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Hernia Repair

(Herniorrhaphy; Repair, Hernia)

Click here to view an animated version of this procedure.

Definition

A hernia forms when your abdominal wall weakens, bulges, or tears. The inner lining of the abdomen and small intestine can poke out of this weakened area. A hernia repair is a surgery to push the abdominal material back where it belongs and to repair the abdominal wall.
Inguinal Hernias
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Reasons for Procedure

A hernia repair is done if the hernia is large and causing pain. Some hernias, called strangulated hernia, can cut off blood supply. Strangulated hernias require immediate hernia repair surgery.
Without surgery, the hernia will not heal. The pain and size of the hernia usually increases over time.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a hernia repair, your doctor will review a list of possible complications, which may include:
  • Damage to neighboring organs or structures (such as, intestine or bladder)
  • Infection
  • Bleeding
  • Scarring
  • Pneumonia and other risks of general anesthesia
Factors that may increase the risk of complications include:
  • Having neurological, heart, or lung conditions
  • Age: older than 70 years
  • Obesity
  • Smoking
  • Active infection

What to Expect

Prior to Procedure

Your doctor may do the following:
  • Physical exam
  • Blood tests
  • Urine tests
  • Electrocardiogram (ECG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
On the days before and the day of your procedure, your doctor may recommend that you:
On the days before and the day of your procedure, your doctor may recommend that you:
  • Follow a special diet.
  • Take antibiotic medicine.
  • Shower the night before, using antibacterial soap.
  • Arrange for someone to drive you home and to help you at home.
  • The night before, eat a light meal. Do not eat or drink anything after midnight.
  • Wear comfortable clothing.

Anesthesia

Depending on the type of repair, you may receive:
  • Local anesthesia—the area will be numbed
  • General anesthesia —used most often, you will be asleep

Description of Procedure

There are two main types of surgeries. A conventional surgery or laparoscopic surgery. Conventional surgery uses a large incision so that the doctor can directly access the area. Laparoscopic surgery uses smaller incisions and special surgical tools. You and your doctor will discuss the risks and benefits of each surgery to determine which may be best for you. Factors like your overall health, location of hernia, and complications will play a role in the decision.
Conventional Hernia Repair
An incision is made over the hernia site. The hernia will be moved back into the abdominal cavity, or the sac may be removed. In the case of hiatal hernia, the stomach is moved from the chest cavity back down to the abdominal cavity.
For some, the weakened muscles that allowed the hernia to develop are sewn together. If the weakened area is large or in the groin, a piece of mesh will be placed over the area to create a new wall. If mesh is used, the muscle is not sewn together. The incision will be closed with stitches or staples.
Laparoscopic Hernia Repair
Small incisions will be made around the hernia. Special surgical tools will be placed through these incisions. A small camera will be passed through an incision so that the doctor can see inside the abdomen. Other small instruments will be used to complete the repair.
After the procedure, the incisions will be closed with stitches or staples. A sterile dressing will be applied.

Immediately After Procedure

You will be taken to a recovery area. Fluids and pain medicines will be delivered through an IV. If there are no problems, you will be moved to a hospital room to recover.

How Long Will It Take?

Less than two hours

Will It Hurt?

Anesthesia prevents pain during surgery. You may feel pain during recovery, but taking pain medicine will help.

Post-procedure Care

When you return home, do the following to help ensure a smooth recovery:
  • In most cases, you can return to your normal diet after a few days.
  • During the first few days, slowly return to your normal routine.
  • Take pain medicine as needed.
  • Ask your doctor about when you can do certain activities (such as driving, sexual activity). You may need to wait 1-2 weeks.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Avoid excess strain (such as vigorous exercise and lifting) for 6-8 weeks.
The recovery time will be shorter for laparoscopic surgery.
There is some risk that the hernia could return. To reduce your risk:
There is some risk that the hernia could return. To reduce your risk:

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain that you cannot control with the medicines you have been given
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
  • Excessive tenderness or swelling
  • Cough, shortness of breath, or chest pain
In case of an emergency, call for medical help right away.

RESOURCES

Hernia Information http://www.hernia.org

National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov

CANADIAN RESOURCES

The Canadian Association of Gastroenterology http://www.cag-acg.org

Health Canada http://www.hc-sc.gc.ca/index-eng.php

References

The causes and surgical treatment of abdominal hernia. American Medical Association website. Available at: http://www.medem.com/medlb/article%5Fdetaillb.cfm?article%5FID=ZZZESG4TWAC&sub%5Fcat=195. Accessed November 10, 2005.

Hernia. Cleveland Clinic website. Available at: http://www.clevelandclinic.org/health/health-info/docs/3600/3619.asp. Updated June 2008. Accessed June 9, 2008.

Hernia repair. American College of Surgeons website. Available at: http://www.medem.com/medlb/article%5Fdetaillb.cfm?article%5FID=ZZZBTQW1RWC&sub%5Fcat=195. Accessed November 10, 2005.

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