Alternative Names Herniorrhaphy Definition Hernia repair is surgery to correct a hernia.

A hernia is an abnormal bulging of internal organs, often the intestine, through a weakness in a muscular wall. Description This article focuses on surgery to repair a hernia. For information on a specific type of hernia see:

Inguinal hernia Femoral hernia Hiatal hernia Umbilical hernia

Before surgery, you will be given a sedative to make you drowsy. A local or spinal numbing medicine (anesthesia) will be used so you do not feel pain during the procedure. In some cases, the procedure is done while you are under general anesthesia (unconscious and pain-free). The surgeon makes a cut over the area of the hernia. The bulging tissue or organ is placed back inside the muscle wall, the muscle tissue is repaired, and the skin is closed. In many inguinal hernia repairs, a small piece of plastic mesh is used to repair the defect in the muscle tissue. Laparoscopic hernia repair is becoming more popular. This approach uses a minimally invasive technique. Why the Procedure is Performed Hernia repair may be recommended when a hernia is painful or symptoms interfere with daily activities. It may also be done when there are large bulges through a small hole, which interferes with blood flow or causes a blocked intestine. Most hernias should be repaired to prevent the possible complications of restricted blood flow or blocked intestine. Risks Risks for any anesthesia include:

Reactions to medications Problems breathing

Risks for any surgery include:

Bleeding Infection

Additional risks of hernia repair include:

Injury to nearby structures Hernia returns

Outlook (Prognosis) Most hernias can be repaired with a simple operation with minimal risks to the patient. Recovery Small children have no activity restrictions following routine hernia repair. Older children should avoid contact sports for at least 3 weeks. Getting hit where the wound is could cause the skin to open or it may disrupt the repair (less common). Adults should avoid heavy lifting or straining for about 6 - 8 weeks after surgery. Such activity can disrupt the hernia repair. Do not take a bath for at least 5 days after the operation. Soaking may separate the skin tapes and the wound could break open. Sponge bathing for infants and showering for older children are permitted the day after surgery. The wound tapes should be carefully patted dry after showering. Expect complete recovery from surgery in about 2 - 4 weeks.
When you need an operationAbout hernia repair A hernia (her-ne-ah) occurs when a small sac containing tissue protrudes through an opening in the muscles of the abdominal wall. The technical name for the operation that repairs a hernia is called a herniorrhaphy (her ne-orah-fe). This booklet will explain: Why you may need to have a hernia repaired The ways in which a hernia can be corrected surgically What to expect before and after the operation Remember, as routine as a hernia repair is (over half a million operations were done in the US last year), no two people undergoing a herniorrhaphy are alike. The reasons for and the outcome of any operation depend on your overall health, your age, the severity and size of your hernia, and the strength of your abdominal tissues. This booklet is not intended to take the place of your doctors professional opinion. Rather, it can help you begin to understand the basics of

these surgical procedures. Read this material carefully. If you have additional questions, you should discuss them openly with your doctor. About Hernias A hernia develops when the outer layers of the abdominal wall weaken, bulge, or actually rip. The hole in this outer layer allows the inner lining of the cavity to protrude and to form a sac. Any part of the abdominal wall can develop a hernia. However, the most common site is the groin. A hernia in the groin area is called an inguinal (inggwi-nal) hernia (inguinal is another word for groin). Inguinal hernias account for 80 percent of all hernias. In an inguinal hernia, the sac protrudes into the groin towardand sometimes intothe scrotum. Although most common in men, groin hernias can also occur in women. Another type of hernia develops through the navel, and it is called an umbilical hernia. A hernia that pushes through past a surgical incision or operation site is called an incisional hernia. A hiatal hernia forms when the upper portion of the stomach slides into the chest cavity through the normal opening created by the esophagus, or food pipe. Who Gets Hernias? Most inguinal hernias in adults result from strain on the abdominal muscles, which have been weakened by age or by congenital factors. The types of activity associated with the appearance of an inguinal hernia include: Lifting heavy objects Sudden twists, pulls, or muscle strains Marked gains in weight, causing an increase in pressure on the abdominal wall Chronic constipation, which places a strain on the abdomen while on the toilet Repeated attacks of coughing A hernia is called reducible if the protruding sac of tissue can be pushed back into place inside the abdomen. If the hernia cannot be pushed back, it is called irreducible, incarcerated, or imprisoned. The symptoms of inguinal hernias vary. Sometimes the onset is gradual, with no symptoms other than the development of a bulge. Other times, the hernia will occur suddenly with a feeling that something has given way. This feeling can be accompanied by pain or discomfort. Signs and symptoms of inguinal hernias can include: Visible bulges in the scrotum, groin, or abdominal wall A feeling of weakness or pressure in the groin A burning feeling at the bulge A gurgling feeling In some cases, an irreducible hernia gets so pinched that the blood supply is cut off and the tissue swells. Rapidly worsening pain or a tender lump is a signal

that the hernia has strangulated. When strangulation occurs, the tissue can die quickly and become infected. Within hours this condition can lead to a life-threatening medical emergency that requires immediate medical attention. Preparing for the Operation Unless the hernia is strangulated, hernia repair typically is an elective operation. Only you can decide whether you ought to proceed with the repair. However, you must realize that (1) the hernia is not going to heal by itself and (2) pain may increase in the area of the hernia, and it will usually increase in size over time. Prior to admission to the hospital, you may be given standard tests to measure your complete blood count and electrolyte levels, as well as a urinalysis. Your surgeon may require additional studies depending on your condition and age. Prior to the operation, you will dress in a surgical cap and gown, receive a sedative by injection, and have a needle placed in the back of your hand or in your forearm for connection to an intravenous line in the operating room. In addition, the area where your incision will be made will be shaved. The procedure generally takes less than two hours. You may be given a local, spinal, or general anesthetic depending on your surgeons preference, your age, your state of health, and the procedures degree of difficulty. Outpatient Surgery Unless there is cause for concern, hernia repair can be done on an outpatient basis. On the day of your operation, you should wear loose-fitting, simple clothing to the hospital, such as a sweat suit and slip-on shoes. That way, upon discharge, you will be able to get dressed easily without too much strain or discomfort. Generally, you should not eat on the morning of your operation. You should have a friend or relative drive you home after the operation and, ideally, someone should stay with you the first night, particularly if your bedroom is on the second floor of your house because stairs will be difficult for you to climb. Types of Procedures Today, surgeons are performing a variety of techniques to repair hernias. You should talk with your surgeon to determine what type of repair method is appropriate for you. The Conventional Method. In this case, an incision is made over the site of the hernia. The protruding tissue is returned to the abdominal cavity, and the sac that has formed is removed. The surgeon repairs the hole or weakness in the abdominal wall by sewing strong surrounding muscle over the defect. This is the most common method of hernia repair. Tension-free Mesh Technique. For this technique, an incision is made at the site of the hernia and a piece of mesh is inserted to cover the area of the abdominal wall

defect without sewing together the surrounding muscles. Recovery is swift, and the likelihood of the hernia recurring is small. The mesh is safe and generally well-accepted by the bodys natural tissues. However, be certain to discuss this procedure with your surgeon and understand how it will be done. The Laparoscopic Method. A laparoscope is a long metal tube with a fiberoptic light source and a telescopic eyepiece, which is connected to a TV monitor. The scope is inserted into the abdominal cavity through a small incision and is used to view the hernia in the abdominal wall while the surgeon repairs the hernia through additional tubes that are inserted into the abdomen through separate incisions. A general anesthetic is usually required. Some surgeons are using this technique. However, the technique is presently under evaluation, and the long-term outcome for hernias repaired using this method is currently unknown. It is important to note that this method is new, it is still being evaluated, and it is not an option for every patient. It is up to you and your surgeon to decide whether it is right for you. Complications Are Few As with any operation, infection and bleeding can occur. Most of the time, however, these problems are easily handled, without the need for a hospital stay. A slight chance also exists that the intestine or bladder can be injured during the operation. The formation of scar tissue is another possibility. Any infection associated with the operation will be treated with antibiotics, but otherwise such drugs are not typically used or required. It is important to note that since the laparoscopic method of hernia repair is relatively new, its complications are not as well defined as the complications that are associated with the other methods. Recovery As with any operation, the amount of pain that is experienced varies from patient to patient. A patient's discomfort also depends on the location and type of hernia that was repaired, as well as the technique that was used to perform the repair. Generally, you will have some difficulty walking the first few hours after the operation, and climbing stairs the first couple of days. Bathing will require care so as not to wet the incision site. Sexual activity is usually too uncomfortable to enjoy the first week or two. Your surgeon will advise you regarding heavy lifting, jogging, or doing strenuous exercise depending on the type and degree of difficulty it took to do the repair. You should be able to drive your car within a few days. Depending upon your occupation, you can expect a recovery period lasting from one to six weeks. Proper recovery is as important as the hernia repair procedure itself. During the recovery phase, the repair takes hold. The smoother your recovery, the better the chances that your hernia will not recur. While every attempt is made to minimize any recurrence, the perfect

repair does not exist. However, the recurrence rate over many years is small, and is estimated to be about 1-5 percent.

What is a hernia?
A hernia is an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia. Serious complications from a hernia result from the trapping of tissues in the herniaa process called incarceration. Trapped tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.

Where are hernias located?

The most common location for hernias is the groin (or inguinal) area. There are several reasons for this tendency. First, there is a natural anatomical weakness in the groin region which results from incomplete muscle coverage. Second, the upright position of human posture results in a greater force occurring at the bottom of the abdomen, thereby increasing the stress on these weaker tissues. The combination of these factors over time breaks down the support tissues enlarging any preexisting hole or leads to a tear resulting in a new hole. Several different types of hernia may occur, and frequently coexist, in the groin area. These include indirect, direct, and femoral hernias, which are defined by the location of the opening of the hernia from the abdomen to the groin. Another type of hernia, called a ventral hernia, occurs in the midline of the abdomen, usually above the navel (umbilicus). This type of hernia is usually painless. Hernias can also occur within the navel (umbilical hernia).

What are the symptoms of a hernia?

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.

What other types of hernias are there?

Epigastric, umbilical, incisional, lumbar, internal, and Spigelian hernias all occur at different sites over the abdomen in areas that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Internal hernias can be extremely difficult to diagnose until the intestine (bowel) has become trapped and obstructed because there is usually no external evidence of a lump.

How is a hernia repaired?

A hernia repair requires surgery. There are several different procedures that can be used for fixing any specific type of hernia. In a standard repair, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness. Once this has been achieved, the hole is then closed, usually by some combination of suture and a plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a piece of cloth. One of the problems with this approach is that it can put excessive strain on the surrounding tissues through which the sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of many different methods of suturing the deep tissue layers in an attempt to provide better results. In order to provide a secure repair and avoid the stress on the adjacent tissue caused by pulling the hole closed, an alternative technique was developed which bridges the hole or weakness with a piece of plastic-like mesh or screen material. The mesh is a permanent material and, when sewn to the margins of the defect, it allows the body's normal healing process to incorporate it into the local structures. This has proved to be a very effective means of repair. After the hernia repair is completed, the overlying tissues and skin are surgically closed, usually with absorbable sutures. More and more of hernia repairs are now being done using laparoscopic techniques

What is laparoscopic hernia repair?

A number of factors have led to the recent development of a new method of repair called laparoscopic hernia repair. This technique is really an extension of a traditional mesh repair method that was used in patients who had already experienced several hernia recurrences at the same site. Previously, this mesh repair approach had required a separate incision somewhat removed from the target area. However, with the progressive development of the instruments and techniques for laparoscopic surgery, the same procedure can now be done with several relatively small incisions. This allows the surgeon to enter the space behind the hernia defect and place the mesh with minimal injury to the surface of the abdomen. The advantages of this method include coverage of all the potential sites of groin hernia, which reduces the risks of recurrence while also decreasing the amount of postsurgical pain.

What about the use of a laser in hernia repair?

This is a relatively common question. It arises because, for a time, there were some surgeons marketing "laser hernia repair." While a laser may have been used to make the incision and to separate the tissues, the laser has no application in the repair of a hernia. It is impossible to perform the necessary structural repair with a laser, which functions essentially as a cutting tool. Hopes that somehow an incision made with a laser would significantly reduce pain have not been confirmed.

What kind of anesthesia is used for hernia surgery?

Most hernia repairs (except in children) can be done with a variety of anesthetic methods. With modern general anesthetic techniques and monitoring, general anesthesia (inducing "sleep") can be very safe. However the surgery can also be performed under local anesthesia or regional anesthetics, often at the same time using sedation medications to help relax the patient. The specific type of anesthetic for an individual patient is selected after careful evaluation of the patient's general health and individual concerns.

Can strengthening the muscles make a hernia go away?

Unfortunately, exercising to improve a hernia is likely to aggravate the condition. The hernia exists because of a localized absence of muscle and supporting structure. Exercise can strengthen the surrounding muscles, thereby worsening the localized weakness and increasing the pressures inside the abdomen. The result is that more tissue can be forced through the defect and enlarge the hernia.

What can be done to prevent a hernia?

Most of the factors that lead to the development of hernias are beyond the control of the individual. Some of those factors are inherited and develop as the individual grows. The arrangement of the local tissues and their thickness and strength may greatly affect the relative risk of developing a hernia over a lifetime. However, that risk can be increased by failure to use good body mechanics when lifting, poor abdominal support posture, and weight-control problems.

Are hernias inherited?

Since genetics dictate inherited features and structure, there is a significant risk of inheriting the anatomical features that may predispose to a hernia. There may also be inherited factors that result in tissue weakness, which ultimately allows the deterioration of the supporting structures and leads to the formation of a hernia. However, this does not necessarily imply that the offspring of an individual with a hernia will ultimately develop the problem.

Do hernias usually develop on both sides of the body?

Groin hernias are somewhat more likely to develop on both sides. This is probably because the structural elements develop symmetrically, and the stresses on the body that occur over time are similar on both sides. When a patient becomes aware of a groin swelling on one side, examination by a doctor will often identify a small hernia on the opposite side.

Should all hernias be repaired?

In general, hernias that are at risk for complications, that cause pain, or that limit activity should be repaired. If they are not repaired, there is a risk that an emergency surgical procedure may be required at a later date. Sometimes, a hernia can be temporarily controlled by wearing a belt-like device that applies external compression, which pushes the tissues back into the abdomen and holds them there. This device is called a truss. The truss must be carefully applied on a daily basis. It should only be used for selected situations following careful evaluation by a doctor.

How can I tell if a lump or swelling is a hernia?

Not all lumps or swellings on the abdominal wall or in the groin are hernias. A doctor should evaluate any such swelling. Other possible causes include growths or enlarged lymph nodes. These problems require entirely different types of evaluation and treatment.

Hernia At A Glance

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area. There are many different types of hernias. Serious complications from a hernia result from the trapping of tissues in the hernia (incarceration), which can result in the damage of death of the tissue. Hernia repair and the treatment of hernia complications require surgery.

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. Hiatal hernia A hiatal hernia repair is slightly different from the other hernias described here, because it corrects a weakness or opening in the diaphragm, the muscle that separates the chest cavity from the abdominal cavity. This surgery is done to prevent the stomach from shifting up into the chest cavity and to prevent the stomach from spilling gastric juices into the esophagus, causing pain and scarring. An incision is made in the abdomen or chest, and the hole or weakness in the diaphragm is located and repaired. The top of the stomach is wrapped around the bottom of the esophagus, and they are sutured together to hold the stomach in place. Sometimes the vagus nerve is cut in order to decrease the amount of acid the stomach produces. External sutures can be removed in about one week. This type of hernia repair often requires a longer hospital stay than the other types, although techniques are being improved that reduce invasiveness of the surgery and the length of the hospital stay. Preparation

Before the operation, the patient will have blood and urine collected for testing. X rays are taken of the affected area. In a hiatal hernia, an endoscopy (a visual inspection of the organs) is done. Patients should meet with the anesthesiologist before the operation to discuss any medications or conditions that might affect the administration of anesthesia. Patients may be asked to temporarily discontinue certain medications. The day of the operation, patients should not eat or drink anything. They may be given an enema to clear the bowels. Aftercare Patients should eat a clear liquid diet until the gastrointestinal tract begins functioning again. Normally this is a short period of time. After that, they are free to eat a healthy, well-balanced diet of their choice. They may bathe normally, using a gentle, unscented soap. An antibiotic ointment may be prescribed for the incision. After the operation, a hard ridge will form along the incision line. With time, this ridge softens and becomes less noticeable. Patients who remain in the hospital will have blood drawn for follow-up studies. Patients should begin easy activities, such as walking, as soon as they are comfortable, but should avoid strenuous exercise for four to six weeks, and especially avoid heavy lifting. Learning and practicing proper lifting techniques is an important part of patient education after the operation. Patients may be given a laxative or stool softener so that they will not strain to have bowel movements. They should discuss with their doctor when to resume driving and sexual activity. Risks As with any surgery, there exists the possibility of excessive bleeding and infection after the surgery. In inguinal and femoral hernia repair, a slight risk of damage to the testicles or their blood supply exists for male patients. Accidental damage may be caused to the intestinal tract, but generally complications are few. Normal results The outcome of surgery depends on the age and health of the patient and on the type of hernia. Although most hernias can be repaired without complications, hernias recur in 10-20% of people who have had hernia surgery. Key Terms Endoscopy A procedure in which an instrument containing a camera is inserted into the gastrointestinal tract so that the doctor can visually inspect the gastrointestinal system. Gangrene Death and decay of body tissue because the blood supply is cut off. Tissues that have died in this way must be surgically removed. Peritoneum

The transparent membrane lining the abdominal cavity that holds organs such as the intestines in place.