About 600,000 hernia operations are performed each year in the United States, but sometimes people will try to ignore the symptoms -- discomfort, a lump appearing on their abdomen, even pain. Left untreated, hernias can become serious and even fatal conditions, says Dr. Sheldon Lerman, a general surgeon with St. Joseph Medical Center.
Can you describe what a hernia is?
A hernia is a defect in the abdominal wall. The contents of the abdominal cavity, usually either intra-abdominal fat or part of the intestine, bulge out through a defect in the abdominal wall.
What are the symptoms of a hernia?
People many times make the diagnosis themselves. The hernia may happen when they strain by coughing or lifting heavy objects or can be the result of prolonged standing.
They will feel a bulge under the skin on the abdominal wall or in their navel or groin area. They may feel discomfort or pain in the area, though there are some hernias that are asymptomatic. I would say that most people are aware that they have a hernia, but there are some cases in which the diagnosis is made when they have a routine physical exam by a doctor.
What happens if a hernia goes untreated?
A hernia will not get better over time or resolve on its own. Left untreated, most hernias will become larger and will cause discomfort or pain. Sometimes hernias may incarcerate (which means the hernia cannot be pushed back into the abdominal cavity) and become strangulated (which means the blood supply to your intestine becomes compromised). This is a surgical emergency that needs immediate attention.
Who is at risk for hernias?
Hernias occur in every age group, even newborns. Both men and women can get hernias.
You mention different kinds of hernias. Can you describe them further?
Hernias are generally classified by their location in the abdominal wall. The three most common include inguinal (groin), umbilical (navel) and incisional. An incisional hernia occurs in a scar from a previous operation of the abdomen.
How are hernias treated?
The treatment is surgical repair. A delay in repair usually results in a larger hernia. The repair is usually done with mesh, which is commonly made from polypropylene or PTFE (Gortex) or a combination of the two. The question is whether the surgery is done open or laparoscopically.
Which type of surgery do you prefer?
I usually perform an open operation. Most hernias I operate on are inguinal hernias in the groin. I perform a repair in which I place the mesh behind the abdominal wall similar to a laparoscopic repair. It's comparable to placing a patch on the inside, not the outside, of a tire. The advantage over a laparoscopic repair is that it takes a shorter time, and I don't enter the abdominal cavity, where major complications can occur. It also offers less pain and a faster recovery.
What is the recovery time?
Most operations are performed as outpatient surgery. There is no limit to physical activity as soon as the incision site feels comfortable. Most people are back to work in a week or two.
How many hernias do you typically repair a year?
Approximately 300.
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