Hernia Repair Health Article

Definition

Hernia repair is a surgical procedure to return an organ that protrudes through a weak area of muscle to its original position.

Purpose

Hernias occur when a weakness in the wall of the abdomen allows an organ, usually the intestines, to bulge out of place. Hernias may result from a genetic predisposition toward this weakness. They can also be the result of weakening the muscle through improper exercise or poor lifting techniques. Both children and adults get hernias. Some are painful, while others are not.

There are three levels of hernias. An uncomplicated hernia is one where the intestines bulge into the peritoneum (the membrane lining the abdomen), but they can still be manipulated back into the body (although they don't stay in place without corrective surgery). This is termed a reducible hernia.

If the intestines bulge through the hernia defect and become trapped, this is called an incarcerated hernia. If the blood supply to an incarcerated hernia is shut off, the hernia is called a strangulated hernia. Strangulated hernias can result in gangrene.

Both incarcerated and strangulated hernias are medical emergencies and require emergency surgery to correct. For this reason, doctors generally recommend the repair of an uncomplicated hernia, even if it causes no discomfort to the patient.

Precautions

Hernia repair can be performed under local, regional, or general anesthesia. The choice depends on the age and health of the patient and the type of hernia. Generally hernia repair is very safe surgery, but—as with any surgery—the risk of complications increases if the patient smokes, is obese, is very young or very old, uses alcohol heavily, or uses illicit drugs.

Description

Hernia repairs are performed in a hospital or outpatient surgical facility by a general surgeon. Depending on the patient's age, health, and the type of hernia, patients may be able to go home the same day or may remain hospitalized for up to three to five days.

There are two types of hernia repair. A herniorrhaphy is used for simpler hernias. The intestines are returned to their proper place and the defect in the abdominal wall is mended. A hernioplasty is used for larger hernias. In this procedure, plastic or steel mesh is added to the abdominal wall to repair and reinforce the weak spot.

There are five kinds of common hernia repairs. They are named for the part of the body closest to the hernia, or bulge.

Femoral hernia repair

This procedure repairs a hernia that occurs in the groin where the thigh meets the abdomen. It is called a

femoral hernia repair because it is near the spot where the femoral artery and vein pass from the leg into the trunk of the body. Sometimes this type of hernia creates a noticeable bulge.

An incision is made in the groin area. The tissues are separated from the hernia sac, and the intestines are returned to the abdomen. The area is often reinforced with webbing before it is sewn shut. The skin is closed with sutures or metal clips that can be removed in about one week.

Inguinal hernia repair

Inguinal hernia repair closes a weakness in the abdominal wall that is near the inguinal canal, the spot where the testes descend from the body into the scrotum. This type of hernia occurs in about two percent of adult males.

An incision is made in the abdomen, then the hernia is located and repaired. The surgeon must be alert not to injure the spermatic cord, the testes, or the blood supply to the testes. If the hernia is small, it is simply repaired. If it is large, the area is reinforced with mesh to prevent a recurrence. External skin sutures can be removed in about a week. Patients should not resume sexual activity until being cleared by their doctor.

Umbilical hernia repair

This procedure repairs a hernia that occurs when the intestines bulge through the abdomen wall near the navel. Umbilical hernias are most common in infants.

An incision is made near the navel. The hernia is located and the intestines are returned to the abdomen. The peritoneum is closed, then the large abdominal muscle is pulled over the weak spot in such a way as to reinforce the area. External sutures or skin clips can be removed in about 10 days.

Incisional hernia repair

Incisional hernias occur most frequently at the site of a scar from earlier abdominal surgery. Once again, the abdomen is opened and the intestines returned to their proper place. The area is reinforced with mesh, and the abdominal wall is reconstructed to prevent another hernia from developing. External sutures can be removed in about a week.