minimally invasive and open surgery for hernias.
The answer to this question, however, varies based on a patient’s particular condition. Older patients with larger, asymptomatic hernias that are less likely to strangulate are often not considered good candidates for hernia surgery. They should still see a qualified specialist to determine if this is the case, but often they are able to watch and wait. In these cases, a hernia repair becomes more of a lifestyle issue, rather than a necessity.
For younger patients who are in generally good health and for those that have relatively smaller hernias, a hernia repair is almost always indicated. This is because younger patients with smaller hernias are a greater risk for strangulation. Further, as the hernia progresses, it will become more complex to repair and create a greater potential for complications. Most younger patients with a hernia we’ll eventually have it repaired, even if today it is small or asymptomatic.
The risks of strangulation are small and as such many patients will have the choice whether or not to undergo surgery. Symptomatic hernias are almost always repaired while asymptomatic hernias may offer the patient some leeway.
When surgery is indicated for a hernia, correcting it early is imperative to avoid longer-term complications and serious pain. Contact us for a consultation and to learn more about the varied treatments available to you.
Next Steps In Repairing a Hernia
It is important to note that the sooner your physician identifies and treats the hernia, the greater the options available and the greater the chance of a successful procedure. The biggest concern of waiting too long to treat a hernia is the progression of the hernia to a larger and more complex repair. This increases the chances of a complication after surgery.
Further, there exists the possibility of strangulation. This means that the opening through which the organ has passed tightens, effectively pinching the organ, reducing blood flow and causing an emergency situation. A strangulated hernia requires immediate surgery, which is often less successful than a planned surgical procedure.