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The following hypothetical consultation about a hernia repair surgery is presented for purposes of general information. If you think you have a similar condition, please see your primary care doctor to discuss your individual case and the exams and treatments that are best for you.
Hernias affect approximately 5 million people in the United States every year. The most common type of hernia is an inguinal hernia, which occurs in about 25 percent of men and 2 percent of women. An inguinal hernia occurs when tissue protrudes through a weakness or an opening in the muscles of the abdominal wall.
Although hernias do not always require surgery, hernias do not repair themselves without surgery. Over half a million hernia repair operations were performed in this country last year. In our example, the patient is a 55-year-old man whose primary care doctor discovered the hernia and referred him to the Hernia Center to discuss surgery.
Doctor: How can I help you today?
Patient: I have two hernias and my primary care doctor says I probably need surgery.
Doctor: I see. Is this the first time you have had a hernia?
Doctor: When did you start having problems?
Patient: About six weeks ago it started hurting, and I noticed this bulge here on the left side of my belly. And then I noticed the same kind of thing on the other side, not quite as bad. I figured it was a hernia, and I went to my primary care doctor.
Doctor: And what did he say?
Patient: He said that’s what it is, and he said neither one of them is a reducible hernia, as they won’t go back in on their own.
Doctor: Have you had any difficulty urinating?
Patient: Yes, some. It is not very severe.
Doctor: How about constipation?
Patient: No, no problem there.
Doctor: Do you have any condition that causes you to do a lot of coughing?
Doctor: Have you had any recent weight gain?
Patient: Well, I’ve put on maybe twenty pounds in the last couple of years.
Doctor: Has there been any physical activity, any heavy lifting, or sudden twisting or pulling, that you might have done?
Patient: Oh, I’m always overdoing it. I might have done something, but nothing stands out.
Doctor: What kind of work do you do?
Patient: I’m a manager in a manufacturing company.
Doctor: Does it involve a fair amount of physical activity?
Patient: No, it’s pretty much a desk job.
Doctor: All right. I’d like to examine you now, and then we’ll talk about the surgery.
The doctor examines the patient, noting the presence of inguinal hernias on both sides of the patient’s groin. The hernias reduce back into the abdomen with gentle pressure. The prostate exam is normal.
Doctor: Well, as you may know, the muscles in the abdomen tend to get weaker as we age, and some people also have a weakness in the abdominal muscles that they’re born with. In any event, if you combine weaker muscles and a weight gain - which puts more strain on the muscles - and then you do some heavy lifting, you can develop a hernia.
Patient: Is surgery the only way to handle it?
Doctor: Some hernias are reducible, some aren’t. Yours is, with some effort. These are the type of hernias that cause real troubles if left alone, so we recommend an operation to fix them.
Patient: What is the surgical procedure?
Doctor: We do either a laparoscopic operation, or a standard open operation for hernia repair, depending on the patient. You are a good candidate for laparoscopic hernia repair because you have bilateral hernias - hernias on both sides. We often use mesh materials that strengthen the weakness, so it’s more secure, and it doesn’t hurt as much as pulling the muscles together primarily.
Patient: Laparoscopic surgery means a quicker recovery, doesn’t it?
Doctor: Yes, at least in terms of pain. In general, patients recover more quickly from a laparoscopic hernia repair in that they feel comfortable going back to normal activities a day or two earlier than the open-type repair.
Patient: Will I need to stay in the hospital overnight?
Doctor: No, it’s an outpatient procedure. Barring some unforeseen circumstance, you’ll go home the same day.
Patient: How long does the operation take?
Doctor: On average, a hernia repair surgery takes less than two hours.
Patient: Will there be a scar?
Doctor: There will be three very small scars with the laparoscopic hernia repair. We make three small incisions, about half an inch long: one near the belly button and two on each side right above the top of your pelvic bone. Sometimes we put them right down the middle of your belly just below the bellybutton. We insert an endoscope through one incision, and instruments through the others to do the repair.
Patient: What are the risks?
Doctor: As in any operation, there are the risks of the anesthetic. With the laparoscopic hernia repair, you will have general anesthesia, and although quite rare, there is a chance that you will have a reaction to the anesthesia or that you will have trouble breathing. If you were to have a standard hernia repair operation, you would have a local or maybe even a spinal anesthetic, which carries a slightly lower risk of major complications.
Patient: Are there other risks?
Doctor: From the hernia surgery itself, there is a very low risk of bleeding or infection, and the possibility of injury to the tissues around the hernia- for example, the intestines or the bladder. We do everything we can to minimize those risks. Infection is also a standard risk. If there is an infection, we will give you antibiotics to treat it, and though rare, the mesh may have to come out with yet another operation. There is also about a 5 percent long-term risk of hernia recurrence. That is why we want you to take it easy after surgery, so it doesn’t stress the repair until it’s strong again.
Patient: What would happen if I did not have this surgery? Can I do without it?
Doctor: The hernia will not heal on its own. The risk of not getting the hernia repaired is that it could get larger and more painful. Plus, there’ a good chance in your situation that the protruding tissue will become trapped in the future. If this happens, the blood supply to whatever is trapped may be cut off, and it could easily become gangrenous, or “dead.” In that case, it might be necessary to do emergency surgery.
Patient: I would like to avoid that. What do I need to do to prepare for the surgery?
Doctor: We’ll instruct you not to eat or drink anything after midnight before the surgery - with some exceptions. On the morning of the surgery, you can take your normal medicines with a small sip of water. You’ll come here to the hospital and you’ll need to have someone with you who will be able to drive you home after the procedure. We do the procedure in the operating room, under general anesthesia for laparoscopic surgery, and we keep you here afterward long enough to make sure that you are ready to go home. If you choose the open-type of surgical repair, you may have the option for local anesthesia and what we call “conscious sedation”- where you do your own breathing rather than have a machine breathe for you. Concious sedation may allow you to go home earlier, with less of a “hangover.”
Patient: How long does it take to recover from the surgery?
Doctor: For the first couple of days, you will be, sore and swollen. I like to describe it like this (demonstrating sore, hunched-over walking). For the first two days, you’ll probably find walking uncomfortable. After that, you’ll straighten up and have less pain. You’ll probably need pain medicine for 2-5 days. There is a wide range in what folks need for this type of operation. You should be able to drive within a few days, as soon as you’re comfortable and not taking pain medicines. Generally, it takes patients four to six weeks to return completely to their normal activities.
Patient: How soon will I be able to go back to work?
Doctor: It depends on your occupation. Patients have gone back to work as soon as the next day. In general, patients take between two and six weeks off work to recover.
Patient: Will there be any restrictions on me after the surgery?
Doctor: We tell patients not to do any heavy lifting for the full six weeks, as it might compromise the repair if you strain it earlier.
Patient: What do you consider heavy lifting?
Doctor: Anything you cannot comfortably lift at arm’s length is too heavy, and of course anything that hurts is too heavy.
Patient: What are the chances that the surgery won’t work, or that my hernia will come back?
Doctor: The surgery has a very high success rate. Only about 3 to 5 percent of patients develop another hernia after surgery.
Patient: Well, I’d like to get these taken care of. What do I need to do to set up the surgery?
Doctor: My assistant will schedule it for you and give you some written instructions to help you prepare for the surgery. Do you have any more questions about the laparoscopic versus open approach to hernia repair?
Patient: Well, what would you have if it were you in my situation?
Doctor: Great question! Considering my own personal desires and all I know about this, I’d probably have the laparoscopic surgery. But, you get to choose.
Patient: Well, I like what you’re thinking. I like the laparoscopic option too. Please tell your team that I chose the laparoscopic surgery, and I’ll coordinate my best times with your office.
Doctor: Great. I’ll next send in our nurse-educator. Let me or my office know if anything comes up that you’re not sure about, or if you have any questions at all, OK?
Patient: OK, sure. Thank you.
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