If you’ve noticed pain in your stomach or groin after a physical activity that involves heavy lifting, you may have developed a hernia. Hernias form when one of your internal organs breaks through the surrounding muscles. Jeffrey Sternberg, MD, is a leading board-certified surgeon who specializes in gastrointestinal tract and colon conditions. His expertise can put you at ease when you need medical treatment anywhere between your chest and your thighs. Call or book an online appointment today with The Sternberg Clinic in San Francisco.
What is a hernia?
A hernia is a defect in the abdominal wall that permits internal fat or an organ such as the small bowel, colon, or bladder to protrude outside the abdominal cavity. The most common types are inguinal, umbilical, femoral, and ventral or incisional. The majority of hernias (80%) are inguinal (groin) hernias. Hernia repair is one of the most frequently performed procedures in the United States, and over 600,000 inguinal hernia repairs alone are performed annually. While they can occur in either gender, groin hernia is much more common in men.
What causes a hernia?
A hernia develops as a consequence of intra-abdominal pressure pressing outwards on a congenital or acquired weakness of the abdominal wall, leading to the herniated outpouching.
What is the danger of a hernia?
If a hernia is large enough, a piece of bowel or bladder can become trapped (incarcerated). If the trapped organ swells and chokes off its blood supply, it can die (strangulate) or perforate. Luckily, these complications are uncommon.
When should a hernia be repaired?
Most hernias should be repaired as they tend to enlarge over time and will eventually limit your activity. While small asymptomatic hernias can be observed, you should consider having a hernia repaired if:
- The hernia is large or enlarging as the larger the hernia, the more difficult it is to repair. Also, patients with larger hernias are at higher risk for incarceration and strangulation.
- The hernia is irreducible (you are unable to push the contents back in)
- The hernia is causing you discomfort or preventing you from exercising.
What is the preferred method of repair?
The standard of care for the repair of hernias is a repair with mesh. Mesh repairs that reinforce the strength of the abdominal wall have two important advantages to non-mesh repairs:
- Lower recurrence rates
- Less post-operative pain
Mesh is a woven, non-reactive, synthetic material and after a repair, one’s own tissues grow into the mesh resulting in a composite material that is substantially stronger than the original abdominal wall. This strength leads to a low recurrence rate. Repairs with mesh are less painful than those without mesh because mesh repairs do not require the stretching of one’s tissues.
Please don’t worry about the mesh leading to serious problems. I place mesh behind the abdominal wall (not in front of it). As a result, the mesh is hidden and can’t be felt. Also, the meshes that I use to repair all forms of hernias have not been documented to cause serious complications when used properly. The FDA has never recalled any of these forms of mesh.
The goal of any inguinal hernia surgery is to perform the operation with a low recurrence rate and a minimal degree of postoperative groin pain. I perform both anterior (open) inguinal hernia repairs and laparoscopic inguinal hernia repairs. I usually prefer the laparoscopic technique when appropriate, as patients tend to have less postoperative discomfort and are typically back to sports within a week or two. This is a minimally invasive technique where a small camera is placed through the belly button to view the hernia defect. Small (5 mm) instruments are then placed through two small incisions and the hernia is patched with a piece of mesh from inside the abdomen.
Hernia repairs are performed as a same day surgery procedure at a surgery center. Patients typically feel relatively well in a day and return to work in one to several days. Most patients return to exercise and sports within two weeks.