CDTVProceduresHernia Repair Printer Friendly Page

A hernia is a tear or weakness in the abdominal wall. Parts of the abdomen can push through the wall to create a bulge or lump. Among the reasons hernias develop are heavy lifting, excessive weight gain, chronic coughing, constipation, or a natural weakness in the abdominal wall.

Most hernias–about 80 percent–occur in the groin and are called inguinal hernias. Hernias can also form near the umbilicus (the belly button) and the site of a previous operation (called an incisional hernia). When hernias occur on both sides of the groin, they are known as bilateral inguinal hernias.

Initially, the hernia may or may not cause pain, but as the tear grows, simple acts like coughing, sneezing, lifting heavy objects and straining during urination and bowel movements may cause discomfort. Pain can indicate that the hernia has twisted or strangulated, cutting off the blood supply. This is a serious medical situation that calls for immediate attention.

Repair of a Hernia

Hernias are repaired surgically. With the "open" technique, a 3- to 5-inch incision is made, after which healthy tissue is cut through until the hernia is found. The defect that has led to the hernia is sutured closed, and the weak area is sometimes reinforced with a mesh-like material. The healthy tissue that was cut through is sutured back together. This method is usually performed as same-day surgery, often using local anesthesia. Although the patient is discharged quickly, the healing process still may limit normal activity for many weeks. The return-to-work time ranges from 3 to 5 weeks, and the surgery leaves a large scar.

Laparoscopic hernia repair takes a different approach from the conventional procedure. Instead of repairing the hernia from outside the abdominal wall, the restoration is made from inside the wall, similar to putting a patch on a tire. This avoids the cutting of muscle and tissue and significantly shortens the healing period.

During this minimally invasive procedure, three to four 1/4 inch to 1 inch incisions are made for entry of the laparoscope- a telescope-like instrument attached to a camera- and specially designed surgical instruments. The videosurgeon locates the hernia, then uses the instruments to place a large mesh patch at the site from inside the abdominal wall. Laparoscopic repair is done using general anesthesia, and almost all patients go home the same day. Post-operative pain is reduced, and the patient may return to work within a week. The surgery leaves only 3 to 4 small scars.

The laparoscopic technique can be especially beneficial for patients with bilateral or recurrent hernias. With bilateral hernias, both repairs can be made at the same time without additional incisions. The "open" procedure has a higher risk of complications for patients who have had previous hernia repair.

There are advantages and disadvantages to both techniques, and the patient, together with his or her surgeon, can determine which is the best option.

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