Author: Andreas Schneider, M.D., Providence Portland Medical Center – general surgery, minimally invasive complex gastrointestinal surgery
What is a hernia?
Hernias are defects within the muscles in the abdominal cavity, through which an organ or part of an organ has migrated. This often causes pain, swelling, obstruction or even ischemia and necrosis of the affected organ, requiring emergent surgery.
These defects can be present either at birth or acquired through time. Often the acquired hernias present at specific sites within the abdominal cavity, such as the umbilicus, the groin and pelvis, or the diaphragmatic hiatus. These are known weak spots within the abdomen that, when stressed with pressure or tension, weaken and tear. This leads to progressive widening of the defect.
Incisional hernias also are considered acquired hernias and often can present after surgery. Some studies show that 15-27% of patients undergoing emergent laparotomy develop an incisional hernia within one or two years.
Why Providence for hernia treatment?
Providence Surgery Clinic East specializes in all types of hernia repairs of the abdominal wall, such as umbilical, epigastric, ventral or incisional hernias, Spigelian, inguinal and femoral. We also specialize in hernias of the upper abdomen, such as hiatal hernias, para-esophageal and other diaphragmatic hernias.
Our surgical experts know the benefits of minimally invasive surgery for wound healing, postoperative pain and recovery. We know that not all hernias are the same and tailor the surgery based on the patient and the hernia. We perform robotic-assisted, laparoscopic and standard open hernia repairs.
To ensure best outcomes and to minimize risks for recurrence, we follow our patients closely during their recovery and also long term.
What are risk factors for developing a hernia?
Hernias are the result of an imbalance between tissue integrity and the amount of strain or tension placed on them. Increased intra-abdominal pressure is a major risk factor. Patients with high BMI, chronic cough, COPD or constipation are at increased risk for hernia formation. Critical factors such as tissue integrity and wound healing are compromised by smoking, chronic inflammation or infection, immunosuppression, steroid use, uncontrolled diabetes, advanced age and malnutrition. These factors, when improved prior to surgery, can decrease the risk of recurrence and improve outcomes.
What are hernia symptoms?
Depending on which organ is involved, symptoms can vary from no symptoms at all to severe pain and bowel obstruction requiring emergent surgery. Most common early symptoms are mild nausea, swelling that is reducible and intermittent pain at the hernia site. More severe symptoms are constant pain, nonreducible swelling, overlying skin changes, erythema, fevers, chills, signs of systemic illness and signs of intestinal obstruction, such as severe nausea, abdominal distention and vomiting.
All patients with hernias who can tolerate an operation should be evaluated by a surgeon. Asymptomatic hernias often were watched in the past, but we now recommend considering surgery earlier since small defects are easier to repair. Patients with hernias that are symptomatic should get a surgical consultation to evaluate and assess risk from the hernia, as well as their overall risk for surgery. Patients with severe symptoms should seek medical attention immediately.
Patients diagnosed with a hernia do not need to stop physical activity. The benefits of physical activity for overall health outweigh the potential risks. If certain activities cause symptoms, the patient may want to avoid those activities for comfort. They also may want to try an abdominal binder or hernia belt.
What are the treatment options for hernia repair?
Surgery is the only way to correct a hernia once it has formed. The surgery can be minimally invasive or open, depending on the location and size of the hernia, as well as patient factors such as medical comorbidities and BMI.
Do all hernia repairs need mesh?
Since hernias are due to an imbalance between strain on tissues and their integrity, placement of permanent nonabsorbable synthetic mesh can help decrease tension and increase the integrity of the repaired tissues. Randomized control trials have shown that permanent mesh decreases the rate of hernia recurrence by 50% and is now considered the standard of care in many situations. Providence surgeons discuss all surgical options with the patient and offer a balanced opinion about mesh vs. non-mesh hernia repairs.
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James Imatani, M.D.
Katherine Ching, M.D.
Andreas Schneider, M.D.
Jennifer Rodgers, M.D.
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