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Overview

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.


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, says Kurt E. Roberts, MD, FACS, a Yale Medicine surgeon with extensive experience in hernia repair.

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.

Yale Medicine's surgical team strives for the least-invasive approach that will yield the best result. At Yale Medicine, about 85 percent of inguinal hernias are treated laparoscopically, which is higher than the national average, says Dr. Roberts.

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.

“Stitches tear, so you have the risk of the hernia popping open again,” says Dr. Roberts. “The advances being made in mesh and mesh affixation are quite significant.”

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.

“Ninety-five plus percent of patients are very happy and satisfied with the results of hernia repair,” says Dr. Roberts.

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.

“We treat the whole spectrum, from straightforward hernias to advanced and complex hernias,” says Dr. Roberts. “Most surgeons treat only simple hernias and refer the more advanced and complex.