Frequently Asked Questions About Hernia Surgery
What is a Hernia?
Hernias are protrusions of fatty tissue or an organ through the abdominal wall in the groin area. These can result from a congenital defect, or occur as the muscle experiences an acute or repetitive stress or strain. This pressure pushes organs and surrounding tissue through the defect, creating the characteristic "bulge" associated with hernias.
How Do I Schedule Hernia Surgery?
After your consultation with a surgeon, your surgeon’s office will help schedule the procedure at either Abington Hospital or Abington – Lansdale Hospital.
To find a surgeon at Abington Hospital, call our physician referral service at 215-481-MEDI. To schedule an appointment with a surgeon at Lansdale Hospital, call please 215-368-1122.
What is Tension-Free Minimally Invasive Hernia Surgery?
Older techniques for repairing hernias involve cutting and/or pulling the muscle together to close and repair the defect, creating tension on the muscles. This often results in swelling, stiffness and pain which could last several months. In addition, the tension inhibits the healing process and therefore does not permit adequate healing of the sutured muscle edges. Under these circumstances, hernias are much more likely to recur.
Our minimally invasive surgical technique helps eliminate unnecessary swelling and pain. Our surgeons use a specially designed type of surgical mesh, which they place safely and securely beneath the hernia itself. The mesh may also help keep the hernia from recurring.
Are All Mesh Repair Surgeries Similar?
Some surgeons sew the muscles surrounding the hernia together, then apply mesh on top to reinforce the repair. This type of repair creates tension and could lead to inadequate healing. In fact, many patients who have this type of repair could find that the mesh lifts apart, resulting in a recurrence of the hernia.
Our surgeons safely place the mesh beneath the muscle - not on top of it. The mesh expands beyond the edges of the hernia. The muscles are not sewn together and so they are not under tension. The mesh repairs the defect and acts as a living platform to allow tissue to grow. The hernia is painlessly healed as the mesh painlessly grows to become part of the abdominal muscle wall.
How is the Mesh Held in Place?
The technique used by our surgeons does not involve suturing muscles together. Instead, mesh is placed under the muscles which effectively and safely repairs it. The process is customized for each patient. Surgeons size and position the mesh to match the hernia. Once in place, the mesh has little or no tendency to move or migrate. Surgeons use a few, loosely tied dissolvable sutures to orient the mesh in its proper location. Sutures dissolve fully within weeks without pulling on the muscles. As these sutures dissolve, tissue grows into and around the mesh, securely holding it in place against the muscle. Tissue begins to grow within hours of the procedure. As the mesh becomes incorporated into the muscle wall, it serves as a scaffold as the hernia heals.
Can Mesh Be Rejected?
The mesh used in hernia repairs is a synthetic plastic material (either Polypropylene or Gore Tex (PTFE)). Since it is plastic, it is totally inert or non-reactive in the body. Unlike materials made of foreign protein, plastic mesh cannot be rejected and allergic reactions rarely occur. This technique results in extremely low infection rates, and only rarely is repeat surgery necessary. Most infections are successfully treated with antibiotics.
For Whom is This Technique Recommended?
This technique is appropriate for most patients (even children) of any age or state of health. Since it is performed using local anesthesia and sedation, recovery is quick and relatively painless.
Which Types of Hernias are Repaired by This Minimally Invasive Technique?
Almost all abdominal wall hernias may be safely and effectively repaired using our outpatient, minimally invasive technique:
Most patients return to normal activity in a few days. However, surgical repair of extremely large incision or ventral hernias and hiatal (esophageal) hernias are performed with general anesthesia and require a hospital stay.
What is the Benefit of Using Local Anesthesia?
In most cases, hernia repairs do not require general anesthesia and the patient remains conscious. A safe, short-acting sedative is administered intravenously. A local anesthetic (such as Novocain) is administered at the site of the surgery. Once the skin is completely numb, the local anesthetic is injected into deeper layers. Patients remain calm, relaxed and often do not even feel this injection. When the area is fully anesthetized, surgery can be safely and effectively performed while the patient is awake but comfortable and pain-free.
In addition to avoiding complications from general anesthesia, local anesthesia allows patients the ability to cough, strain and press down during surgery so surgeons can examine the repair to assure it is secure.
It is possible that large and/or complex or multiply recurrent hernias (such as large incisional hernias) may require light general anesthesia. Most of our hernia repairs are performed using local anesthesia.
What About Large and Complex Hernias?
Even large, recurrent and complex hernias can be successfully repaired using our surgical technique. Although some hernias require general anesthesia to be effectively repaired, most inguinal and umbilical hernias and many incisional hernias can be repaired using sedation and local anesthesia, even if they are large or complex.
How is a Hernia Diagnosed?
A physician trained in the evaluation of hernias may diagnose hernias using a physical examination. Hernias are suspected when a "bulge" is present coming through a hole or defect in the muscle. In difficult or complex cases, examination by a specialist or specific tests (scans) may be recommended.
Is This Type of Hernia Repair Covered by Insurance?
Most health insurance plans cover the costs of hernia surgery. For information, contact your insurance carrier to determine coverage.
What if I Have Other Medical Problems?
Since our surgery is performed under local anesthesia, the risks associated with general anesthesia (being put to sleep) are avoided. Patients with heart disease, diabetes, high blood pressure and other medical conditions tolerate this surgical technique very well. Many are even discharged the same day. To determine if the medical condition is controlled, we may ask for clearance from your personal physician.
What About Post-Operative Visits?
Patients traveling a long distance for this surgery will have a comprehensive post-operative evaluation before they leave for home, either the day of surgery, or the next morning. Post-operative care and expectations are fully discussed before leaving the hospital. Since the sutures dissolve, the tiny incision does not need special care. Patients may also follow up by phone.
How Long Does It Take to Recover?
Since muscles are not cut or sewn together, pain is minimal. There are few restrictions and the recovery period is rapid. Most patients return to their normal activities, without restrictions, safely and comfortably in a few days!
The above recommendations are appropriate under most circumstances following inguinal (unilateral or bi-lateral), umbilical or femoral hernia repair. Recovery following Incisional and or more complex hernias may be somewhat longer depending on the nature and complexity of the hernia, and patient's over-all health status.
How Long Until I Return to Work?
In most cases, patients who have had inguinal (unilateral or bi-lateral), umbilical or femoral hernia repair, may resume driving in two or three days. Those with desk jobs may return to work within two to three days in most cases. Patients whose jobs require light physical labor can usually return with few restrictions in 10 days to two weeks. Patients whose jobs require performing heavy labor may be required to wait up to three weeks before returning to resume full activity. But they may be able to perform more moderate activity and work much sooner.
When Can I Play Sports and Resume Recreational Activity?
In most cases, physical and recreational activities are recommended following inguinal (unilateral or bi-lateral), umbilical or femoral hernia repair:
- IMMEDIATELY AFTER SURGERY: Brisk walking, treadmill and stationary bike activity can usually be resumed immediately. Patients may resume jogging, gentle swimming and light golfing within two or three days.
- FIVE TO SEVEN DAYS AFTER SURGERY: Moderate aerobic exercise, and light to moderate free weights and exercise activity such as golf, light tennis, Alpine skiing, skating, bowling, softball, lap swimming and hiking can resume within five to seven days.
- TEN to 12 DAYS AFTER SURGERY: In most cases, normal sports and recreational activities can be safely resumed.
- TWO WEEKS AFTER SURGERY: No limitations on physical activity (even contact sports) are required beginning about 14 days after surgery.
The above are general recommendations, and cases may differ. Specific instructions are provided based on each patient’s individual physical needs, ability, skill and training level.
When Can I Travel After Hernia Surgery?
Many patients travel from outside our community. After a brief period of observation, patients are generally discharged the same day, and may travel up to three to four hours to return home. Patients who come from further away may stay overnight in a local hotel. Surgeons can rapidly check the patient the next morning, releasing them to travel home by any mode of transportation, including air.
Patients with incisional hernias or large and/or complex hernias may stay in the area for up to two days after surgery. Please discuss this with your surgeon prior to making final arrangements.
How Does Hiatal Hernia Repair Differ?
Unlike abdominal wall hernias, hiatal hernias occur within the abdomen and affects the diaphragm. These hernias cause stomach acids to travel up into the esophagus, resulting in heartburn and erosion or ulceration. Recommended treatment is predominantly medical, but certain patients may require surgery which is performed laparoscopically.