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HERNIAS
Description:
 A hernia is a weakness or defect in the lining of the abdominal
(belly) or pelvic (groin) wall. It can be present at birth or
develop over the years.
Signs and Symptoms:
You may see or feel a lump under the skin or in males a bulge in the
scrotum (this is usually intestine). This may present with straining
while lifting heavy objects, during a bowel movement or urination.
Coughing and sneezing may also produce a bulge. The lump may
disappear when laying down or even with gentle pressure. A hernia
can be present without an obvious lump. It can be painful or cause a
burning sensation. Sometimes it may be present for years without any
symptoms.
Treatment:
 What should you do if you suspect that you have a hernia? There is
no acceptable nonsurgical medical treatment for a hernia. The use of
a truss (hernia belt) can help keep the hernia from bulging but
eventually will fail. The truss also causes the formation of scar
tissue around the hernia making the repair more difficult. Have your
doctor perform an examination, because if the repair is delayed it
can result in incarceration (intestine is stuck and cannot get back
inside) or strangulation (intestine is stuck and develops gangrene).
The latter is an emergency.
The hernia will not go away, it will only get bigger. The bigger the
defect the bigger the operation required to fix it.
Under certain circumstances the hernia may be watched and followed
closely by a physician. These situations are unique to those
individuals who are high operative risks, ie, severe heart or lung
disease, or bleeding problems. Of course, even in the high risk
person, if the symptoms become severe or if strangulation occurs,
then an operation must be performed.
Surgical Options:
 What type of operation is best for you? There are two main options
for hernia repair:
1) Open Repair: The traditional, open repair has been the gold
standard for over 100 years. There are 5-10 different approaches and
can be performed routinely with local and intravenous sedation. Open
repair is generally painful with a relatively long recovery period.
2) Laparoscopic Repair: Laparoscopic repair has been developed
over the last 10 years. It is usually performed under general
anesthesia but spinal anesthesia is an option. Local anesthesia can
be used under special circumstances. Benefits of Laparoscopic
(laparoscopic) repair compared to the open repair are: shorter
operative time, less pain, and shorter recover period.
Laparoscopic
Hernia Surgery:
 For Laparoscopic hernia surgery a telescope attached to a camera is
placed through a small opening under the belly button. Two other
small cuts are made (each no larger than the diameter of an eraser
on the end of a pencil) in the lower abdomen. The defect is covered
with a mesh (synthetic material made from the same material that
stitches are made from) and secured in position with other
stitches/staples/titanium tacks or tissue glue.
Risks to Laparoscopic Hernia Surgery:
As with the open operation, bleeding and infection can occur. The
risk of nerve injury appear to be less than in open repair, as does
the potential for recurrences of the hernia.
After the Operation:
 Usually you can be discharged home a few hours after the completion
of the Laparoscopic hernia operation. Take it easy the first few
days. Walking stairs is allowed, and walking outside (weather
permitting) is encouraged. Taking a bath or shower 48 hours after
the operation is permitted. Avoid driving for at least 3 days and
any time while taking pain medication.
Remember to make a follow-up appointment with your surgeon 1-2 weeks
following the operation. Seek medical attention sooner if you
develop fever, bleeding, severe belly pain, excessive swelling or
nausea and vomiting.
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