Surgical Facts

Hernia Surgery

When A Hernia Happens.........

Men and Women of all ages can have hernias. Children can have them, too. Commonly called a "rupture," a hernia is weakness or tear in the wall of your abdomen. How does this happen? Acquired hernias are caused by wear and tear over the years. Congenital hernias result from a weakness in your abdominal wall that is present at birth. Hernias may get worse with time or physical stress. Children's hernias are almost always congenital.

Noticing A Bulge..........

It's usually easy to recognize a hernia. You may notice a bulge under your skin. Or, you may feel pain when you lift heavy objects, cough, or strain during urination or bowel movements. The pain may be sharp and immediate. In some cases, the pain may be a dull ache that gets worse toward the end of the day or after standing for long periods of time.

Seeing Your Physician.........

If you think you have a hernia, see your doctor right away for a medical evaluation. This is the only way to accurately diagnose your problem. You and your physician can work together to determine the best time for hernia repair. This surgery helps prevent future complications and allows you to resume an active life.

Your Evaluation.........

Your physician evaluates your condition with a medical examination. This helps your doctor decide whether your hernia needs to be treated right away or in the near future.

Surgery: The Best Treatment.........

Once a diagnosis is confirmed, your physician is likely to recommend surgery. Non-surgical treatment, such as a truss (a supportive wrap), is only a temporary solution, not a cure. It's usually better to have surgery before the hernia gets bigger and complications arise.

Back To An Active Life.........

Within a short period of time after your surgery - usually no longer than 6 weeks – full recovery is usually expected. Then you can return to your normal activities, free of the pain and worry your hernia caused you.

The Story Behind A Hernia.........

Picture an old tire. Its outer wall is like the layers of tissue surrounding your abdomen (the abdominal wall). The tire's inner tube is like the thin inner lining of your abdomen (the peritoneum). Instead of holding air, your abdomen holds in the intestines and other vital organs. Usually, the outer wall is strong enough to keep these contents in place. But, if the wall gets weak, a hernia may form.

The Layers Of Your Abdomen.........

• The Abdominal Wall: Made up of layers of muscle, fat and other tissue that surround your abdomen.
• The Omentum: The layer of fat that covers your intestines.
• The Peritoneum: The Inner lining of your abdominal cavity.
• The Intestines: Part of the digestive "tube" extending from your stomach to your anus (the opening to the outside of your body).
• The Spermatic cord: (In males) this contains the blood vessels and nerves that pass from the abdominal cavity into the scrotum.
• The Groin: The area between your abdomen and your thigh.
• The Scrotum: (In males) it is the sac of skin that holds the testicles (male reproductive glands).

Possible Weakness = Possible Hernia.........

The wall of your abdomen contains areas of possible weakness. These areas include natural spaces and thin tissue, such as the umbilical ring around the naval, the internal ring in the groin, and the scrotum. Hernias may develop at these or other areas due to aging, injury, an old incision, or a weakness present at birth.

• The Umbilical Ring: The abdominal wall around the navel is a possible weak spot that may give way to a hernia.
• The Internal Ring: The abdominal wall at the groin area is an area of possible weakness that may give way to a hernia.
• The Peritoneum: The testicles may fill with fluid (a hydrocele) and is a possible weak spot.

How Hernias Develop.........

• The Wall Weakens or Tears: When the abdominal wall weakens, sometimes to the point of tearing, a loop of intestine or fatty tissue may push against the inner lining, forming a sac. You're not in immediate danger at this point. You may not even be able to see a bulge, but you may feel burning or tingling.
• The Intestine Pushes Into the Sac: Most hernias form a bulge as the intestine pushes into the sac. If the bulge flattens out when you lie down or push against it, you have a reducible hernia. Although you're not in immediate danger, you still need hernia repair.
• The Intestine May Become Trapped: If the intestine becomes trapped, or incarcerated, you won't be able to flatten the bulge. You have a non-reducible hernia, which is often painful. Prompt surgery is required.
• The Intestines May Become Strangulated: If the intestine is tightly trapped, or strangulated, it eventually loses its blood supply and dies. A strangulated intestine can also block digestion and case severe pain. Emergency surgery is required to relieve the blockage and to repair the hernia.

Where Hernias might Occur.........

• An Incisional Hernia: Occurs at the site of a previous surgical incision, anywhere on the abdomen.
• An Umbilical Hernia: Occurs in the umbilical ring, a possible weak spot around the naval.
• A Direct Inguinal Hernia: Occurs near the internal ring, a possible weak spot in the groin.
• A Femoral Hernia: Occurs high in the thigh, another area of possible weakness, just below the groin.
• An Indirect Inguinal Hernia: Occurs at the internal ring, a possible weak spot in the groin.

Indirect Inguinal Hernia.........

Indirect inguinal hernias are the most common type. The result of a weakness at the internal ring, they can be present at birth or may occur later in life. In men, they can extend into the scrotum. In women, they can extend to the labia (the outer folds of the genital area).

• Why Indirect Inguinal Hernias Happen: In men, a weakness may occur at the internal ring, where the testicles pass down (descend) during natural development from the abdominal cavity into the scrotum. In women, a hernia can occur in the same area. As the hernia develops, this space may enlarge and fill with intestines or part of the omentum (fat layer).
• How An Indirect Inguinal Hernia Is Fixed: An incision is usually made on an angle just above the crease where the abdomen meets the thigh. The hernia sac is lifted and opened, and the intestine or other tissue is placed back into the abdominal cavity. Then the excess sac may be tied off and removed. The opening at the internal ring may be tightened and the abdominal wall reinforced with sutures or with a sheet or plug of synthetic mesh. The skin incision may be sutured or stapled.

Direct Inguinal Hernia.........

Direct inguinal hernias happen less often than indirect hernias. They are more common in men and usually occur after the age of 40. Direct inguinal hernias result from a weakness that develops in the groin area near the internal ring.

• Why Direct Inguinal Hernias Happen: Direct inguinal hernias may develop if muscle or other tissue near the internal ring weakens. This is often a result of aging or injury.
• How A Direct Inguinal Hernia Is Fixed: An incision is usually made on an angle just above the crease where the abdomen meets the thigh. The sac containing intestine or other tissue is placed back into the abdominal cavity. The weakened area of the abdominal wall is reinforced either with a sheet of plug of synthetic mesh of by suturing the abdominal tissue. The skin incision may be sutured or stapled.

Femoral Hernia.........

Femoral hernias are more common in women than in men. The result of a weakness below the groin, femoral hernias are often small but non-reducible. They can cause serious complications, such as strangulation of the intestine.

• Why Femoral Hernias Happen: A weakness in the lower groin area may allow a hernia sac to form. The sac, which contains intestine, drops into the femoral canal, a space near the femoral vein that carries blood from the leg.
How A Femoral Hernia Is Fixed: An incision is made above the crease where the abdomen meets the thigh. Then, either a classic repair or mesh plug repair is done. The hernia sac is lifted out of the femoral canal and opened. Intestine or other tissue is then placed back into the abdominal cavity. The excess sac may be tied off and removed. For the classic repair, the femoral canal is closed with sutures or reinforced with a sheet of synthetic mesh, The skin incision may be sutured or stapled. During mesh plug repair, the intestine or other tissue is pushed up the femoral canal into the abdominal cavity. A plug of synthetic mesh is used to fill the canal.

Incisional Hernia.........

Incisional hernias bulge through scars form previous surgical incisions and may develop months to years after the initial surgery. Incisional hernias need medical attention because they may widen and become increasingly difficult to repair.

• Why Incisional Hernias Happen: Incisional hernias are often caused by weakened scar tissue or abdominal pressure due to obesity or excessive coughing. Incisional hernias can be found at or near any previous abdominal incision.
• How A Incisional Hernia Is Fixed: The incision from the earlier surgery is reopened at the site of your hernia. The intestine or other tissue in the hernia sac is placed back into the abdominal cavity. The opening is sutured or reinforced either with a sheet of synthetic mesh or by suturing the abdominal tissue. The skin incision may be stapled or sutured.

Umbilical Hernia.........

An umbilical hernia looks like an inflated or bulging naval. It is caused by a weakness that you may have at birth or acquire over time. Children and adults of both sexes can develop umbilical hernias.

• Why Umbilical Hernias Happen: Umbilical hernias result from a weakness in the umbilical ring, which allows a hernia sac to form. Although they may be present at birth, umbilical hernias are sometimes caused by abdominal pressure due to obesity, excessive coughing, or pregnancy.
• How A Umbilical Hernia Is Fixed: A semicircle incision is made near your navel. The intestine or tissue in the hernia sac is placed back into the abdominal cavity. The umbilical weakness is tightened with sutures or reinforced with a sheet of synthetic mesh. The skin incision may be closed with sutures or staples.

Hernias In Children.........

Children's hernias result from a weakness in the abdominal wall that is present at birth. The most common types of children's hernias are umbilical and indirect inguinal hernias. Umbilical hernias may heal without surgery, but indirect inguinal hernias probably will not. Both umbilical and inguinal hernias will cause a bulge that can be seen and felt.

Your Child's Surgical Experience.........

Be sure that you child doesn't eat or drink anything (not even water) after midnight the evening before surgery. This lowers the risk of vomiting during surgery. Routine blood and urine tests may need to be done. Your child may be given something to help him or her relax. During surgery, anesthesia will be used so that your child will feel no pain.

• Umbilical Hernia Repair: A semicircular incision is made near the navel. The navel is raised and the hernia sac is cut away. The opening in the umbilical ring is closed. Then, the navel is returned to its normal position.
• Indirect Inguinal Hernia Repair: An incision is made in the lower abdomen. After the hernia sac is removed, the opening at the internal ring may be narrowed. If the hydrocele sac or undescended testicle is present, it can be repaired, too.

Your Child's Recovery.........

Most children can go home the same day of surgery, after a short recovery time. Before you take your child home, your surgeon will schedule a follow-up appointment with you. Don't be alarmed if you notice some swelling or discoloring around your child's penis. This is normal

Contact Your Physician If Your Child Experiences Any of The Following Problems:

• Fever
• Excessive swelling
• Redness
• Bleeding
• Increasing pain

Before and After Your Hernia Operation.........

If you are diagnosed with a hernia, you and your physician may begin making plans for surgery. Hernia repair is often same day surgery, so you may be able to go home within several hours. Once you're home, it's up to you to make your recovery as quick and comfortable as possible by easing slowly back into your daily activities.

Preparing For Surgery.........

To make an accurate diagnosis, your physician will talk with you about your medical history, perform a thorough physical examination, and may do other tests. Then your physician's office will help you schedule surgery at a hospital or surgical center. When you check in on the day of your surgery, you will be asked to sign consent forms if you haven't already. Then you'll change into a gown and have your blood pressure, pulse, and temperature taken. Your physician or anesthesiologist may talk with you about which type of anesthetic you'll be given to keep you pain-free during the operation.

Before Surgery.........

• Schedule Lab Tests: Your physician may request blood tests, an electrocardiogram (ECG), and a chest x-ray a few days before surgery to be sure that your heart and lungs are in good shape.
• Ask About Medications: Before your surgery, you may be told to stop taking medications, including over-the-counter pills such as aspirin.
• Quit Smoking: Quit smoking to avoid straining your hernia from "smoker's cough" and to promote good blood flow for healing.
• Avoid Heavy Lifting: Avoid putting excess strain on your hernia. Don't do any heavy lifting prior to your surgery.
• Don't Eat or Drink: To reduce the risk of vomiting when you're under anesthesia, don't eat or drink anything (not even water) after midnight the evening before surgery.
• Arrange for Help: Plan to have someone drive you to the surgical center and pick you up afterward. You'll want to take it easy after surgery, too, so you may need extra help at home.

Your Recovery.........

Following your surgery, you may be given medication to relieve any pain in the area of your incision. Your incision will be covered with a bandage. You may also have an intravenous tube in your arm to provide fluid and nourishment for the first few hours after surgery. In most cases, you'll be able to go home as soon as you're able to eat, drink, urinate, and walk around. It's normal to see some swelling or discoloring around your incision. This will disappear with time.

Back at Home:

To ensure a smooth recovery after surgery, follow these guidelines:

• Lifting: If you must lift something, lift only light objects that you can manage easily. Keep your back straight, and allow your legs to do most of the work.
• Sex: Ask your physician how soon after surgery you may have sex, since it may put a strain on your incision.
• Medications: Your incision site may be swollen, bruised, tender, or numb following surgery. Your doctor may give you pain medication to use during your first few days at home.
• Driving: Driving may strain your incision. Ask your doctor about when you can drive. Don't drive while taking pain medication.
• Exercise: Moderate exercise helps improve your circulation. You can walk as much as is comfortable. It's also okay to climb stairs, but take them slowly, one at a time.
• Diet: To avoid constipation that could cause you to strain against your incision, eat a high-fiber diet and drink lots of fluids. If necessary, ask your doctor about using a stool softener.
• Work: Your physician will let you know when it's okay to work again. If you have a desk job, you may be able to go back to work within a couple of weeks. If your job requires more physical activity, you may have to wait longer.
• Follow-up Visits: Your physician may schedule a follow-up visit in about a week. During the visit, your physician will remove stitches or staples, if necessary, and check the progress of your healing. More follow-up visits may be scheduled as needed.

Call Your Physician if you experience any of the following problems:

• Fever
• Excessive swelling (some testicular swelling is common)
• Urinary retention
• Redness
• Bleeding
• Increasing pain

NOTE: The material presented here is provided for informational and reference of the condition stated, and is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem.