Metro Bariatrics - Amir Moazzez MD, FACS

Hernias

A hernia is an abnormal protrusion of contents from one space to another through a defect or a hole. The type of hernia is named based upon the location. Most patients feel a soft, pliable mass or a bulge. This mass or bulge is referred to as the hernia which contains intra-abdominal contents: fatty tissue, intestines, organs, etc. As long as you are able to push or reduce the contents, this is referred to as reducible. However, when the bulge is fixed and tender to touch, the hernia becomes incarcerated (as going to jail). This hernia must be repaired urgently to prevent the contents from being strangulated. A strangulated hernia is one when the blood supply is cut off causing ischemia or gangrene. If this is not dealt with emergently, the patient would become septic. We repair hernias to prevent incarceration and/or strangulation.

Most patients are either diagnosed with a hernia by their primary care physician or by themselves. They see a bulge. Sometimes patients feel pain in the area, especially in the groin region. These usually represent muscle or tendon injury rather than a hernia. Your physician will be able to distinguish between the two. If the diagnosis is uncertain, re-examination may be necessary or performing a CT scan of the abdomen and pelvis may be required.

Treatment: The natural history for hernias is to increase in size over time. Hernias do not spontaneously resolve; they require repair. Surgical repair consists of reducing the contents of the hernia, and then closing with reinforcements (i.e. mesh). Mesh is used to reinforce the repair to prevent recurrences. The surgery is performed via an open or laparoscopic approach.

Types of Hernias:

Types of repairs: Laparoscopic or open. The traditional repair for hernias is the open method. An incision is made over the hernia, the defect is dissected, and then the defect is closed with mesh. Mesh is a prosthesis which bridges the gap and reinforces the repair thus reducing the recurrence rates. The advantage of laparoscopic repairs are not just smaller incisions and faster return to activities, but several studies have suggested lower recurrence rates and a better repair. Instead of an incision over the defect, smaller incisions (2-4 1/2cm incisions) are made to enter the space, inflate with CO2 gas, reduce the contents of the hernia, and then place mesh covering the defect with plenty of overlap. There are less wound care issues, better recovery rates, and less need pain medications.