All you need to know about hernia repair
Hernioplasty is a type of hernia repair surgery where a mesh patch is sewn over the weakened region of tissue.
Hernia repair surgery is one of the most common surgeries to be performed. According to a 2014 study by the Association of VA Surgeons, more than 350,000 ventral hernias or those in the abdominal region are repaired annually in the United States alone.
- Small hernias may not cause any symptoms
- In general, hernia surgeries are classified as herniorrhaphy or hernioplasty.
- Hernia repairs are day surgeries, so people go home a few hours afterward.
- Hernia surgeries are considered fairly safe and effective.
Hernia repair surgery may be necessary if the hernia causes long-term pain and discomfort, or the pain worsens.
It often takes 1 to 2 years before hernias begin to cause noticeable, irritating, or painful symptoms. Some people may only notice hernia symptoms when doing activities, such as strenuous exercise, for example.
Hernia symptoms and factors that indicate surgery may be necessary include:
- long-term hernia pain or discomfort
- pain or discomfort that interferes with everyday activities
- pain or discomfort intensifying or worsening over time
- large hernias
- fast-growing hernias
- hernias in places where they might worsening or enlarging, such as the groin
- sharp abdominal pain and vomiting
- hernias that put pressure on nerves to cause irritation and numbness
In some cases, hernias never end up causing enough symptoms to warrant medical intervention. But hernias cannot resolve or heal without surgery, so when negative symptoms occur surgery is necessary.
Types of repair
The different types of hernia surgery include:
Herniorrhaphy (tissue repair)
Different types of hernias will require different types of surgery. An overnight hospital stay may be required.
Herniorrhaphy is the oldest type of hernia surgery and is still being used. It involves a surgeon making a long incision directly over the hernia then using surgical tools to open the cut enough to access it.
Tissues or a displaced organ are then returned to their original location, and the hernia sac is removed.
The surgeon stitches the sides of the muscle opening or hole through which the hernia protruded. Once the wound has been sterilized, it is stitched shut.
Hernioplasty (mesh repair)
In hernioplasty, instead of stitching the muscle opening shut, the surgeon covers it with a flat, sterile mesh, usually made of flexible plastics, such as polypropylene, or animal tissue.
The surgeon makes small cuts around the hole in the shape of the mesh and then stitches the patch into the healthy, intact surrounding tissues.
Damaged or weak tissues surrounding the hernia will use the mesh, as a supportive, strengthening scaffold as they regrow.
Hernioplasty is better-known as tension-free hernia repair.
Types of hernia
The type of repair may depend on the nature of the hernia. Three types of hernias are most common, including:
- Reducible hernia: When the hernia can be pushed back into the opening it came through.
- Irreducible or incarcerated hernia: When the organ or abdominal tissues have filled the hernia sac, and it cannot be pushed back through the hole it came through.
- Strangulated hernia: When part of an organ or tissue becomes stuck inside the hernia with its blood supply often cut off.
Both hernia surgery techniques can either be done through a large incision or laparoscopically, which involves accessing the misplaced tissues through three or four small cuts made adjacent to the hernia.
Laparoscopic surgeries are done with a lighted fiber-optic cable called a laparoscope that acts like a video camera. By inserting the laparoscope through the small cuts, the surgeons can see what they are doing inside someone's body.
Before a person is discharged from hospital, their surgeon will explain what activities should be avoided and for how long.
It usually takes 3 to 6 weeks for a full recovery after hernia surgeries. Usually, it will take 1 to 2 weeks before a person can go back to everyday activities and work.
As with all surgeries, there are some side effects associated with hernia repair surgeries.
The incision site or wound will probably appear noticeably swollen and red. It will also usually be painful, especially to the touch.
Over-the-counter pain or anti-inflammatory medications may help reduce inflammation and its associated symptoms. Inflammation can also be reduced more immediately by applying ice to the area for 10-minute intervals once every hour.
Less common, but possible complications and risks associated with hernia repair surgeries include:
- organ or tissue damage
- recurrence or return of the hernia
- seroma or a fluid-filled sac under the surface of the skin
- nerve damage and neuralgia or nerve pain that causes tingling or numbness
- constipation or slow bowel movements
- inability or difficulty urinating
- incontinence or urine leakage
- hemorrhage or internal bleeding and hematoma or pooling of blood at the wound
- extensive scaring or adhesions
- incisional hernia that develops through a surgical cut
- fistula or an abnormal opening between two organs
- urinary tract infection
- blood clot
- pneumonia, lung infection, or breathing difficulties
- kidney complications or failure
- mesh pain
When to see a doctor
After receiving the surgery, any significant pain or discomfort including fever, increasing pain, and change in the skin around the site of incision, should be reported to a doctor.
Signs and symptoms that should be assessed by a doctor include:
- the incision remains inflamed and painful for more than a few days after surgery, especially if symptoms become worse or more intense
- new symptoms develop that were not present in the immediate hours after surgery
- hernia bulge changes color, especially a dark shade of red or purple
- paleness or change in skin tint
- odor or discharge from the incision, either blood, puss, or clear fluid
- the incision wound will not heal
- hard, swollen testicles
- inflammation and pain that does not respond to pain medications or ice
- stomach cramps
- no bowel movement for 3 or more days
- sharp abdominal pain and vomiting
More serious complications that require immediate medical attention, most commonly infection, can occur in the days and weeks after surgery.
Certain factors can complicate hernia repair surgeries and increase the risk of negative side effects or the surgery failing.
Common risk factors for hernias and undergoing hernia repair include:
- family history
- high blood pressure
- connective tissue disorders
In the case of pregnancy, some 1 in 2,000 American women develop a hernia during their pregnancies, according to the American College of Surgeons.
The risk factors for developing a hernia are the same as those that tend to increase the risk of developing or having recurrent hernias.