A hernia occurs when an internal part of the body pushes through a weak spot in the surrounding muscle or tissue wall. This typically creates a visible bulge in the abdomen or groin area. Although small hernias may not cause symptoms, the tissue defect will not heal on its own. Since a hernia can lead to serious complications, such as trapped tissue losing blood supply, specialized medical attention is necessary for diagnosis and treatment.
Initial Steps for Diagnosis and Referral
The first step for a patient noticing a bulge or feeling pain in the abdomen or groin should be to consult a primary care physician (PCP). The PCP will conduct a physical examination, which often involves having the patient cough or strain to make the bulge more apparent. In many cases, a physical exam alone is enough to confirm the presence of a hernia.
If the diagnosis is unclear, the physician may order imaging tests. An ultrasound is typically used first because it is non-invasive and uses sound waves to create real-time images. For complex cases or in emergency situations, a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) provides a more detailed view of the abdominal structures. Once confirmed, the PCP refers the patient to a surgical specialist for definitive treatment planning. Sudden, severe pain or a hard, non-reducible lump requires immediate emergency care, as this may indicate a life-threatening complication.
The Primary Specialists Who Perform Repair
The medical professional who most frequently fixes a hernia is a General Surgeon. These physicians are experts in abdominal and soft-tissue surgery, which includes the repair of all common hernia types like inguinal, femoral, and umbilical hernias. To be recognized as a specialist, a General Surgeon must complete at least five years of residency training and pass rigorous examinations to become Board Certified by the American Board of Surgery (ABS).
A board-certified General Surgeon performs routine or straightforward hernia repairs. However, the repair of large, complex, or recurrent hernias, often referred to as abdominal wall reconstruction, may involve a multidisciplinary approach. In these intricate cases, the General Surgeon may collaborate with specialists such as Plastic Surgeons. Plastic Surgeons are trained in tissue rearrangement and reconstruction, which is beneficial when a large tissue defect requires complex techniques to restore the abdominal wall’s strength and function.
Methods of Surgical Repair
Hernia repair surgery, known as herniorrhaphy, is generally performed using one of three techniques: open, laparoscopic, or robotic-assisted. The traditional open repair involves a single incision directly over the hernia site, allowing the surgeon to push the protruding tissue back and repair the defect. This method is often preferred for very large hernias or for patients who cannot undergo general anesthesia.
Laparoscopic repair is a minimally invasive approach that uses several small incisions to insert a camera and specialized instruments. This technique results in smaller scars, less post-operative pain, and a generally faster recovery time compared to open surgery. Robotic-assisted repair is an advanced form of laparoscopic surgery where the surgeon controls robotic arms, which provide enhanced dexterity and a high-definition, three-dimensional view of the surgical field.
Regardless of the approach, the repair typically involves either a tension-free mesh repair or primary closure. The tension-free method, which is the standard of care for most hernias, uses a synthetic mesh patch to bridge the defect without pulling the surrounding muscle tissue together. This significantly reduces the risk of the hernia returning. Primary closure, or non-mesh repair, involves stitching the edges of the muscle defect together. Because the tension created by this method can lead to higher recurrence rates, it is generally reserved for very small hernias or when mesh is contraindicated.
What Happens After Surgery
The recovery period varies depending on the type of hernia and the surgical technique used. Patients are often discharged on the same day as the procedure. Post-operative instructions generally include restrictions on physical activity, with most surgeons advising against lifting anything heavier than 15 to 20 pounds for at least two to four weeks to allow the repair site to heal fully. Patients must avoid driving while taking prescription narcotic pain medication and wait until they can perform an emergency stop without pain. Follow-up appointments monitor the surgical site for signs of infection, such as fever, excessive drainage, or worsening pain.
While recurrence rates are low with modern techniques, patients must watch for a return of the bulge or a new lump at the surgical site. This necessitates immediate medical re-evaluation.