What You Need to Know About Hernias, Part I

More than 5 million Americans have a hernia, according to the National Center for Health Statistics, but only 750,000 get treatment for them every year.

Hernias occur when a portion of an organ bulges outward through a muscle or tissue opening. Hernias most often occur when this happens in the abdomen’s inner wall. Most hernias can easily be repaired during an hour-long minimally invasive procedure or open surgery, and patients generally don’t have to stay overnight in the hospital for treatment.

There are several types of hernias, including incisional hernia, umbilical hernia and femoral hernia, which take place in the groin or thigh. In the coming months, we’ll do a series delving further into this topic, but this first post will cover incisional ventral hernias. Here’s what you need to know:

Incisional Ventral Hernias

Ventral hernias refer to hernias that occur in the abdominal wall. This can be present from birth, or develop throughout life. When this hernia occurs on a previous incision site, usually directly under the surgical scar, we refer to it as an incisional hernia.

Incisional hernias occur because the scar tissue or muscle at the incision site may be weak, causing the abdominal wall to protrude outward. Emergency surgery, smoking, diabetes, being overweight, length of the incision and a history of wound infection also contribute to the risk of these hernias. Up to 20 percent of patients who have undergone a laparotomy, or a procedure that involves a large incision in their abdomen, will develop an incisional ventral hernia. People who have had a C-section, appendectomy or bowel operation have an increased risk of developing a hernia.

A hernia can appear in the first year after surgery, or three to five years (sometimes longer) after the original procedure. In some instances, the hernia is there earlier and a patient and his or her doctor won’t know until it gets large enough to see. Unless your doctor does a routine follow-up with CT scans, a hernia may not be obvious. When we notice a bulge can depend on the size of the patient. Ultrasounds can also detect hernias in the right patient, such as thin patients who are in good shape, but it largely depends on the person’s body size and the shape of the abdominal wall.

Patients who have a bulge in their abdominal wall usually complain about pain or seek to get a hernia repaired for cosmetic reasons, since the bulge can be unsightly. However, hernias can come with serious long-term risks, such as bowel obstruction and the potential for something to get stuck in them, which is why we choose to fix them electively.

Treatment & Recovery

Unfortunately, hernias never go away — they only stay the same or get worse. The recovery time and the quality of repair is usually much better in an elective surgery as opposed to emergency situations. Hernias also are easier to fix when they’re smaller, which is another reason it’s better to treat them early.

After hernia surgery, recovery time will depend on how the repair has to be done. This is one of the major advantages of robotic surgery, in which a patient is receives the operation the same or next day. Within a week of surgery, patients typically resume normal activity. However, those with high intensity jobs (for example, weightlifters) may be out of commission for a few weeks.

To reduce the likelihood of a repeat hernia, it’s best to avoid the things that increase your risk in the first place. You should stop smoking before and after the repair—which makes a big difference. Losing weight and maintaining weight loss also can reduce your risk of a hernia. All these things can impact the healing process. With hernias, as with many other health conditions, a healthy lifestyle is the best form of prevention.