Hernia Repair Surgery

Hernia Repair Surgery

Hernia Repair

Hernias come in many shapes and sizes. They occur in many different sites and different circumstances. Basically, a hernia occurs when something pushes through a natural barrier to a place where it does not belong. The defect created when this happens does not heal by itself. It requires hernia repair surgery to close the opening. In some cases the material which pushes through the defect, goes back to where it belongs leaving only the defect. In others the material becomes trapped or “incarcerated” in the defect. In the worst case, the trapped material may have its blood supply cut off and become “strangulated”. In this circumstance the situation becomes an emergency and requires surgery right away.


Inguinal Hernia

This is the classic “groin” hernia which is most common in men. It can also occur in women but is less common. It involves material from inside the abdomen and pelvis which pushes through one or more layers of the abdominal wall. It is usually caused by lifting or exertion. The area involved is always the same and is naturally the weakest part of the abdominal wall. The material in the hernia is usually fat, but can be the intestine or bladder. There are two types, direct and indirect. Indirect is more likely to have been present from a young age. Direct is more likely due to age and weakened tissue. Both are treated the same way and the difference is generally only of interest to the surgeons. An inguinal hernia is usually identifiable by a bulge in the lower abdominal wall and may extend into the scrotum. Inguinal hernias do not get better with medication or by themselves. They enlarge. They require repair when they are painful, cause constipation or vomiting.

Ventral Hernia

This refers to any hernia which occurs in the midline of the belly wall. They will typically happen in the area between the belly button and the bottom of the rib cage. They can contain many different types of items and as with others, should be repaired to prevent bigger problems from happening.

Incisional Hernia

This is a weakness which happens in an area of a prior scar. Scar tissue is NEVER as strong as normal tissue and if you are unlucky, old incisions can develop weak areas. Whatever organs exist below the scar can become entrapped, or the area can simply continue to get weaker and larger leading to an uncomfortable bulge. NOTE: In each of the above situations, there are a variety of ways to perform the hernia repair. Sometimes “open” repair is recommended. In others, a laparoscopic approach may be recommended. It depends on the surgeon and the setting. There are times where suture material is used alone. There are others where a mesh support is used in addition to sutures for added support. Our surgeons are experts in these techniques and will advise you of which is best for your situation and why.

Hiatal Hernia

This is a different type of hernia because it is not associated with the abdominal wall and not externally detectable. A hiatus hernia happens at the diaphragm inside the belly. Pressure against the organs inside the abdomen can actually push the stomach up through the diaphragm muscles causing this problem. Because they are overweight, this is common in our patients. Approximately 30% of patients having bariatric surgery will have a hiatal hernia. Most people do not even know it is present. Some people will have symptoms of reflux or heartburn associated with it. We repair a hiatal hernia when we identify it in all patients, overweight or normal weight. Not repairing this can lead to eventual full herniation and entrapment of the stomach in the chest. This is an emergency. It can also lead to other problems including chronic changes in the esophagus and possible cancer. Generally, after we repair the problem, reflux and heartburn symptoms go away completely. Most patients no longer require any heartburn medications.

Internal Hernia

This is unique to people who have had previous abdominal surgery. It happens when a loop of intestine becomes trapped leading to a bowel obstruction. The usual causes are adhesions from prior surgery (scar inside the abdomen) which create spaces where things can become trapped or open sections of the mesentery of the intestine. At the NJ Bariatric Institute, by far the most common reason for internal hernias is exceptional weight loss. When patients are obese and have surgery, there is very little space in the abdomen. When they lose their weight, the fatty tissue melts away and leaves much more room for intestinal movement than was present previously. The weight loss also allows the tissues not to be pressed tightly together. When things separate, new openings can occur and occasionally, the intestine can become trapped. It happens in a small number of patients, but is best diagnosed by Bariatric professionals. Blood tests, x ray studies and even CT Scans are notoriously unreliable. Pain is the first sign. Whenever a patient experiences new abdominal pain they should call for surgical advice FIRST! Call us; it could save your life.

If you would like more information or like to schedule a consultation for hernia repair surgery call us at 973-437-8700