Q. Do all hernias require surgery?
A. Hernias that limit activity or cause symptoms should be repaired. Small, asymptomatic hernias may be safely watched but will not go away without surgery. Most hernias will increase in size over time and may cause symptoms. In the absence of competing medical problems, most hernias are recommended to be fixed in the elective setting to address symptoms and prevent future complication.
Q. Are hernias dangerous?
A. There is always a risk that an untreated hernia may lead to incarceration where the abdominal contents entering the hernia become stuck. This can lead to pain, nausea, vomiting and constipation with intestinal blockage, and in rare cases, necrosis of the herniated bowel. In these cases, the blood supply to the bowel may be cut off, leading to it rupturing and the development of peritonitis. While this is an infrequent event, elective repair of at-risk and symptomatic hernias is recommended.
Q. What is the typical recovery after inguinal hernia surgery?
A. Modern surgical techniques including the open "tension-free" Lichtenstein repair and laparoscopic inguinal hernia repair have led to rapid recovery. The length of stay in hospital and recovery times vary according to the extent of the operation and your general health, but most patients undergo outpatient surgery and are back to normal activity within one week. It is normal to take pain medications post-operatively to help with your recovery. Walking, movement and routine activity are encouraged immediately after surgery. Strenuous activity should be avoided for four weeks after surgery.
Q. How are hernias repaired?
A. Surgery remains the only way to repair a hernia. Methods include open and laparoscopic repairs. Different mesh types are used as well as variations in technique, depending on your individual case. Surgical options and their risks and benefits will be discussed with you at the time of your consultation.
Q. Can my hernia be repaired without general anesthesia?
A. Yes. This is one of the many conveniences of the Lichtenstein operation. Most inguinal, femoral and umbilical hernias can be repaired under local or regional anesthesia. Sedation may be administered based on individual preference in consultation with our anesthesiologists. Laparoscopic repair requires a general anesthetic and temporary intubation with a breathing tube. For patients that prefer to avoid general anesthesia and those that have medical comorbidities that make general anesthesia higher risk, open surgery is preferred.
Q. What is the difference between laparoscopic and open hernia repair?
A. Like the open technique, laparoscopic repair is performed using a mesh. Unlike the open technique, the operation is performed through three small incisions, the largest of which is 1 cm. in size with placement of the mesh behind the abdominal muscles instead of in-between the muscles. Laparoscopic surgery requires general anesthesia and bladder catheterization. Both can normally be performed as an outpatient operation.
Q. Can all types of hernia be repaired laparoscopically?
A. With inguinal hernias, if a patient has had a prior lower open abdominal operation (prostate surgery, cesarean section, colon surgery), the scarring may preclude laparoscopic repair. If a hernia is small and accessible, there is little difference in the amount of post-operative pain between an open and laparoscopic repair. An open operation is preferred as it avoids general anesthesia and entering the abdominal cavity. If repairing a hernia requires a larger incision, a laparoscopic approach is probably beneficial. Inguinal, incisional, umbilical, paraumbilical, epigastric and Spigelian hernias can all be repaired laparoscopically. Large defects, however, are often best managed with abdominal wall reconstruction to bring the abdominal muscles back to their natural location.
Q. Which is better: open or laparoscopic inguinal hernia repair?
A. Open and laparoscopic operations are equally effective in repairing hernias. Open repair is safe, reliable and avoids the need for general anesthesia and bladder catheterization.
Laparoscopic repair has been statistically reported to have slightly less post-operative pain, less wound numbness and an earlier return to work. There is a slightly higher recurrence rate with laparoscopic repair but both remain low (open < 1 %: laparoscopic < 3%). Laparoscopic repair is advantageous in bilateral and recurrent cases.
Chronic pain after inguinal hernia repair is possible with both types of repair. In cases where this occurs after laparoscopic repair, this may be more difficult to address due to the deeper position of the mesh. Each individual will have their own idea of which is the right approach for them and the benefits and risks of each will be discussed. At the Lichtenstein Amid Hernia Clinic, both options are available to you.
Q. Will I be in pain after the operation?
A. With Lichtenstein and laparoscopic tension-free repairs, there is significantly less discomfort post-operatively. However, this is still a major concern for patients and we take great care to minimize post-operative pain. All open repairs are usually performed under local anesthesia. This usually helps to minimize post-operative pain. In laparoscopic operations, local anesthetics are injected into incisions. Inpatient admissions requiring complex abdominal operations are offered epidural anesthesia. We provide patients with painkillers to go home with. A combination of narcotics and ant-inflammatory medications is effective in minimizing pain. We recommend that these be taken regularly for the first 72 hours and then as needed thereafter.
Q. When will I be able to return to work?
A. This depends on individual factors such as sensitivity to pain as well as the type of work you do. Typically, office workers whose jobs do not require much physical activity can usually return after a few days. Those with jobs that involve a lot of physical activity may require two or three weeks before returning to work.