Abdominal Wall Hernia
Abdominal wall hernias are among the most common of all surgical problems. More than 1 million abdominal wall hernia repairs are performed each year in the United States. Two-thirds are inguinal hernia repair—reviewed in an article in this publication in August -- and one third are “ventral hernias.” A hernia means that some part of the contents from within the abdominal cavity – some fat or sometimes a part of the intestine -- protrudes through an abnormal opening, weakness, or tear in the muscles of the abdominal wall. Ventral abdominal wall hernias occur in several locations and the most common are epigastric, umbilical, and incisional.
Epigastric hernias occur in the muscles the upper abdominal wall, on a line between the breast bone and the navel or umbilicus.
Umbilical hernias occur near the navel, which has a natural weakness from the blood vessels of the umbilical cord.
Incisional hernias can develop soon after surgery or many years later. They affect more than 10% of patients who have had abdominal surgery.
Hernias can cause burning, pressure, or pain. They can be caused or enlarged by excess abdominal pressure due to being overweight, excessive coughing, or pregnancy. Most hernias can be diagnosed by physical examination, as there is often a visible bulge. Your physician may ask you to cough or strain in order to make it more obvious on examination. If it is difficult to determine with certainty, then physicians will sometimes order an ultrasound exam or a CT scan.
Hernias may be reducible – the contents put back into the abdomen – or incarcerated, when it cannot be reduced into the abdomen. There is a risk that the incarcerated contents become strangulated (the tissue dies) – making this an emergency and often a more complex and dangerous operation.
A hernia does not get better over time, nor will it go away by itself. There are no exercises or physical therapy regimens that can make a hernia improve or heal. Hence most physicians encourage repair of hernias in patients who are medically able to undergo the procedure, even if there are no symptoms – but especially if it does not reduce into the abdomen. Symptomatic hernias and those that are incarcerated should almost always be repaired.
Hernia repair requires a trip to the operating room, and the ability to tolerate anesthesia. Most all hernia surgeons strengthen repairs with a mesh of woven material to bolster the muscles and prevent hernia recurrence. Hernias can be repaired with a traditional “open” incision or using a minimally invasive technique with a laparoscope to enter the abdominal cavity and repair from the inside. Open surgery mandates doctors make an incision which must be large enough for the surgeon to fit his/ her hands or surgical instruments inside the abdomen. Open surgery allows doctors to see and touch your organs and tissue while operating.
Minimally invasive surgery (laparoscopy) is done through a few small incisions using long, thin surgical instruments and a camera. The camera sends images to a video monitor in the operating room which guides surgeons as they operate.
Robotic surgery is the next evolution of minimally invasive approach and features a magnified 3D high-definition vision system and special instruments that bend and rotate far greater than the human wrist.
This enables your doctor to operate with enhanced vision, precision, dexterity, and control. There is early data that suggests less postop pain and faster return to activity with robotic procedures.
Your surgeon will choose the technique which they feel is the most appropriate for your age, medical conditions, surgical risk, and potential outcome. Each type of repair has its advantages, risks, and benefits. Recovery time is variable, but most patients can return to light activity within a few days. Timing for return to work or vigorous activity will be recommended by your surgeon.
Dr. Baker is a board certified General Surgeon, a Fellow of the American College of Surgeons, and a retired US Navy Admiral. He is the Senior Partner of West Coast Surgical Associates (formerly Walnut Creek Surgical Associates) with offices in Walnut Creek, Concord, and San Ramon. For more information call 925-933-0984 or view the surgical team at www.wcsurgeons.com