INGUINAL HERNIA REPAIR
A hernia is simply a defect in the wall of your abdomen. Inguinal hernias occur in your groin primarily from a congenital weakness in the coating of your muscle called the fascia. Heavy lifting and straining can cause this weakness to give way, or it can just occur slowly over time. Hernias do not heal themselves and once formed only get larger and more troublesome. However, it is safe to watch small hernias that are not causing any symptoms. Symptoms are typically pain, often with certain activities but also at rest. The pain is usually in the groin but can also travel down the inside of the leg or in to the testicle. Any hernia causing pain needs to be fixed.
OPTIONS FOR REPAIR
There are many different approaches to fixing a hernia and Dr. Thoman has performed all of them. The two main categories are OPEN or LAPAROSCOPIC.
OPEN INGUINAL HERNIA REPAIR
An incision is made in the groin, the hernia sac is reduced and a mesh screen is sewn into the muscle to strengthen the area. The advantage is any general surgeon can perform this operation and it can be done by numbing the area and avoiding general anesthesia. The disadvantage is there is a higher risk of wound infections and injury to the nerves as well as more pain then with the minimally invasive approach.
LAPAROSCOPIC HERNIA REPAIR
The space under the muscle is accessed with a balloon and then inflated with CO2 gas to create a working space as shown below:
There are multiple areas of weakness that are reinforced with a 6 x 6 inch lightweight plastic screen. If the defect is large the screen is anchored to the bone with tiny titanium screws that will not set off alarms or interfere with an MRI. These are necessary around 25% of the time. While Dr. Thoman has performed over 2000 laparoscopic hernia repairs, for the last 500 he has used a proprietary design that involves a suturing process to lock it in place. Typically both sides can be repaired in less than 30 minutes. The advantages of the laparoscopic approach include less pain, fewer wound complications, faster return to full activity and less chance of nerve injury. The only disadvantage is it requires a full general anesthetic.
Regardless of approach, hernia surgery can almost always be performed outpatient in around 3 hours including preparation, surgery and recovery. A local anesthetic is injected at surgery and pain is usually not excessive. Around 50% of patients never take narcotic pain medicine. A prescription is given and filled if needed. We recommend using Ibuprofen or Naproxen for several days. Ice or heat could be applied based on comfort. Bruising and swelling is expected and always resolves eventually. Ambulating is encouraged right away, but lifting or straining should be avoided. A general guide is no lifting more than 10 pounds for 2 weeks. In 5 or 6 days most people can return to light aerobic activity such as swimming or biking.