Written By: Wendy Liu, DO – General and Bariatric Surgeon

“It was just a small little bump and now it’s become the size of a grapefruit!”

I have certainly heard that phrase more than a handful of times. Sounds like this patient has a hernia!

A hernia is a hole in the abdominal wall in which fat or intestines may protrude through. This can develop near the natural weakness of the body such as the belly button, or down by the groin. It may also be due to prior abdominal surgeries you may have had, causing a weakness and subsequently a gap in the strength layer of your abdominal wall, called fascia. Progressively, the lining of your abdomen will push through this gap, forming a hernia sac. Contents inside your abdomen like fat and intestines may push through this gap and remain in the hernia sac. This is what causes pain and discomfort to your abdomen.

Hernia that occurs down in the groin are classified as inguinal or femoral hernias. Men and women can both get inguinal and femoral hernias, however they do occur more frequently in men. Most people recognize this as a bulge near their groin. Some inguinal hernias do not cause pain whereas others may impede you from doing your favorite activity or your job. These are all reasons to seek out an evaluation and decide if hernia surgery is right for you.

Hernias can become alarming when a piece of intestine gets stuck, or “incarcerated”. If a loop of bowel is unable to be pushed back into the abdomen, it is called a “strangulated” hernia. This becomes an emergent situation where an operation needs to be performed right away to hopefully save this piece of intestine from dying. Contrary to popular belief, the larger the hernia, the less chance of strangulation. The defect in the abdominal wall is large enough for the loop of intestine to exit and return to the abdomen without getting stuck. Moderate sized hernias such as defects that are 2-3 inches wide are riskier where the bowel may get stuck, swell up, and is unable to be pushed back, or “reduced”.

A hernia is a problem that never goes away. They simply get bigger with time. Things that we do in our daily lives such as coughing, sneezing, or straining when going to the bathroom, are all things that can make hernias become bigger. Certain jobs doing heavy lifting may also increase the size of the hernia. Obesity and weight gain are other silent factors that contribute to enlarging hernias. More weight means more strain on your abdominal wall to keep all the contents inside. The only way to fix a hernia is surgery.

Over one million hernia repairs are performed in the United States each year. The advancement and innovation of hernia surgery has skyrocketed in the past two decades. What used to be performed as a big cut operation is now done with little incisions in the outpatient setting. With the use of the minimally invasive robotic surgery platform, we can accomplish large operations with little morbidity. Surgeon innovators around the country have demonstrated success at repairing hernias that are upward of 6 inches using the minimally invasive robotic technique. Depending on the size and complexity of the hernia, the surgery can be done in the same day, or require one night hospitalization. The types of hernia surgery is beyond the scope of this article, and surely it would confuse anyone! A key concept to describe the abdominal wall is in its comparison to puff pastry. It has multiple layers. The goal of the surgery is to reduce anything that is stuck within the hernia, close the hole in the abdominal wall, and sandwich a piece of mesh in between the layers of the abdominal wall to give it strength and decrease the chance of future recurrence. This way, the mesh never touches the intestines while creating a good scaffold for the native tissue to grow. The use of mesh is critically important to reduce the chance of recurrence, especially for larger hernias and more obese patients. There is a vast amount of literature to corroborate this evidence. After the operation is complete, many patients can return home and can walk around just a few hours after surgery. The beauty of minimally invasive surgery is how quickly patients can bounce back to their normal lives, enjoying the things they used to.

In conclusion, a hernia is a condition that will never improve. Daily activities of living may worsen and enlarge a hernia over time. Don’t wait to have this looked at. The bigger the hernia, the more difficult it is to repair. Discuss this condition with your general surgeon and decide what is the best path forward.

Please contact Western Wisconsin Heath at 715-684-1111 to set up an appointment to see Dr. Wendy Liu or Dr. Peter Dahlberg to discuss if a hernia repair is right for you.

References:

1. America Hernia Society (AHS)
2. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)