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.
Types of Hernia
The term hernia is a general one meaning the protrusion of an internal organ through the fascia of a muscle wall in the abdomen. As such, hernias can take several forms in various locations and for differing reasons. The most common forms of hernia are:
Inguinal hernias are those that present in the groin area. The vast majority of hernias occur here. In most cases, a hernia in the groin is a result of the small intestine pushing through the abdominal wall muscle. Most patients will report tenderness in the area along with a bulge that can be felt or even seen under the skin. These hernias generally occur in male patients, although female patients may also suffer from inguinal hernias. Learn more about inguinal hernias
Femoral hernias occur in the lower groin and upper thigh area. These hernias are less common than an inguinal hernia and form lower in the body. Femoral hernias tend to be more common in women and should be repaired as soon as possible as they have a higher chance, than other hernias, of becoming strangulated.
Incisional hernias are caused by an incision or surgery. A surgical procedure or incision can compromise the strength of a muscle wall and allow a hernia to form. Incisional hernias do not necessarily occur immediately after surgery. In fact, patients have reported incisional hernias years after a procedure. Care should be taken to minimize strain on any area of the abdomen on which a surgical procedure has previously been performed.
Umbilical hernias form near the navel. The navel or belly button is a particularly weak point in the abdominal wall. Every human being is predisposed to weakness at the umbilicus. Umbilical hernias can be created or exacerbated by obesity or pregnancy.
There are other forms of hernias as well, some of which are more common than others. Seeing a qualified medical professional at the first signs of a hernia is the best course of action to diagnose and treat it quickly.
Causes of Hernias
The causes of hernias are many and varied. Age, general health, congenital disorders, lifestyle choices and more can all affect the incidence of a hernia. The common thread however is that they are caused by weakness of or strain on the fascia, or protective covering, of the abdominal wall. Hernias are progressive, meaning once they form, no matter how small or painless, they will only get worse. Below are some of the most common causes of hernias.
Causes of an Inguinal (Groin) Hernia
Inguinal, or groin, hernias are by far the most common hernia conditions in the United States. An inguinal hernia can develop as a result of two factors – weakness in the abdomen and excessive strain on that weak point, caused by one or more of the following:
- Heavy lifting
- Straining on the toilet
- A strong sneeze or cough
- Other activities that put strain on the abdomen
The fact is that any pressure placed on the abdominal wall can cause a hernia. Bodybuilders lifting hundreds of pounds or even mothers lifting their child can all develop a hernia. Conversely, some people will never develop a hernia no matter what strain they place on their body.
Some men will be predisposed to an inguinal hernia from birth. This is usually a result of weakness in the abdomen where the testicles descended through the abdomen and into the scrotum at birth (known as the testicular canal). While it is not always practical or necessary to determine whether or not the hernia is congenital, these inguinal hernias commonly appear in early childhood through to mid-life.
The vast majority of inguinal hernia patients are male, mostly because of, genetics, their lifestyles and work choices. Further, the uterus acts as a protective shield from inguinal hernias in women.
Causes of an Incisional Hernia
Incisional hernias can occur as a result of the weakening of the abdominal wall due to a surgical incision. Many open and even laparoscopic abdominal procedures will inherently weaken the abdominal wall. The point of incision, whether small or large, represents a possible exit point for internal organs. While surgery is not a guarantee that a hernia will form, it does represent a higher risk. Of course, there is not much one can do to prevent this other than to keep abdominal pressure to a minimum. However, the minimization of incisional hernias is one reason to choose a laparoscopic abdominal procedure.
Causes of an Umbilical Hernia
Umbilical hernias occur around the belly button as a result of the weakened nature of the abdominal wall in that area. This is not an individual problem, but one that affects every human being from birth. Umbilical hernias can be exacerbated by pressure in the area. Common causes include obesity and pregnancy, both of which place added pressure on the abdominal wall near the umbilicus.
Other Causes of Hernias
There are several inherently weak points in the abdomen, at which a hernia can develop. Age is a factor in hernia development as muscle begins to weaken as we get older. Lifestyle situations including smoking and obesity can also increase the chance of hernia development. Some hernias may even be caused by congenital problems that cannot be avoided. This is especially true for men and inguinal hernias. Indeed, those with family members that had a hernia are predisposed to hernia development themselves.
Signs and Symptoms of a Hernia
Generally speaking, the signs and symptoms of any abdominal hernia are very similar, no matter where they present. Diagnosis of a hernia will largely depend on the physician evaluating the symptoms below as well as some diagnostic testing if necessary. The signs of a hernia may include:
Bulging in the Abdomen
A bulge in the abdomen that can be felt under the skin is the most common sign of a hernia. Particularly severe hernia bulges can even be seen as a protrusion under the skin. When patients suffering from a hernia lie down or change position, the organ may retreat back through the abdominal wall and the bulge or lump will temporarily go away. This does not mean the hernia is repaired. Once a patient assumes a normal upright position, the hernia will likely return.
A hernia-related bulge that cannot be pushed back into the abdomen can be a serious condition known as strangulation or incarceration that requires a trip to the Emergency Room, and likely surgery, right away.
Hernia pain can be mild, modest or severe. The severity of a hernia is not commensurate to the pain that they cause. Mild hernia pain may actually represent a severe case and vice versa. Similarly, the location of the pain experienced with a hernia can be varied. Localized pain is usually dull in the beginning and can get progressively worse as the hernia expands. The stretching of the fascia around the hernia can often be felt and is very painful. Hernia pain can also extend outward from the hernia site if connected nerves, in other areas of the abdomen, are affected. This is known as referred pain.
Hernias do not repair themselves. In fact, they can become progressively worse and more complex to repair. The more complex a repair, the greater chance of complications after surgery. For that reason, we suggest that you contact our office as soon as possible, if you suspect you have a hernia.
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. You may also be interested in when minimally invasive hernia surgery is not appropriate.
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.