What percent of men get a hernia?
Hernia Repair Surgery
Hernias are a common problem and surgeons have been repairing them for a long time. A hernia is a condition in which part of an organ is displaced and protrudes through the wall of the cavity that contains it. It usually doesn’t get better or go away on its own. So, for most hernias, surgery is often the only remedy.
“There are multiple approaches for hernia repair depending on location and size and I will strive to use the most evidence-based option while prioritizing the minimization of pain and scarring,” says Yale Medicine surgeon Randal Zhou, MD, who specializes in hernia and bariatric surgery.
When is hernia surgery appropriate?
The majority of hernias require some type of surgical approach. Lifestyle changes, including diet modifications or exercise, are not enough to repair the condition.
Leaving the hernia untreated only makes the condition worse. Particularly for hernias in the groin, pressure and pain will increase not just with strenuous activity, but also with every cough or sneeze.
What are the different types of hernia treated with surgery?
Ventral hernia is a bulge of tissues through an opening, or defect, in the wall of the abdominal muscles. The most common types of ventral hernias are umbilical hernias (belly button) and incisional hernias, which occur at the site of a previous surgery that weakened the abdominal wall.
Inguinal hernia happens when fatty or intestinal tissues bulge through the inguinal canal, or groin. It is the most common type of hernia among men, affecting 25 percent of them in their lifetimes, compared to 2 percent of women.
Hiatal, or para-esophageal hernia, occurs when part of the stomach or other organs from the abdomen protrude into the chest cavity.
What are different types of hernia surgery?
Depending on the type of hernia and its size, doctors may treat it with either minimally invasive, laparoscopic procedures or with traditional open surgery. General anesthesia is used in both approaches.
As a general rule, open surgery is used for hernias that are very small or very large. Those that fall in between can be treated laparoscopically.
How does hernia surgery work?
For a laparoscopic repair, three or four incisions, the largest of which is half an inch, are typically made on the side of the abdominal wall. A laparoscope, or thin telescope with a light on the end, is passed through. The hernia hole, or defect, is covered with mesh and affixed with staples, essentially serving as a patch.
With open surgery, the size of the incision is determined by the size of the hernia. For example, a small hernia might only require an incision of half an inch.
Most hernias, regardless of the type of surgery, are repaired with mesh reinforcements made from synthetic or biological materials. Mesh is favored over stitches in many instances, except for very small hernias.
What is surgery like for ventral hernias?
Laparoscopic Surgery. Three or four tiny incisions are made on the side of the abdominal wall. The abdomen is inflated with carbon dioxide so that surgeons can visualize the hernia and select the appropriate mesh to cover and reinforce the hernia. The surgery takes about one hour.
If you have this type of surgery, your recovery may require an overnight stay in the hospital and pain medications for three to five days. You will be restricted from lifting anything more than 20 pounds for two weeks. Depending on your job, you may return to work after a week or two.
After about a month, most patients feel fine and are back to normal.
Open Surgery. The incision for small ventral hernias is only about half an inch. In these cases, the repair can be made with stitches, instead of mesh.
Open surgery for large ventral hernias, often called complex hernias, often requires abdominal wall reconstruction. Using this technique, surgeons move the abdominal muscles around to close the defect caused by the hernia and place mesh in between the muscle layers.
If you have open surgery for small ventral hernias, you usually can return home the same day and expect to recover within a week.
If you are treated for a large ventral hernia, you will usually need to stay in the hospital for two to three days. Recovery takes one to two weeks, with most patients returning to work after two to four weeks. Pain medications are typically needed for five to six days.
What is surgery like for inguinal hernias?
Laparoscopic Surgery. After making three small incisions, surgeons go behind layers of the abdominal wall muscles and lay reinforcement mesh between them.
Patients recovering from laparoscopic inguinal hernia surgery typically go home the same day as surgery and can expect to take pain medications for three to five days. They are restricted from lifting anything more than 20 pounds for two weeks. Depending on the patient’s job, he or she may return to work after a week or two.
After about a month, most patients feel fine and are back to normal.
Open Surgery. A single incision is made in the groin, and if the hernia is bulging out of the abdominal wall or into the inguinal canal, it is pushed back. Mesh is placed over the weakened area.
Patients recovering from open surgery for an inguinal hernia can expect to stay in the hospital for two to three days. Most patients take pain medication for a few days and depending on the patient’s job, he or she may return to work after a week or two.
What is surgery like for hiatal hernias?
Laparoscopic Surgery. Most hiatal hernias can be repaired laparoscopically with small incisions. Surgeons push the stomach back down from the chest and repair the hole. The stomach is then wrapped around the esophagus to create a valve that allows food to go down, but stops acid from coming back up.
Patients can expect to stay in the hospital overnight and require pain medications for three to four days. They are restricted to a soft-food diet for two weeks. Depending on the patient’s job, he or she may return to work after a week or two.
What are the risks and outcomes of hernia surgery?
A small number of inguinal hernias that are repaired with open surgery or laparoscopically recur. Also, about half of patients who undergo hernia surgery develop a seroma, or an accumulation of fluid at the site of the hernia that appears like a bulge. The seroma might stay for two to three months before disappearing.
What makes Yale Medicine’s approach to hernia surgery unique?
Yale Medicine specialists take a multidisciplinary approach to hernia repair, with a team of minimally invasive surgeons, plastic surgeons (for very large hernias) and exercise physiologists who can help with rehabilitation. Each patient can expect to receive a personalized treatment plan.
“At Yale, we prioritize abdominal core health,” says Dr. Zhou. “Instead of just fixing a defect, we aim to improve your quality of life and restore autonomy.”
Hernias
A hernia (pronounced: HUR-nee-uh) is when part of an organ or tissue in the body (such as a loop of intestine) pushes through an opening or weak spot in a muscle wall. It can push into a space where it doesn’t belong. This causes a bulge or lump.
Hernias are most common in areas like the belly, groin and upper thigh area, and belly button area. They also can happen in any area where you may have had an incision from surgery.
How Do People Get Hernias?
It might take a long time for a hernia to develop or it might develop suddenly. Hernias are caused by a combination of muscle weakness and strain, although the cause of the weakness and the type of strain may vary.
Hernias are actually most common in babies and toddlers. And most teens who are diagnosed with a hernia actually have had a weakness of the muscles or other abdominal tissues from birth (called a congenital defect). In these cases, straining your muscles doesn’t cause the hernia; it only makes the hernia more apparent (and painful!).
Here are some types of strain on the body that may induce hernias:
- obesity or sudden weight gain
- lifting heavy objects
- diarrhea or constipation
- persistent coughing or sneezing
- pregnancy
These types of strain on their own probably won’t give you a hernia. But if there’s also a weak muscle, a hernia is more likely to result.
Many hernias are discovered during routine physical exams. If you’re a guy, you may have had a physical exam where your doctor gave you a testicular exam and checked your testicles for a hernia. By placing a finger at the top of your scrotum and asking you to cough, the doctor can feel if you have a hernia.
Females can get hernias, too, especially if they’ve been pregnant or are obese. A doctor can check for any possible hernias in girls by gently pressing on the organs or looking for possible signs during an examination.
What Are the Types of Hernias?
Inguinal Hernias
Inguinal (pronounced: IN-gwuh-nul) hernias are more common in guys than girls. In an inguinal hernia, part of the intestines protrudes through an opening in the lower part of the abdomen, near the groin, called the inguinal canal.
In guys, the inguinal canal is a passageway between the abdomen and the scrotum through which the spermatic cord passes (the testicles hang from the spermatic cord). In girls, the inguinal canal is the passageway for a ligament that holds the uterus in place. Nearly all cases of inguinal hernias in teens are due to a congenital defect of the inguinal canal. Instead of closing tightly, the canal leaves a space for the intestines to slide into.
If you have an inguinal hernia, you might be able to see a bulge where your thigh and your groin meet. In guys, the protruding piece of intestine may enter the scrotum, which can cause swelling and pain. Other symptoms of an inguinal hernia might include pain when you cough, lift something heavy, or bend over. These types of hernias are fixed with surgery. In fact, inguinal hernia operations are the most common type of surgery done on kids and teens.
Epigastric Hernias
In an epigastric (pronounced: eh-pih-GAS-trik) hernia, which is also called a ventral hernia, part of the intestines protrudes through the abdominal muscles located between the belly button and the chest.
It’s mostly guys who have to worry about this type of hernia — about 75% of epigastric hernias are in males. People with this type of hernia may notice a lump. Surgery is a common way to fix this problem.
Incisional Hernias
People who had surgery in the abdominal area might get this type of hernia. In incisional hernias, part of the intestines bulges through the abdomen around a surgical incision. In this case, surgery weakened the muscle tissue in the abdomen. This type of hernia requires another surgery to repair it.
Hiatal Hernias
This type of hernia happens at the opening of the diaphragm where the esophagus (the pipe that food travels down) joins the stomach. If the muscle around the opening to the diaphragm becomes weak, the top part of a person’s stomach can bulge through the diaphragm.
Hiatal (pronounced: hy-AY-tul) hernias are common, although small ones don’t usually cause any symptoms. Unlike the other types of hernia, you can’t see a bulge on the outside of your body, but you might feel heartburn, indigestion, and chest pain. Hiatal hernias can be treated with medicine and diet changes, but sometimes need surgery.
What Do Doctors Do?
If you notice a bulge or swelling in your groin, abdomen, scrotum, or thigh, talk to your doctor. Sometimes a hernia may also cause sharp or dull pain, which can get worse upon standing.
With most types of hernias, the doctor can see and feel the bulge and diagnose someone with a hernia.
Over time, a hernia may become larger and more painful. In some cases of hiatal hernia, a piece of the intestine could become trapped (this is known as incarceration). In a true surgical emergency, the blood supply could be cut off to the incarcerated intestine (this is known as strangulation). This situation is painful and dangerous because it can cause infection and may cause the strangulated tissue to die.
If you’ve had a hernia operation and you notice redness or discomfort around your incision (the area where the cut was made for the operation), be sure to let your doctor know. It could be a sign of infection that needs further treatment.
Can Hernias Be Prevented?
Here are a few tips that can help prevent hernias:
- Stay at a healthy weight for your height and body type. Talk to your doctor or a dietitian about a healthy eating and exercise program if you think you are overweight or obese.
- Make fruits, veggies, and whole grains part of your diet. Not only are these foods good for you, they’re also packed with lots of fiber that will prevent constipation and straining.
- Be careful when weight lifting or lifting heavy objects. Make sure you lift weights safely by never lifting anything that’s too heavy. If you have to lift something that’s heavy, bend from your knees, not at your waist.
- See your doctor when you’re sick. If you have a lasting cough from a cold or you sneeze a lot because of allergies, see your doctor about cough or allergy medicines.
- Quit smoking.Smoking can cause a nagging cough, and this can strain your abdominal muscles. The risk of getting hernias is just one more reason to kick the habit!
The ins and outs of a very common condition: Hernias
Hernia: It’s something that happens to millions of Americans. A hernia is a condition in which an organ or internal tissue bulges through a weak spot in the muscle or connective tissue that surrounds it. Hernias can occur in several areas of the body including the abdomen, diaphragm, groin, upper stomach and belly button.
While anyone can develop a hernia, they are more common in men than women, according to experts at the UW Medicine Hernia Center. About 23 percent of men will get an inguinal (groin) hernia at some point in their lives compared to just 3 percent of women. The most common hernias, those in the abdominal region, result in approximately 4.7 million outpatient visits each year, according to the U.S. Department of Health and Human Services.
Contrary to popular myth, simply lifting something heavy does not cause a hernia.
“Hernias are typically caused by a combination of genetics and wear and tear on the body, often due to age,” said Dr. Rebecca Petersen of the UW Medicine Hernia Center, which is located at Northwest Hospital. Petersen is a UW assistant professor of surgery.
Hernia-exam
Clare McLean
Petersen, a UW assistant professor of surgery, checks a patient’s abdomen for a possible hernia.
Petersen examines a patient’s abdomen for possible hernia.
Many hernias are present at birth. Over time, they can stretch and grow larger. Lifting, straining and chronic cough can contribute to or enlarge a pre-existing hernia. There also are a number of risk factors for hernia, including obesity, smoking and lung disease, malnutrition and diabetes.
Petersen noted that not all hernias are painful. Some people even have a hernia without realizing it.
“The patients I see usually seek medical attention after noticing a bulge that gradually becomes more and more uncomfortable,” said Petersen. “Your doctor can easily determine if you have a hernia with a simple physical examination.”
In the past, the only available treatment for hernias was to wear a truss or “hernia belt” that helped press the bulge of the hernia back in place, which could relieve some of the discomfort. The earliest hernia operations were done with traditional open surgery. Today, minimally-invasive laparoscopic surgery to repair hernias shortens post-surgery hospital stays and recovery time.
Many hernias do not require immediate intervention, however.
“I usually don’t operate on patients with groin hernias who don’t have any discomfort. There’s very little risk of anything going wrong when they don’t have any pain symptoms. I tell them to keep an eye on the hernia and make an appointment to see me if it becomes uncomfortable,” said Petersen. “When surgery becomes necessary, I prefer to take advantage of minimally-invasive techniques to decrease recovery time and pain. I always try to individualize the hernia repair, depending on the patient’s risk factors and symptoms.”
Though bothersome, most hernias are essentially harmless. However, a rare complication called strangulation can occur when part of the patient’s intestine gets trapped within the hernia. Blood flow to the intestine can become cut off, thereby causing the tissue to die. The consequences can be life-threatening.
“All hernia patients should be aware of the possibility of bowel strangulation. If you start to feel a painful hardened bulge associated with nausea, vomiting, worsening abdominal pain or notice changes in your bowel movements, you should seek emergency care immediately,” said Petersen.
Although most hernias will not develop into a strangulation and may remain a mere annoyance for years, hernias do not heal on their own. The only way to permanently eliminate a hernia is through surgery. The prospect of surgery may be daunting to some, but hernia repair is a routine and common procedure. The U.S. Department of Health and Human Services records some 600,000 inguinal hernia surgeries per year. Most experts, including those at the UW Medicine Hernia Center, agree that when a hernia begins to interfere with your quality of life, it’s time to consider getting it fixed.
