Hernia repair surgery

Overview

Hernia surgery, also known as herniorrhaphy, is the predominant treatment for hernias, which occur when an organ protrudes through the muscle or tissue wall, typically in the abdomen or groin. During the procedure, surgeons reposition the organ and herniated tissue, strengthening the protective barrier through techniques such as stitching or utilizing surgical mesh to prevent recurrence.

Types

• Open (traditional) hernia repair: A surgeon makes a single incision to access the herniated tissue. The organs and tissue are repositioned, and the surgeon strengthens the area by stitching it together, often using surgical mesh for reinforcement.
• Laparoscopic hernia repair: Also known as “keyhole surgery,” this technique involves making several small incisions, usually three or four. A thin tube with a tiny camera (laparoscope) is inserted through one incision to provide visual guidance, while surgical instruments are inserted through the others for repairing the hernia.
• Robotic hernia repair: Variation of laparoscopic surgery, this method utilizes robotic surgical instruments controlled by the surgeon from a console. The surgeon manipulates the robotic tools to repair the weakened tissue responsible for the hernia.

Reasons for undergoing the procedure

Hernias, though not always requiring immediate treatment, typically worsen over time, appearing as bulges where internal tissue pushes through a tear or opening in the muscle or tissue wall. This can lead to discomfort or pain. Depending on their location, hernias can affect nearby organs and lead to complications. For example, in individuals with testicles, hernias can extend into the scrotum, causing swelling and discomfort, particularly during sexual activity. Surgery may be necessary if the hernia causes symptoms or poses a risk of complications. According to the FDA, over 1 million hernia surgeries are performed annually in the United States, with approximately 20 million surgeries worldwide, with the majority addressing inguinal hernias, which are the most common type.

Risk

Hernia surgery, like any surgical procedure, carries certain risks, both immediate and long-term, which your medical team will strive to minimize. Short-term complications may include infection at the incision site, seromas (fluid buildup), hematomas (blood accumulation), injury to nearby tissues or organs, and temporary difficulties emptying the bladder, which may require short-term catheterization.

Long-term complications that may arise after recovery include the erosion or breakdown of the surgical mesh, deep tissue infections related to the mesh, and hernia recurrence, although this is uncommon. In males, hernia repair in the groin area can lead to pain during sex due to nerve vessel damage or disrupted blood flow, potentially affecting testicular health or fertility, though such complications are rare.

Some individuals may experience persistent pain beyond three months post-surgery, termed post-herniorrhaphy neuralgia. Management may involve medication or additional surgical interventions.

Before the procedure

Preparation for hernia surgery involves several steps:

• Medical history review: Your healthcare provider will review your medical history to assess your overall health status, including any existing conditions or pregnancies.
• Medication review: Your medications, including herbs and supplements, will be evaluated to ensure they won’t interfere with the surgery or recovery process.
• Diagnostic tests: Blood tests or imaging may be ordered to assess your health and determine if you’re fit for surgery.
• Pre-surgery instructions: Your healthcare provider will provide specific instructions to prepare for the surgery. This may include discontinuing blood thinners like aspirin and fasting before the procedure.
• Post-surgery arrangements: You’ll need to arrange for transportation home after the surgery, as you may not be in a condition to drive.

During the procedure

Surgery for hernia repair can vary depending on the type of procedure required, whether it’s open, laparoscopic, or robotic. Overview of the general process:

• Anesthesia: You’ll receive medications to prevent pain. For laparoscopic surgery, you’ll likely need general anesthesia, which puts you to sleep. Open surgeries may only require local or regional anesthesia, leaving you awake but without sensation in the surgical area.
• Incisions: In open surgery, the surgeon makes a single incision, typically several inches long. For laparoscopic surgery, they make several small cuts, usually three or four, each no longer than an inch.
• Repair: The surgeon will reposition the herniated tissue and strengthen the surrounding tissue, often using sutures or surgical mesh to create a sturdy barrier and prevent recurrence of the hernia.
• Closure: Once the repair is complete, the surgeon will close the incisions with sutures and dress the wounds.
• Duration: The duration of hernia surgery can range from as little as 30 minutes for straightforward repairs to up to five hours for more complex cases. Robotic surgery tends to take longer than open or laparoscopic approaches.
• Pain management: Under general anesthesia, you won’t feel any pain as you’ll be asleep. If awake with local anesthesia, your healthcare provider will monitor your comfort level and adjust medication accordingly. Pain management during recovery may involve the use of pain relievers for several days to weeks.

After the procedure

Most hernia repair surgeries are outpatient, allowing patients to return home on the same day. However, for more complex repairs, a hospital stay of one or two nights may be necessary. Upon waking in the recovery room, medical staff will monitor vital signs until the effects of anesthesia wear off, typically taking a few hours. It’s essential to arrange for someone to drive you home and plan to rest for the first 24 hours post-surgery, although basic activities like walking are usually feasible with caution.

Outcome

Your recovery period varies depending on factors such as the type of hernia and the complexity of the surgery. Here’s a general guideline:

• Returning to work: Most individuals with non-physically demanding jobs (e.g., desk jobs) can typically resume work within a few days. If your job involves heavy lifting or strenuous activity, you may need to wait a few weeks.
• Light exercise: You can usually engage in light activities like walking the day after surgery, but avoid overexertion. Gradually increase your activity level as you heal.
• Consult your healthcare provider: Your specific timeline may differ based on your job requirements and overall health. Consult your healthcare provider for personalized guidance.

Signs of complications: Monitor your recovery closely and contact your healthcare provider if you notice any of the following signs of complications:

• Fever and chills
• Constipation or inability to pass gas
• Drainage of pus from the incision
• Pain, redness, warmth, or swelling at the incision site
• Blood seeping through the bandage

Seek immediate medical attention if you experience any of the following:

• Deep vein thrombosis (DVT) signs:
  • Leg pain (including calf, behind the knee, and thigh) or groin pain
  • Sudden swelling, warmth, or redness in the leg or groin area
• Sepsis symptoms:
  • Fever
  • Chills
  • Rapid heart rate
  • High blood pressure
  • Warm, clammy, or sweaty skin
  • Shortness of breath

Prompt action is essential for managing these potentially serious complications. If you notice any of these signs, do not hesitate to go to the emergency room for immediate evaluation and treatment.