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Surgery in Hernia

A hernia occurs when there is a weakening in the abdominal wall. This weakening of the natural support allows abdominal contents (bowel) to slide into the hole (referred to as the “Defect”). If part of the bowel slides through and gets caught (incarcerated), it can be painful and dangerous since the blood supply can be jeopardized. You may feel or see a pouching out (lump or swelling) of the belly or groin area, or you may feel and see nothing at all. Hernias are more noticeable when standing, coughing and straining, and may disappear when lying down. They sometimes can be pushed in with the finger, but all should be examined by a physician.

Sites of Hernia
The groin area is the most common site of a hernia (80%), hernias in this area are called inguinal hernias. But hernias can occur below the groin area (femoral), at the belly button (umbilical), in the abdominal area and at sites of prior surgery (incisional).

Causes of Hernia
Men, women, and children of any age can get hernias. They can occur because you were born with a natural weakness in the abdominal wall, or from a weakness acquired with age. Contributing factors include previous surgery in the abdominal area, excessive weight gain, pregnancy, constipation, infection, malignancy, or trauma. Strenuous physical activity including heavy lifting may also be a contributing factor.

Treatment
Hernias don’t go away. All defects, even ones that show no symptoms (“Asymptomatic”), should be surgically corrected since the risks of surgery are much less than the risks to you of not fixing the hernia. Once you develop symptoms, surgical repair is mandatory. Small asymptomatic hernias can sometimes be pushed back into place by your doctor, but surgery is the only way to really fix a hernia.

Surgical Repair
There are two main ways to surgically fix a hernia: open repair and minimally invasive laparoscopic repair.

Open Surgical Repair of Hernia
This type of repair involves making a cut (incision) over the hernia, carefully dissecting through the body tissues and closing the area of weakness. Usually a mesh (composed of gortex, teflon or other material) is sewn into place over or under the weakened area to make it stronger and to prevent recurrence. After the repair, the incision is closed and covered with bandages and tape.

Local anesthesia (lidocaine, mepivacaine) is commonly used to prevent you from feeling pain during the procedure. In addition, the anesthesiologist gives a mixture of short–acting sedating medications to provide comfort. Occasionally spinal or general anesthesia may be required for larger hernias or more complicated cases. Postoperative pain may be managed with a combination of intravenous, intramuscular and oral painkillers. You may have some trouble urinating for the first 12–24 hours following the procedure.

The main disadvantage of the open technique is that it can cause considerable pain. You may not be able to return to work for a week or longer and full activity may not be possible for up to six weeks. Swelling and black and blue discoloration of the wound site is common. Repairs of repeat inguinal hernias, and two sided repairs, are much more painful and have a much longer recovery period.

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