Hernia Repair Surgery
Hernia surgery is the definitive and, quite honestly, the only option for repairing symptomatic hernias. But before we get into the hernia surgery process, it is important to understand that not all hernias need to be repaired. It is true that hernias are a progressive condition, meaning that they get larger and more complex to repair as time goes by. However, there are circumstances in which hernias may not need immediate repair. The most common reason for not repairing a hernia is that it is asymptomatic. Some patients may never even know they have a hernia, and it is found incidentally while undergoing diagnostic testing for other abdominal conditions. If the hernia is not causing any significant trouble, like pain or impediments to lifestyle, it is possible to avoid surgery. Further, elderly patients who often have a higher surgical risk, have a lower chance of hernia strangulation due to the naturally weakened musculature in their abdomen. They, too, may not require hernia surgery. The ideal candidate is a younger, physically-fit person who is a good candidate for surgery and has a smaller hernia defect. Their surgical risk is very low, and the benefit they will derive from having a hernia repaired is significant.
How hernia surgery works
Hernias are repaired most often using traditional laparoscopy or robotically-assisted surgical techniques. This requires between three-to-five tiny incisions in the abdomen versus the single large incision of open surgery. Please note that there is a small possibility that the laparoscopic procedure will have to be converted to open. Feel free to discuss this risk with Dr. Higa at consultation.
Hernias are repaired under general anesthesia, which means that you will be completely asleep for the entire procedure. Surgery can be performed in an outpatient surgical center or in a hospital setting, depending on your insurance requirements as well as your preference. Hernias require approximately an hour of operative time, with most patients able to return home on the day of surgery.
During surgery, Dr. Higa will start by dissecting the hernia and reduce the contents of hernia. This means pushing the protruding tissue back into the abdomen where it belongs. At this point, the hernia will be repaired using a non-tension method. This is done with hernia mesh. Hernia mesh is a plastic lattice that lays over the top of the hernia defect rather than suturing the hernia closed, which can weaken over time and open back up again. The mesh is biocompatible, meaning that the body does not typically reject it. Most mesh is permanent and creates a very strong framework for scar tissue to close the defect completely. Without mesh, the likelihood of recurrence is significantly higher. Read our discussion on the use of mesh in hernia repair.
In decades past, titanium tacks were used to affix the mesh to surrounding musculature. Over time, these were replaced with absorbable tacks. Today, however, no tacks are needed at all. One side of the mesh is adherent to the tissue and essentially sticks in place by itself. The result is that irritation of, or damage to, the nerve structures around the hernia defect simply don’t happen, resulting in quicker recovery and a lower risk of long-term chronic pain. Read our discussion on chronic pain after inguinal hernia surgery.
Once the hernia has been repaired, the incisions in the abdomen are closed and the patient is brought to the recovery room. Recovery can take somewhere between two and four hours, during which time the patient will be cared for by the nursing staff at the hospital or surgery center. Once they are conscious, able to walk and able to urinate, they will be discharged home with the assistance of a family member or friend.
At Home / Early Recovery
Once at home, you will have to be very careful in the first several weeks after surgery. Lifting heavy objects can cause the mesh to migrate or the hernia to recur. Therefore, you should not lift anything more than 5 or 10 pounds within the first six weeks after surgery. In the days after surgery, you should see the pain and swelling decrease at the site of the hernia. You will not be able to drive for several days for a couple reasons. First, if you are taking narcotic pain medication, this will impair your ability to drive. Second, emergency braking may be painful and could increase your risk of having an accident in the first few days after surgery.
During this time, it is imperative that you walk as much as possible. Start with a small walk on flat surfaces with someone next to you in case you feel significant pain. Each day, try to ambulate further, as this is very helpful in the recovery process and in avoiding infection. Only walk as much as feels comfortable. If you begin to feel any discomfort, rest and try again the next day.
You will have a follow-up appointment with Dr. Higa about ten days to two weeks after surgery. During this time, he will check your wounds and make sure that recovery is progressing appropriately. He will offer a timeline for returning to normal activity, including exercise and sports.
After about six weeks, assuming recovery has gone to plan, you may be able to return to normal activity. Activities that place significant strain on the abdomen, such as heavy lifting — whether at home or at work, or intense sports, may require longer than six weeks.
Risks and considerations of hernia surgery
Hernia surgery is very safe and effective, and most risks revolve around the inherent risks of any surgery, including reaction to anesthesia, blood loss, pain, infection at the wound sites, and in extremely rare cases, death. Employing a skilled and experience surgeon such as Dr. Higa reduces these risks significantly.
There is a chance that the hernia could return. This is known as recurrence. A hernia repair, using mesh and laparoscopic technique, has a risk of recurrence around 1 to 2%. Obesity, smoking, lifting heavy weights prior to complete recovery, and general poor health can all increase the risk of a recurrence. For most patients, the hernia repair is permanent and strong.
Some patients, particularly those who have undergone an inguinal or groin hernia repair, may experience chronic pain after surgery. In most cases, this pain resolves itself within a few months after surgery. A very small number of patients may experience pain longer-term. But while we do not know the exact cause of chronic pain after hernia surgery, we do know that proper mesh selection, the degree of pain before surgery, and surgical technique to identify and preserve nerve structure, all play a part in reducing the likelihood of chronic pain.
While older meshes had a greater chance of curling or migrating, the current generation of mesh has improved significantly, and the likelihood of mesh-related complication is significantly lower than it has ever been. Part of this is also proper selection of mesh by your surgeon, which is directly related to their experience in hernia surgery.
The bottom line: Hernia surgery is often a necessary part of hernia repair to avoid the significant consequences of incarceration or strangulation. However, patients should take comfort that, for an experienced hernia surgeon, a hernia repair is a very straightforward and routine procedure. Modern technique and technology has reduced the risk of hernia surgery, and the vast majority of patients experience no major complications. To learn more about hernia surgery, we encourage you to schedule a consultation with Dr. Higa who will explain his surgical philosophy and technique.