An abdominal hernia appears when the thin inside lining under the muscle wall that is closest to the organs inside pushes through the muscle. They most commonly manifest as a bulge. When this happens, intestines or other tissue may push out with it. This occurrence is similar to the inner tube of a tire pushing through the tread.
When to Consider Repair
Small hernias without pain can be watched carefully with the understanding that over time there is a significant likelihood that discomfort will develop or enlargement will occur. 25% of asymptomatic inguinal hernias in a Veterans study became symptomatic, requiring repair within a two-year period. If there is increasing size, discomfort, or an episode of incarceration, then surgical repair should be considered more urgently. Having a hernia is still an indication to have it repaired.
The general principle is to re-establish the wall to keep the insides from pushing out through the abdominal vault. This requires sewing it closed or, more commonly, placing a plastic mesh against the muscle wall to create a barrier. Mesh is like a window screen but made out of plastic. The body creates scar tissue around the mesh to hold it in place to be permanent. Because there are no foreign proteins, the body won’t “reject” mesh. There are several approaches available, as well as types of mesh. The options will be discussed with you during consultation.
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Bleeding and infection are possible, as with any operation. A single dose of intravenous antibiotics is given just before surgery to help prevent infection. No additional antibiotic is needed unless there are specific circumstances where the potential for infection is high.
Pain or numbness – There are small nerves throughout the body which allow communication to and from your body parts. During surgery to repair hernias, small branches of nerves may be divided, leaving numb areas, usually near the incision. It would be very rare to have nerve damage that would affect the function of a body area. Occasionally some small nerve branches may get “trapped” in scar tissue or next to the mesh during the repair. Many of these situations will improve with time but if they remain severe or persistent, then additional testing to localize where a problem may exist or further surgery may be needed.
Damage to organs is very rare but more likely in larger hernias where an organ is protruding out into the hernia. The bowel can be injured and, if recognized, repaired at the same time. Unrecognized injury can lead to additional complications. I have not had this complication since my practice started. Injury to the testicle or its blood supply can occur. I have had to remove a testicle in four older men at the time of hernia repair due to very large single-sided hernias.
Intravenous medication is given, and then after a patient is asleep, a breathing tube is placed into the mouth to help with breathing during the procedure. It is removed before being awake again. General anesthesia is required for any laparoscopic repairs, large hernias, or patient preference.
Sedation with Local Anesthesia
Heavy sedation medication is given through an IV, then while a patient is “out,” I inject local “numbing” medication in the area to keep any pain from being felt during the surgery. At the end of the procedure, patients are fully awake, able to eliminate the sedatives in the recovery room, and get out of the hospital faster, feeling better. I recommend this method when possible. Local anesthesia only is used for small hernias. A Local anesthesia injection can be used while a patient is fully awake, although there are not many repairs done with this method.