Hernia Surgery

This is the most common hernia symptom, and for many people, the easiest thing to notice. The most common areas in which they are noticed include the groin (inguinal hernia or femoral hernias), the belly button (umbilical hernia), and the site of a prior abdominal surgery (ventral or incisional hernia). The bulge may vary in size.

Some people don’t notice pain connected to the hernia, and others may notice immediate or excruciating pain. If your hernia is an acute hernia, that is, one that occurs with a sudden tearing or stretching of muscle tissue, you may experience a sharp, sudden pain. Some patients describe a pain similar to a muscle ache or strain. Others just notice a funny feeling or tearing in the groin that wasn’t there before.

Pain from an acute hernia will usually subside in a week or two, but this doesn’t mean that your hernia has gone away. Hernias do not self-repair.

Even if you did not experience pain with an acute hernia, you may experience localized hernia pain when the nerves surrounding the hernia are pinched or stretched as the hernia grows. You may also experience pain in the hernia area during exercise, or while performing strenuous work.

In some cases, a patient feels pain in a different area, away from where the actual hernia is. The nerves around the hernia are irritated, and the pain signals travel along the nerve root to other regions supplied by the same nerve.

Depending on the size and location of the hernia, pain could travel to the testicle, thigh, back or abdomen. This happens because the nerve roots originate from the back and the nerve to the testicle originates in the abdominal region.

Generalized abdominal pain could also be a hernia symptom. This pain is serious, and results from internal abdominal organs, such as intestines, being pinched by the hernia, resulting in a compromised blood supply. Surgeons call this a strangulated hernia.

The pain from a strangulated hernia is an abdominal pain which initially starts as a stomach ache and increases in severity, causing nausea and vomiting later.

If the pinched tissues are not treated, they will die, and the results could be fatal to the patient. Prompt surgery is needed.

If you are experiencing nausea and vomiting with your hernia, you should seek immediate medical treatment. This could be a sign of intestinal obstruction, full or partial, and you may require emergency surgery.

If the hernia is blocking your intestine, you may experience constipation, or possibly blood in your stool. If you have an intestinal obstruction, you may require emergency surgery

If the protrusion compresses a nerve, you could experience numbness or loss of feeling to the area of the hernia.

Sometimes a patient’s bladder will be trapped within the hernia. If this happens, you could experience urinary burning, frequent infections, bladder stones and hesitancy or frequency in urinating. If you are experiencing these difficulties, you should consult your urologist or surgeon and see if they are caused by a hernia.

Hernias can result in a wide array of non-specific discomforts, depending on the placement of the hernia sac or the pressure that the sac places on nearby tissues. These symptoms may or may not be related to your hernia.

Hernia symptoms are usually worse at the end of the day, and may be relieved at night, when you are lying down and the hernia naturally becomes smaller.

While most hernias are classified according to their location, there is another category entirely—complex hernias. Regardless of their location, complex hernias pose their own set of challenges. Very simply, hernias are considered complex when they are more involved than a single, “normal” hernia.

Repairing complex hernias requires an approach that goes above and beyond typical hernia repair. Because of this, patients must be diligent in finding a surgeon with talent and experience in the field of hernia repair.

Types of complex hernias
There are many circumstances under which a hernia may be considered a complex hernia. Below are just a few examples of such circumstances.

• When a patient has had multiple hernia repairs, causing the tissue to weaken with each successive surgery.
• When a patient has multiple concurrent hernias, also known as Swiss cheese hernias.
• When a hernia has become infected.
• When a hernia is strangulated, meaning it is constricting the blood supply to the herniated bowel or organ.
• When an incision from a previous surgery has ruptured, causing a hernia. This is also known as an incisional hernia.

Complex hernia surgery
Dr. Memsic has a comprehensive hernia treatment program that carries each patient from diagnosis to recovery with the highest level of comfort and care. With our state of the art facility and rapid, effective hernia treatments, Dr. Memsic has consistently provided successful treatment of complex hernias.

An epigastric hernia is a hole in the abdominal wall somewhere between the belly button and the chest. It may appear as a lump, and it may grow or shrink in size depending on the time of day, body position, etc. Epigastric hernias can occur in men, women or children.

What causes an epigastric hernia?

Sometimes a baby is born with an epigastric hernia. When this happens, there is a part of the abdominal wall that hasn’t closed properly, leaving a hole.

In adults, too much abdominal pressure can cause an epigastric hernia. It can happen to women during pregnancy, for example, when the abdominal wall is stretched to accommodate the growing baby.

Weight gain, fluid in the abdominal cavity, or even repeated strain from coughing can also cause epigastric hernias to form. Sometimes an epigastric hernia will form because of weakness in the abdominal wall after unrelated abdominal surgery.

A congenital weakness in the abdominal wall can go completely undetected for years, and then appear as a hernia.

What procedures are available for my epigastric hernia repair?

The best epigastric hernia repair for you will depend on the exact nature of your hernia. Epigastric hernias may be simple, such as just a small hole in the abdominal fascia. In this case, Dr. Memsic recommends repairing the hernia by returning the bowel to its proper location, and then closing the hole in the abdominal wall. In many cases, an underlay mesh is used, which is placed to remove tension from the abdominal wall during closure. This gives the abdominal wall a chance to heal well in a tension-free environment, which is the key to a successful hernia repair.

In a child, the epigastric hernia repair procedure is usually very simple. The hole is closed with sutures, and the abdominal muscles grow back together as the child grows.

Sometimes, patients with an epigastric hernia have an underlying condition called “rectus diastasis” or abdominal muscle separation. This can occur in both men and women, but is especially common after pregnancy. The muscles on either side of your abdomen, the ones that make up your “six pack,” are called the rectus muscles. They normally join at your midline, adjacent to your navel. These muscles can separate or stretch apart, called a diastasis. You can tell you have a rectus diastasis because you will notice your abdomen bulges easily after meals, it is difficult to “suck it in,” and your abdominal strength is reduced.

If your epigastric hernia includes rectus diastasis, your abdominal muscles need to be repaired. The separation of the muscles creates a natural weakness of the abdominal wall, so repair of the muscles at the same time as the hernia will decrease the recurrence rate, provide a stronger repair, and increase the strength of your core.

A femoral hernia is a protrusion of the contents of the abdominal cavity into the groin or upper thigh. It is usually something that develops over time, rather than something congenital.

It can be difficult to determine if a hernia is a femoral hernia or an inguinal hernia, and sometimes that determination can only be made once the hernia surgery is already underway. A hernia in the groin area that is above the inguinal ligament is called an inguinal hernia; if the hernia is below the ligament it is a femoral hernia.

In a baby, a femoral hernia is a defect, and it needs to be repaired so that your child will grow up safely and naturally, without danger to his or her bowel system. In a child, the femoral hernia repair procedure is usually very simple. The intestine is placed into its correct location, the hole is closed with sutures, and the tissues grow back together as the child grows.

What causes a femoral hernia?

A femoral hernia is usually caused by strain or pressure of some kind. A chronic cough, straining to have a bowel movement or to urinate can cause a femoral hernia.

In adults, inguinal hernias are usually the result of increased pressure that forces part of the intestines through a weak spot in the abdominal wall that surrounds the inguinal canal— straining during bowel movements, heavy lifting, coughing, sneezing or obesity.

Femoral hernias are most common in women, and older women who are very small or thin are more likely to develop them. Men and children can also develop this type of hernia.

What procedures are available for my femoral hernia repair?

The best femoral hernia repair for you will depend on the exact nature of your hernia. Dr. Memsic will examine you and make a recommendation that is right for your exact situation. Depending on the hernias size and location, as well as the nature and strength of the surrounding tissue, she may recommend using internal sutures or sutures combined with surgical mesh for your femoral hernia repair to seal the hole in the abdominal wall.

A ventral hernia or incisional hernia is a hole in the abdominal wall behind or within the site of an earlier surgical incision. Because of the hole, the contents of the abdominal cavity, such as intestines, can spill out behind the skin, creating a bulge.

Ventral hernias or incisional hernias can occur in men, women or children, and they occur along the midline of the abdomen. They frequently occur at the point of a prior incision, if you have had an abdominal surgery procedure in the past.

What causes a ventral or incisional hernia?

Sometimes, ventral hernias can occur naturally, through areas of the abdominal which may be naturally weaker or strained and pulled by pregnancy. If you have had prior surgery, then the fascia (connective tissue), which is the strength component of the abdominal wall, may have healed poorly.

This can happen for many reasons. The most common reason is infection after the surgery. Other factors can also lead to a hernia, though, including extensive coughing, heavy lifting, obesity, returning to normal activity too soon after surgery, or a physical tendency that predisposes some patients to develop hernias.

If your child develops a ventral hernia, you should get it repaired promptly. Ventral hernias do not close on their own. The longer that your child’s hernia remains, the more dangerous it becomes. If a portion of your child’s bowel slips through the hole in the abdominal wall and becomes trapped, it can lead to a bowel obstruction and require emergency surgery.

In a child, the procedure for repairing a ventral hernia is usually very simple. The hole is closed with sutures, and the abdominal muscles grow back together as the child grows.

What procedures are available for my ventral hernia repair?

Ventral hernias may be simple, such as just a small hole in the abdominal fascia. In this case, Dr. Memsic recommends repairing the hernia by returning the bowel to its proper location, and then closing the hole in the abdominal wall. In many cases, an underlay mesh is used, which is placed to remove tension from the abdominal wall during closure. This gives the abdominal wall a chance to heal well in a tension-free environment, which is the key to a successful outcome.

Sometimes, patients with a ventral hernia have an underlying condition called “rectus diastasis” or abdominal muscle separation. This can occur in both men and women but is especially common after pregnancy. The muscles on either side of your abdomen -- the ones that make up your “six pack” are called the rectus muscles. They normally join at your midline, adjacent to your navel. These muscles can separate or stretch apart, called a diastasis. You can tell you have a rectus diastasis because you will notice your abdomen bulges easily after meals, it is difficult to “suck it in,” and your abdominal strength is reduced.

If your ventral hernia includes rectus diastasis, your abdominal muscles need to be repaired. The separation of the muscles creates a natural weakness of the abdominal wall, so repairing of the muscles at the same time as the hernia repair will decrease the recurrence rate, be a stronger repair, and will increase the strength of your entire core.

“Overlay” mesh repair is never recommended by Dr. Memsic. In this type of approach, surgical mesh is used to cover the hole in the abdominal wall on the outside of the hernia sac, much as you would patch a hole in a tire. Rather than returning your abdominal wall muscle to its natural state, a fix of this type just covers the area of weakness. Future strain or expansion could stretch the hole beyond the patch, pulling it loose and causing the hernia to return.

Overlay mesh repair has a high failure rate. Over 50%of overlay mesh repairs result in a recurrence of the hernia.

Dr. Memsic may recommend that an “underlay mesh” be used as part of your hernia repair. In this case, after returning the bowel to its proper location, mesh may be placed on the underside of the tear to reinforce the repair and remove tension from the abdominal wall during closure. This gives the abdominal wall a chance to heal well without extra strain or tension.

An inguinal hernia is a protrusion of the contents of the abdominal cavity into the inguinal canal, which is located in the groin. It appears as a bulge into groin, or into the scrotum.

Inguinal hernias occur more often in men, because the inguinal canal is larger in males, making the wall naturally weaker. This can commonly be referred to as a testicular hernia in men. But women and girls can also experience this type of hernia as well

What causes an inguinal hernia?

Sometimes a baby boy is born with an inguinal hernia. This happens because, as the baby develops, a muscle ring opens up on each side of the groin to allow the testicles to descend into the scrotum. This channel closes in most boys once the testicles are in place, but if it doesn’t, a portion of the intestine can pass down the channel, resulting in an inguinal hernia.

In a baby, an inguinal hernia is a defect in the inguinal canal, and it needs to be repaired so that your child will grow up safely and naturally, without danger to his or her bowel or reproductive system. You should schedule a consultation with a pediatric hernia surgeon, if you or your pediatrician notice a lump in your child’s groin or scrotum.

In adults, inguinal hernias are usually the result of increased pressure that forces part of the intestines through a weak spot in the abdominal wall that surrounds the inguinal canal— straining during bowel movements, heavy lifting, coughing, sneezing, or obesity.

Men are more likely to develop inguinal hernias because they have a greater likelihood of weakness in this portion of the abdominal wall than women.

Patients undergoing orthopedic or spinal surgery, especially through an abdominal approach, have an increased risk of nerve injury and herniation to the abdominal wall musculature. When this occurs, it is called a lateral hernia. Sometimes one side of the abdomen gets stretched out and bulges, and the belly button is no longer in the midline.

Hernia repair of this type involves complete strengthening of the abdominal wall. The functional musculature is connected together with a soft mesh that returns core strength and reverses the stretching of the abdominal wall.

What are my options for lateral hernia repair?

The best lateral hernia repair for you will depend on the exact nature of your hernia. Repair of this type of hernia involves complete strengthening of the abdominal wall. The functional musculature is connected together with a soft mesh that returns core strength and reverses the stretching of the abdominal wall.

An umbilical hernia is a hole in the abdominal wall behind or beside the navel (belly button). It may appear as a lump behind, underneath or near the belly button, or simply as a protruding navel.

Umbilical hernias can occur in men, women or children. The navel is a naturally weak area for the abdominal wall even in adults, since it once acted as an opening in the abdominal wall through which the umbilical cord passed. That opening normally closes just after birth. If the muscles don't join together completely in the midline of the abdomen, this weakness in the abdominal wall may cause an umbilical hernia at birth or later in life.

In adults, too much abdominal pressure can cause an umbilical hernia. It’s a common occurrence for women during pregnancy, for example, when the abdominal wall is stretched to accommodate the growing baby.

Weight gain, fluid in the abdominal cavity, or even repeated strain from coughing can also cause umbilical hernias to form. Sometimes an umbilical hernia will form because of weakness in the abdominal wall after unrelated abdominal surgery.

A congenital weakness in the abdominal wall behind the navel can go completely undetected for years, and then appear as a hernia.

What procedures are available for my umbilical hernia repair?

The best umbilical hernia repair for you will depend on the exact nature of your hernia. Umbilical hernias may be simple, such as just a small hole in the abdominal fascia. In this case, we recommend repairing the umbilical hernia by returning the bowel to its proper location, and then closing the hole in the abdominal wall. In many cases, an underlay mesh is used, which is placed to remove tension from the abdominal wall during closure. This gives the abdominal wall a chance to heal well in a tension-free environment, which is the key to a successful outcome.

Sometimes, patients with an umbilical hernia have an underlying condition called “rectus diastasis” or abdominal muscle separation. This can occur in both men and women but is especially common after pregnancy. The muscles on either side of your abdomen, the ones that make up your “six pack” are called the rectus muscles. They normally join at your midline, adjacent to your navel. These muscles can separate or stretch apart, called a diastasis. You can tell you have a rectus diastasis because you will notice your abdomen bulges easily after meals, it is difficult to “suck it in,” and your abdominal strength is reduced.

If your umbilical hernia includes rectus diastasis, your abdominal muscles need to be repaired. The separation of the muscles creates a natural weakness of the abdominal wall, so repair of the muscles at the same time as the hernia will decrease the recurrence rate, be a stronger repair, and will increase the strength of your entire core.

Why wouldn’t I want to have a mesh for my umbilical hernia repair?

You may have heard of a “mesh” hernia repair or know someone who has gotten one. While surgical mesh is an excellent surgical tool for some types of hernia repairs, we do not recommend them for patients who want to retain and improve their natural physiology.

In an “overlay” mesh repair, surgical mesh is used to cover the hole in the abdominal wall on the outside of the hernia sac, much as you would patch a hole in a tire. Rather than returning your abdominal wall muscle to its natural state, a fix of this type just covers the hole. Future strain or expansion could stretch hole beyond the patch, pulling it loose and causing the hernia to return. In addition, the surgical mesh is a foreign substance to your body, so there is always the danger that it will be rejected by your body or that it will not be able to perform its desired function.

But the main reason to avoid an overlay mesh repair is that it has a high failure rate. Well over 50% of overlay mesh repairs result in a recurrence of the hernia.

In an “underlay” mesh repair, the surgeon uses a laparoscopic procedure to approach the tear in the abdominal wall from behind – it’s as if you were patching that tire from the inside. These patches may hold a bit better than an overlay patch, but they don’t restore your anatomy to its original position, and the failure rate for them is still about 20%.

In delivering a hernia repair with mesh, surgical mesh is used to strengthen the repair and reduce the rate of hernia recurrence. Over the past 30 years, the use of mesh in hernia repair has increased dramatically. Surgeons have gradually perfected the use of mesh, reducing the rate of infection that was once prevalent.

In addition to providing a lasting result, surgical mesh in hernia repair has been found to provide a higher level of comfort for the patient. By decreasing the operative period and minimizing recovery time, surgical mesh may reduce the amount of trauma to a patient’s body during and after surgery. Nevertheless, every patient is different, and the use of surgical mesh depends on many different factors, including patient preference.

All told, the use of surgical mesh in hernia repair has consistently provided many advantages in hernia repair when used properly and appropriately. However, there are many instances when surgical mesh is not the best solution. In delivering hernia repair, our surgeons weigh every factor before determining whether mesh should be used. Our patients are encouraged to ask any questions they like and thoroughly express their own preference, as this plays a major role in how the hernia repair will be performed.

As an alternative to synthetic mesh, biomesh was created to give patients a natural, organic alternative to artificial material. It’s been found that certain patients have an adverse reaction to synthetic mesh, simply because their bodies dislike foreign, artificial substances. In such cases, patients experience inflammation, infection, fibrosis (excessive scarring) and other foreign body reactions. Biomesh drastically reduces the risk of foreign body reactions, helping patients experience a full and comfortable recovery after hernia repair with mesh.

Biomesh is created from a variety of organic tissues. These include:

• Donated human tissue
• Animal dermis, or skin
• Porcine (pig) submucosa, or a layer of connective tissue that lies under the skin

Hernia revisions are unfortunately common, with as many as 30% treated elsewhere experiencing a second hernia after their first repair. The key to fixing these hernias is to understand why the hernia is recurring, and make sure that we fix the actual problem. Usually we will discover one of these causes for the recurrence:

• Overlay mesh: in most cases, the initial surgeon used an overlay mesh to repair the hernia. This is simply placing a patch on the hole in the abdominal wall and is much more likely to fail than other techniques for repair.
• Infection: in other cases, the patient may have had an infection that prevented the fascia (connective tissue) from closing and healing properly. In this case, it is critical to make sure no infected mesh is still present in the field, and to ensure that the bacteria causing the infection has been eradicated.
• Underlying fascia weakness: the original attempted repair was performed in an area where the fascia is not strong. In most cases involving a fascia weakness, the patient has an unrecognized rectus diastasis. This is a split in the two vertical "six-pack" abdominal muscles, so that there is a gap between them. The whole abdomen will bulge outward in these cases, especially towards the end of the day, and not just in the area of hernia. In this case, the entire muscle split must be repaired when the hernia is repaired, or the hernia repair will be unsuccessful.