A hernia repair, also known as herniorrhaphy, is the surgical procedure to fix a hernia. A hernia occurs when part of an internal organ or body part protrudes into an area where it should not. The most common hernias occur when a piece of intestine or fat pokes through a weak area in the muscular wall of the abdomen. This causes an abnormal bulge under the skin of the abdomen, usually near the groin or navel.

There are two kinds of hernia repair:

• Traditional (open) hernia repair � The surgeon cuts open the skin and fixes the hernia through an opening that is several inches long.
  
• Laparoscopic hernia repair � In this less-invasive procedure, the surgeon makes several small holes in the skin, and inserts a laparoscope (a telescope-like instrument with a camera for viewing inside the abdomen) and long-handled surgical instruments for carrying out the surgery.

More than 700,000 groin (inguinal) hernias are repaired each year in the United States, and additional hernia repair procedures are done to correct hernias in other parts of the body. For most people, a hernia repair does not require overnight hospitalization. Occasionally, people with other serious medical conditions will need a brief hospital stay.

Although there are many different types of hernias, the most common occurs when a portion of the intestine or a bit of fat pokes through an area of weakness in the muscular wall of the abdomen. This causes an abnormal bulge under the skin, often near the groin or the navel. Men are much more likely than women to develop groin hernias. In men there is normally a small hole or defect in the abdominal wall in the groin, where the cord to the testicle passes through. If this defect enlarges abnormally, it can lead to a hernia there.

Hernias can cause pain or pressure or can appear as a painless lump. Most hernias become larger over time and will not permanently resolve on their own. There is a small risk that part of the bowel could get trapped within the hernia, which could lead to a medical emergency. Not all hernias need to be repaired, but you may choose to have surgery if:

• The hernia is causing discomfort or limiting your activities.
• The hernia is growing larger.
• You or your doctor are worried about the risk of the bowel getting trapped.

Most hernias are diagnosed during an office visit with your doctor, and surgery will be planned at a later time, at your convenience. Your doctor will review your medical history and examine you. If there is any chance you might be pregnant, you should inform your doctor before surgery. Your doctor may order certain tests, such as blood tests or an electrocardiogram (EKG) , to make sure that you can undergo surgery safely. About one week before your hernia repair, your doctor may ask you to stop taking aspirin and other medications that could increase the risk of bleeding. You will be asked not to eat or drink anything beginning the night before surgery (except medicines), to reduce the risk of vomiting during surgery.

On the day of your surgery, you should wear loose-fitting clothing. Ask your doctor if you should take your regular medications with a sip of water. You also should make necessary arrangements for someone to drive you home after the surgery.

Hernia repair can be done under different kinds of anesthesia, including general anesthesia, in which you are unconscious during the procedure; and spinal, regional or local anesthesia, in which you are awake but pain is blocked in the area of surgery. An intravenous line is inserted into one of your veins to deliver fluids and medications. The procedure generally takes less than one or two hours to do.

• Traditional hernia repair � In a traditional repair, the surgeon makes an incision several inches long near the hernia. Once the surgeon can clearly see the herniated body part (usually a portion of intestine) he or she gently pushes it back into its proper place. Then the weakness or hole in the abdominal wall is repaired with stitches. Finally, the outer skin incision is closed with stitches.
  
  Surgeons frequently use a synthetic mesh patch to repair hernias. These patches may reduce the tension on the repair, and may reduce pain and make it less likely that your hernia will come back in the future. On the other hand, mesh patches may slightly increase the possibility of scarring or infection.



• Laparoscopic hernia repair � In a laparoscopic repair, a harmless gas is injected into your abdomen to inflate it. This gives your surgeon more room to work and a better view. Next, the laparoscope is inserted through a small incision at your navel. Other surgical instruments, such as tools for cutting and stapling, are inserted in several other small incisions in the abdomen. A camera on the laparoscope transmits images from your abdomen to a viewing screen, to guide the surgeon in using the surgical instruments. The surgeon gently pulls the herniated body part back into its proper place, and then positions a mesh patch over the weakness in your abdominal wall. The patch is secured in place with harmless staples, surgical clips or stitches. At the end of the procedure, your abdomen is deflated and the small incisions are closed with sutures or surgical tape.
  
  Only some surgeons do laparoscopic hernia repair. This is a relatively new procedure, and not all surgeons are convinced that it is better than the traditional surgery. A recent major study that compared traditional and laparoscopic repair for groin hernias found that traditional repairs had better long-term success and resulted in fewer complications, but that laparoscopic surgery caused less pain and allowed people to return to their usual activities more quickly. Traditional hernia repair can be done with the patient under local anesthesia, but laparoscopic repair requires general anesthesia.

After surgery, you will be monitored closely and given pain medication. Most people recover within a few hours and can go home the same day.

Most people can return to desk work, driving and other light activities within a few days of surgery. If you work at a more physical job, you may need to wait for two weeks or more.

You will visit your doctor for follow-up some weeks after surgery. Your doctor will remove any stitches and check the healing of your incisions. You also should speak with your doctor about when you can resume specific activities such as sports, heavy labor and lifting.

Hernia repair is generally very safe surgery. Nevertheless, there is always a small risk of complications including infection, excessive bleeding, blood clots, or injury to the intestine, testicle or other nearby structures.

In children, hernia repair has long-term success in 99 percent of cases. Typically, in adults, the hernia returns in less than 10 percent of people. The rate can be higher in some special situations, however.

Once you return home, call your doctor immediately if:

• You have a fever.
• Your incision becomes red, swollen and tender or it oozes blood.
• You have severe pain or swelling near the location of the surgery.

American College of Surgeons (ACS)
633 North Saint Clair St.
Chicago, IL 60611-3211
Phone: 312-202-5000
Toll-Free: 1-800-621-4111
http://www.facs.org/