1. Inguinal hernia repair:
There are two surgical methods for inguinal hernia repair–
Open Technique:
The most traditional and still the most common technique is to make an incision over the bulge and isolate the hernia. In the last 20 years it has become common to use a mesh to repair the weak tissue around the hernia. The advantages of this technique are that surgeons have used it on hundreds of thousands of patients and it most often can be done under local anesthesia. The disadvantage is that it is very painful during the first two days after surgery and it takes about 4 weeks to return to heavy activity, including physical jobs. In children, young adults, and most women, mesh is not used in the repair. In these patients a strong repair can be achieved with stitches alone.
Laparoscopic Technique:
In appropriate patients, repair of the hernia can be done from inside the abdomen with a laparoscope. This instrument is about as big around as the tip of your little finger, and has a lens with a light at its tip. The operation is done under general anesthesia. The advantages of this technique are that there is less pain in the first 2 days, the return to normal activity is about 2-3 weeks, and that it may be suitable in persons who are overweight. It is an excellent operation for patients who have hernias on both sides and hernias that have recurred following an open repair. The disadvantages are you need to be asleep for the operation and there is a small risk of damage inside the abdomen. The operation is more difficult to learn and is done by only a small group of surgeons, including Dr. Blair.
2. Umbilical hernia repair:
Most umbilical hernias are repaired as day surgery, either with local anesthetic and sedation, or general anesthesia. An incision is made below the umbilicus and the hole is repaired with sutures alone or with mesh. Some bruising and swelling should be expected. As with all day surgery, it is important to begin taking pain medication even before the surgery begins, and regularly after the surgery for the first two days. After resting for few days the patient can gradually return to normal activity. It takes about a month to get back to heavy physical work or exercise. Sometimes umbilical hernias can be repaired using laparoscopic technique that is done through small keyhole incisions, resulting in much less surgical trauma and postoperative pain.
3. Incisional hernia repair:
The incisional hernia may occur in the area of any prior surgical incision, anywhere on the abdomen, and can vary in size from very small, to very large and complex.
The surgery to repair it is done using general anesthetic and requires that the patient will be admitted to the hospital for up to five days. Mesh is usually part of the repair, and drains are placed in the wound for a few days to take away any fluid. As with most hernia operations it takes about a month to get back to heavy physical work or exercise. A newer approach is using the laparoscopic technique. This leads to shorter hospital stay and a faster return to normal activity.
Some hernias can be managed without an operation, particularly if they are painless. However, there is still a small risk of incarceration and care needs to be taken when performing heavy lifting. A hernia belt or truss can control the symptoms of an inguinal hernia allowing you to avoid or postpone surgery.
If you have a hernia you should consult a surgeon for assessment and advice.