HERNIA REPAIR IN ATLANTA

When it comes to inguinal hernia’s, it has been reported that over 750,000 inguinal herniorrhaphies are performed yearly in the United States alone!

This qualifies the inguinal hernia repair as THE most common general surgery procedure performed, not only in Atlanta.

Men Versus Women: Inguinal Hernia Repair By The Numbers?

Men have a 27% risk of developing an inguinal hernia in their lifetime, whereas women have a 3% risk.

There is no single insult that causes the injury (usually) rather, we must take into consideration abdominal straining, collagen diseases that are genetic, intra-abdominal pressure increases and more.

Specific to men; as the testes migrate through the inguinal canal they may experience processus vaginalis which leads to a higher incidence of inguinal hernias in the male species (Indirect Hernia).

Direct hernias, on the other hand, result from an attenuated transversalis fascia lateral to the rectus abdominis muscle above the inguinal ligament.

Femoral hernias, which – commonly – are mistaken for inguinal hernias are known to occur more commonly in females, occur medial to the femoral vein in the femoral canal and carry a higher rate of incarceration and strangulation.

Indications and Contraindications for Laparoscopic Inguinal Hernia Repairs:

General indications for laparoscopic inguinal hernia repair are the same as those for an open inguinal hernia repair.

Classically, the existence of an inguinal hernia has been considered sufficient reason for operative intervention. This has now changed due to studies showing  that the presence of a reducible hernia is not, in itself, an indication for surgery and that the risk of incarceration is less than 1%.

Patients with pain or discomfort, should undergo repair.

However, even an asymptomatic patient, if “medically fit”, should be offered surgical repair.

What To Expect During & After Your Inguinal Hernia Repair

Patients who are undergoing laparoscopic repairs should be educated on postoperative pain, possible temporary discoloration of the groin and scrotum, and seroma formation within the first few postoperative days.

It is also important to discuss with your general surgeon in Atlanta of the possibility of nerve injury and chronic postoperative pain (defined as pain lasting longer than 6 months).

Although this is an uncommon result, it can be highly frustrating to the patient and should therefore be addressed beforehand.

Patients undergoing a unilateral laparoscopic repair should be counseled on the possibility that bilateral hernia repair may be necessary if a contralateral hernia is encountered during surgery.

Consent for this procedure should be obtained!

A hernia, by definition, is the protrusion of tissue or part of an organ through the bone, muscular tissue, or the membrane by which it is normally contained.

Important to note; Hernias can be classified as internal or external and as abdominal or thoracic.

Incisional Hernias Explained

Incisional hernias are very common.

They are the second most common type of hernia after inguinal hernias. Approximately 4 million laparotomies are performed in the United States annually, 2-30% of them resulting in incisional hernia.

Incisional hernias after laparotomy are related to poorly or not at all closure of the fascia which leads to poor healing and involve technical and biological factors.

Approximately 50% of all incisional hernias develop or present within the first 2 years following surgery, and 74% occur within 3 years. 

Indications for Incisional Hernia Repairs

1. Symptoms such as pain and abdominal enlargement
2. Risk of incarceration, especially hernia sacs with a small neck that contain bowel
3. Suitable size – The best candidates are small to moderate-sized hernias in which the contents can be easily reduced and port-site hernias.

What to Expect During Your Incisional Hernia Repair Journey

Laparoscopy requires general endotracheal anesthesia.

This repair is performed under no tension.

The patient is placed in a supine position for almost all hernia repairs. If the hernia is an epigastric defect, the lithotomy position with stirrups is also used. Arms are tucked to the sides. If the defect is not midline, the surgeon should stand on the opposite site of the hernia.

Umbilical hernias acccount for 10% of abdominal wall hernias.

Conditions that lead to increased intra-abdominal pressure and weakened fascia at the level of the umbilicus (eg, obesity, ascites, multiple pregnancies, and large abdominal tumors) contribute.

Umbilical hernias are typically small with a narrow neck

Small with a narrow neck – is a configuration that increases the risk of strangulation and incarceration.

Omentum, small bowel, and colon can be found within the sac.

A direct or true umbilical hernia consists of a symmetric protrusion through the umbilical ring and is seen in neonates or infants.

Indirect umbilical (paraumbilical) hernias protrude above or below the umbilicus and are the most common type of umbilical hernia in adults.

Indications for Umbilical Hernia Repairs

All adult umbilical hernias should be repaired, owing to the high risk of complications.

Here is a list of indications to consider:

Pain
Incarceration
Strangulation
Defect larger than 1 cm
Skin ulceration
Hernia rupture
Incarceration or strangulation is a particular concern in pregnant patients.

After Your Umbilical Hernia Repair:

Patients should be instructed to avoid heavy lifting for 2-4 weeks postoperatively.

Obese patients should be counseled on strategies for weight management.

Continued medical control helps to decrease the risk of recurrence in patients with ascites.

Hernias may be detected on routine physical examination, or patients with hernias may present because of a complication associated with the hernia.

Characteristics of asymptomatic hernias are as follows:

Swelling or fullness at the hernia site. Reported aching sensation (radiates into the area of the hernia). No true pain or tenderness upon examination. Masses that engorge with increasing intra-abdominal pressure and/or standing.

Characteristics of incarcerated hernias are as follows:

-Painful enlargement of a previous hernia or defect
-Cannot be manipulated (either spontaneously or manually) through the fascial defect
-Nausea, vomiting, and symptoms of bowel obstruction (possible)

What do you need to know about Intra Abdominal Hernias?

Patients should be counseled to avoid increase intra-abdominal pressure activities like straining at defecation and lifting heavy objects!

This may require restrictions on work or school-related activities, which should be clearly delineated.

Patients should also receive instruction regarding ways of applying support to the hernia. Numerous medical device companies have developed support items that can assist with this process.

Even with asymptomatic hernias, repair at an early stage (ie, before the hernia enlarges) is preferred.

Referral to a general surgeon in Atlanta for discussion of the available types of hernia repair is warranted; with the advent of new meshes and laparoscopic approaches, the range of repair options is now wider than ever.