Q. What is a hernia?

A. A hernia is a defect in the abdominal musculature which allows the abdominal contents to bulge out through the hernia.  A groin hernia may occur in the direct inguinal, indirect inguinal, or femoral region.

Q. What causes a hernia?

A. Hernias occur due to a combination of intrinsic weakness of the connective tissue fibers in the groin called the fascia, and breakdown of these fibers due to excessive stresses placed on the abdominal wall while lifting, coughing, or straining.

Q. Are there exercises to fix or prevent hernias?

A. Hernias are due to a breakdown of the fascia, not weakness of the muscles. Exercises to strengthen the abdominal muscles wont fix a hernia. The only way to fix a hernia is with a surgical repair.

Q. How is a hernia repaired?

A. Hernia surgery is generally done as an outpatient, with surgery in the morning or

early afternoon, and discharge later that day.  Many different surgeries have been devised to repair groin hernias, and there are a variety of expert opinions regarding how to repair hernias. Currently, many surgeons repair hernias in an "open" fashion by making an incision over the groin and reinforcing the abdominal wall by suturing a synthetic mesh to the outside of the abdominal wall or by sewing the muscles around the hernia together. Another open technique begins with the same incision but continues through the abdominal muscles where the surgeon sutures the mesh to the inside of the abdominal wall.

A laparoscopic hernia repair involves securing a slightly larger piece of mesh behind the abdominal wall muscles but in of front of the peritoneal sac which contains the intestines. In the same way that there are different types open hernia repairs, there are different types of laparoscopic repairs. In general, a laparoscopic repair is done through three small incisions in the midline, near the belly button and the pubis bone.

Q. What is the best way to repair a hernia?

A. There continues to be a variety of opinions among surgical experts about the "best" way to repair a hernia.  Currently, for most patients, I recommend a laparoscopic preperitoneal repair, based on the repair developed by a French surgeon named Rene Stoppa.  This procedure was developed initially to repair problem recurrent hernias, but has been adapted for repair of all groin hernias via laparoscopy. 

The advantages of this laparoscopic repair include:

• Less post-operative pain than conventional open hernia repair.
• Faster return to normal activity compared to conventional open hernia repair.
• Low short-term recurrence rates in our experience and the surgical literature
• Low long-term recurrence rates since the mesh is secured primarily by the force of the peritoneal sac and intestines pushing against it, rather than sutures in the fascia which may eventually pull through. Since the Stoppa repair was designed for problem recurrent hernias, the technique should minimize the chance of developing one

The disadvantages of this repair are:

• Need for general anesthesia.
• Increased technical demands of the repair. Not every surgeon has the experience or skills to perform the repair laparoscopically.

Q. How is laparoscopic hernia repair performed?

A. After the patient is under anesthesia, a small incision about inches is made next to the bellybutton. The laparoscope is placed through this incision. Two other small incisions between and inches are placed directly below the bellybutton about half way down to the pubic bone. The surgeon places operating instruments through these incisions, and after dissecting off the hernia sac, places a 4" x 6" piece of polypropylene mesh through the incision by rolling it up like a rug. After unrolling the mesh, two staples are used to secure the mesh in the appropriate area. The incisions are closed with absorbable sutures and steri-strip tapes, then covered with small dressings. The operation takes under an hour for a one-sided hernia repair, and about an hour if both sides need to be repaired or if the hernia is recurrent

Q. If I have a laparoscopic hernia repair, what can I expect afterwards?

A. Laparoscopic hernia repair is done as an outpatient, though with a general anesthetic. Patients are sent home when they are eating and tolerating oral pain medications, generally two or three hours after surgery. Post-operative pain varies from individual to individual; laparoscopic hernia repair is not pain-free. Most patients abdominal muscles are sore for several days and the small incisions can be bothersome for several weeks. Many male patients find that their testicles are sore for several days after the surgery, and almost all experience a painless black and blue discoloration of the penis and scrotum that looks like a bruise. There are no restrictions on activity (including walking, going up stairs, exercise, sex, or work in or out of the home) after surgery, though most patients are mildly restricted by their post-operative pain. Patients may shower on the same day after surgery, though they should not to take a soaking bath for the first 24 hours after surgery. Dressings are removed at home on the day after surgery and the steristrips generally come off on their own during the first week after surgery.  Some patients return to full activity within the first week, though the majority require two to four weeks until full recovery. We generally recommend that patients plan for a two week recuperation, and avoid driving a car until they are pain free.

Q. What are the possible complications of laparoscopic hernia repair?

A. Most possible complications are common to both open and laparoscopic hernia repairs. These complications include:

• Recurrent hernia if the repair is done incorrectly or breaks down.
• Nerve injury resulting in groin or leg pain.
•  Injury to the blood supply of the testicle, leading to swelling. Although uncommon, severe injury can lead to permanent injury to the testicle. This is more common for recurrent hernias.
• Difficulty urinating for the first 24 hours after surgery.

Almost all complications of laparoscopic hernia repair can be avoided by an experienced laparoscopic surgeon through careful pre-operative planning and meticulous surgical technique.  However, even the best of surgeons cannot always avoid complications. Possible complications specific to laparoscopic hernia repair include:

• Complications of general anesthesia.
• Injury to blood vessels or internal organs, the peritoneal sac, or its contents.