By ZACHARY BOUCHER, MD
Having a hernia can be a difficult thing to live with.
Patients living with a hernia may experience a bulge in their abdominal wall (most often at the belly button) or in their groin. Some hernias are from incisions from previous surgery, and you may feel a bulge just under your previous scar.
The reasons to repair a hernia surgically are varied and range from cosmetic dissatisfaction, pain, and to prevent future blockages. A blockage (also called an obstruction) is the most concerning complication from a hernia, as a piece of intestine can get stuck in your hernia and then get twisted, which is often a surgical emergency. The chance of your hernia causing an obstruction are relatively low overall, but this risk increases depending on different characteristics of the hernia. If you have had a blockage previously your chances of having another are much higher than the general population.
How does one know if they have a hernia at all? Well, there are two ways to know for sure. The simplest method is based on physical exam. Any physician with experience in this field can diagnose a hernia with a high degree of accuracy. If the exam is obvious, no further testing is necessary to diagnose a hernia. If the exam is equivocal, a CT scan picture is the next step to take. This picture can show your entire abdomen from the inside and is gold standard for hernia diagnosis. This picture also often gives surgeons important information about your particular hernia anatomy when planning a repair.
So you know you have a hernia: Should you get it fixed? That is the million dollar question. The answer is maybe. It depends on your overall health, size/location of hernia, and your symptoms. If you are over the age of 90 with a long-standing hernia that does not bother you, surgery would not be the right choice. In a patient who is reasonably healthy with a hernia that causes them symptoms, I generally offer surgical repair.
How will my hernia be fixed? Another excellent question. The answer depends on many factors, namely the size and location of the hernia, in addition to any previous surgeries. My preference is to repair the majority of abdominal wall hernias using robotic surgery, as the incision sizes are much smaller than the typical approach and this repair has equivalent or improved recurrence rates compared to traditional open surgery. “Recurrence” simply means the chance that the hernia will come back some day. As a hernia surgeon, we strive for this number to be as low as possible, often less than 5%. Mesh is often used to reinforce the repair after the defect is closed. We use mesh because it drastically lowers the recurrence rate after surgery so we can keep these hernias from coming back. Mesh often gets a bad reputation, but mesh has come a long way in the past 20 years as we have found strategies to make it safer and more durable.
Fixing a hernia is an extremely satisfying practice, as it can give patients back quality of life long lost due to pain, discomfort or fear.
About the Author
Zachary Boucher, MD, is a General Surgeon with Lakeland Regional Health. To make an appointment with Dr. Boucher, call 863.284.5030.