About Your Surgery
Hernia repair has been around for a long time. That means traditional techniques have been perfected while new options and materials have been developed. While not every technique is right for every hernia, they all have common goals: to provide the strongest repair and least chance of recurrence with the least possible discomfort and quickest recovery.
Your (Grand) Father's Hernia Repair: Open Tension Repair
Until about 25 years ago, hernias were repaired one way, referred to as 'open tension' repair. Here's what that means:
- Open – An incision of 3" to 6" is made in the abdomen to give the surgeon access to the hernia.
- Tension – The edges of healthy tissue around the hernia are pulled together and sewn with sutures.
- The incision is then closed with dissolving sutures or abdominal adhesive.
This method has been tried and true for decades and may be the only way to repair a very large hernia. The incision tends to be painful and recovery can take as long as five to six weeks. The incision also leaves a scar, although it's usually very low on the abdomen. Tension repair has a higher recurrence rate than non-tension, or mesh, repair.
Today's Hernia Repair Options – The Best Reason to Fix Your Hernia Early!
Today's hernia repair options include new techniques and materials that can make surgery less invasive, recovery faster and recurrence less likely. And the smaller your hernia (meaning the earlier you fix it), the more options you're likely to have.
Non-Tension or Mesh Repair
Non-tension means just that. Instead of pulling the tissue around the hernia together, a piece of mesh is positioned to reinforce the area and fixed in place with sutures and/or staples.
The mesh is made of a flexible material that stays in the abdomen and encourages new tissue to grow into it.
Mesh repair has a lower incidence of recurrence than tension repair. There are also different kinds of mesh, including patches, plugs, three-dimensional, expanding, self-absorbing, and even self-gripping mesh that requires little or no sutures to keep it in place. A surgeon who specializes in hernia repair is most likely to have experience using the latest procedures. Ask which ones he or she uses, which may be best for you, and why. Sometimes the best procedure for you is the one with which your surgeon has the most experience and is most comfortable. Don't hesitate to ask!
Laparoscopic or Closed Repair
Many inguinal hernias can be repaired using a 'closed' or laparoscopic procedure – especially when they're smaller. Laparoscopic repair entails inserting special instruments through tiny incisions in the abdomen through which the surgeon is able to visualize and perform the procedure. Laparoscopic repair uses mesh for reinforcement, so it has a lower recurrence rate. Plus, smaller incisions mean less discomfort after surgery, little to no scarring, and a quicker return to normal activity. Many people return to work within a few days.
How It Works
- Your surgeon makes three or four ¼" to ½" incisions in your abdomen. One is near your navel and the others lower down.
- A laparoscope, a fiber-optic tube with a tiny camera on the end, is inserted through one of the openings, allowing the surgeon to visualize the area on a TV monitor.
- The surgeon performs the procedure using tiny surgical instruments inserted through the other openings while viewing it on the TV monitor. The mesh is positioned and fastened in place with sutures and/or staples.
- The instruments are removed and the holes are closed with a stitch or two or with surgical tape.
While open hernia repair may be done under general, regional (spinal), or even local anesthesia with sedation, laparoscopic hernia repair is always done under general anesthesia. If the idea of general anesthesia makes you nervous, it shouldn't. General anesthesia is really extraordinarily safe with today's precise administration and monitoring. Your anesthesiologist is present throughout your surgery and monitors you continuously. When your procedure is finished and the anesthesia is stopped, you'll wake up very quickly.
And if you're concerned about side effects from general anesthesia, such as nausea and vomiting or headaches, you should know these are rare; the exception rather than the rule. Even if you're having open repair, your surgeon may prefer to perform the surgery with general anesthesia. It may be easier and more comfortable for you, too. After all, what's easier than going to sleep, waking up and…it's done?
Before Your Surgery
A few days before surgery, your surgeon may order a pre-op exam consisting of blood tests, an EKG (electrocardiogram) and a chest X-ray, to be sure your heart and lungs are in good condition. You may be instructed to stop taking some over-the-counter medications for a week to 10 days before surgery, such as aspirin or ibuprofen (Advil), which can increase bleeding. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. You may also be given a prescription for pain medication to take after surgery, in case you need it. Fill it before your surgery, so you don't have to think about it after.
The Day of Surgery
- You'll arrive at the hospital the morning of your surgery; you'll sign consent forms, change into a hospital cap and gown, have your blood pressure taken, and be started on an IV (intravenous line). The area of your hernia may need to be scrubbed and shaved to guard against infection.
- The anesthesiologist will meet with you and review the type of anesthesia you and your surgeon have decided on. You'll be given medication to relax you (aka the "I don't care medicine," because you won't…).
- Next you'll be taken to the operating room, your anesthesia will be administered and the next thing you know...
That's It – You're Done.
You'll be waking up in the recovery room with your surgery behind you. Sound easier than dealing with your hernia? It is. Now you can concentrate on your recovery and getting back to your life.