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Hernia


What is a hernia?

If a person feels a lump or bulge in the abdomen, it could be a hernia. The lump may be soft, small, and painless, or it may feel a little painful and swollen. The lump might even be able to be pushed back in, only to pop out again later. When the hernia occurs in the groin, it is called an inguinal hernia. Sometimes you may just experience pain in the groin, and not necessarily a lump.

What causes a hernia?

Hernias occur when part of an abdominal organ or fatty tissue in the abdomen pushes through a weak spot or tear in the abdominal muscles. Most of the time, it is because of fatty tissue that is pushing through the weak spot. Hernias usually occur in areas where the abdominal wall is weakened or thinner, either because the location is already weaker or is made weaker due to a previous surgery. Excessive straining, coughing, heavy lifting can also cause a hernia.


What are the different types of a hernia?

The most common type, inguinal hernias, occur in about 2% of men in the United States. They usually occur in the area where the skin crease at the top of the thigh joins the torso (the inguinal crease. Umbilical hernias are usually at, or around the belly button. Incisional/Ventral hernias occur in an area on the abdomen where you have a previous incision from surgery. Since that area is permanently weakened from surgery, it can be an area where a hernia can develop.


What are the symptoms of a hernia?

For a person with no symptoms, the doctor may discover a lump in the groin or abdomen during a medical exam. Most commonly, people with hernias notice a lump or tenderness and pressure or pain upon bending, coughing, or straining. The lump may be easier to feel when the person stands up. This is a sign of a reducible hernia, meaning it can be pushed back into the abdomen. When a person stands, the lump sticks out noticeably because of the pull of gravity. Other symptoms include a heavy feeling in the groin or abdomen, pain or swelling in the scrotum, pain when lifting something heavy, pain in the groin after you have been standing a lot.


What tests are used to diagnose a hernia?

Generally, a physical exam by the doctor will confirm the presence of a hernia. Most hernias are found this way. In the rare cases where a patient has symptoms but a doctor cannot feel a hernia, then further tests may be ordered. Usually, a CT scan is the test of choice in that instance.


How are hernias repaired?

During open hernia repair, the patient is first put to sleep with general anesthesia. The abdominal wall is then opened in the inguinal area. The protruding tissue is moved back into the abdomen, and the weakness or defect is repaired with a synthetic mesh. Many different types of mesh are available and usually your surgeon will have a particular preference.







What can I expect right after surgery?

Usually, you will be given pain medications prior to discharge. Normal findings after surgery include pain, swelling of the scrotum, bruising, difficulty urinating. It is advisable to place ice packs to the surgical sight for 24-48 hours after surgery. Thereafter, it is important to switch to warm compresses/heating pads and apply that to the surgical site. The first few days after surgery can be quite painful, but the pain improves over the subsequent days.


What are the risks and complications associated with a hernia repair?

Some of the risks include bleeding, infection, hernia recurrence, numbness in the surgical site or scrotum, inability to urinate, scrotal hematoma (bruise), high riding testicle on surgical side, and finally chronic pain in the groin. Complications of the procedure include injury to the intestines, bladder. Keep in mind that the rate of risks or complications is very low.


Can a hernia come back?

A hernia can always come back after it has been repaired once. A recurrence is not necessarily because of bad surgical technique at the initial surgery. While every attempt is made to minimize any recurrence, the "perfect" repair does not exist. However, the recurrence rate over many years is small, and is estimated to be about 1-5 percent. Sometimes the activities a patient resumes may cause a hernia to return.


What if I don’t have the hernia repaired?

If you decide to not have the hernia repaired, it is important to understand the possible progression of a hernia. A hernia usually starts off as being REDUCIBLE, where the bulge can be pushed back inside when it protrudes out. It can progress to become INCARCERATED, where you are unable to push the bulge back inside. At this stage you may notice increased pressure and pain in the area. Finally, an incarcerated hernia can progress to a STRANGULATED hernia. At this point, the hernia will be very tender, irreducible, skin can become red. In this stage, the blood supply to the contents of the hernia is cut-off which can lead to gangrenous (dead) bowel in as little as 6-8 hours. This mandates you go to the hospital because you likely need an emergent operation.

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