Treatment of a Hernia
Non-surgical options for the treatment of a hernia may involve “watchful waiting," with perhaps the physical support of wearable devices such as trusses, corsets, or binders. This is particularly true if the patient’s hernia is not getting larger or causing any pain or discomfort.12
Surgery is the only way to repair a hernia, by restoring the anatomy, and is often necessary for hernias in women and those that cause symptoms in men. In fact, over a million hernia repair surgeries are performed each year in the United States.13
Hernia Repair in Adults
There are several surgical options that a healthcare provider may consider for patients with hernias:
Traditional open surgery may be performed in certain cases such as those in which previous surgery (e.g. cesarean section, hysterectomy or previous hernia in the same area) has caused scar tissue and fibrosis making visualization and performance with minimally invasive techniques (described below) unfeasible. The surgeon may be required to open a large incision for better identification of the anatomy and to control any unexpected complications. For complicated hernias such as those involving strangulation or obstruction, emergency open surgery may be required.
Minimal invasive surgical techniques
Gaining popularity due to their advantages over open surgery, such as fewer complications, less pain and scarring, and less post-operative recovery time. For example, laparoscopic repair may only require small incisions that can be made in the abdominal wall to create space for operative repair using minimally invasive equipment.14
Single incision laparoscopic surgery (SILS™) is another form of laparoscopic surgery repair for hernia which is performed through the navel. It is less invasive than the traditional laparoscopic repair and may result in minimizing the risk of complications.15
Robotic hernia repair
Widely considered to be a safe and effective surgical option. A specialized robot allows 3D visualization of the surgical field and accurate control of the surgical tools.
Surgeons may also opt for the use of surgical mesh to strengthen the hernia repair and reduce the rate of recurrence. Surgical mesh may also provide additional benefits such as improving patient outcome by minimizing operative time and reducing recovery time.16
- Beadles CA, Meagher AD, Charles AG. Trends in Emergent Hernia Repair in the United States. JAMA Surg.2015;150(3):194-200.
- Chan Y, Durbin-Johnson B, Kurzrock EA. Pediatric inguinal and scrotal surgery – Practice patterns in in U.S. academic centers. J Pediatr Surg. 2016 Nov;51(11):1786-1790.
- Kahrilas PJ, Kim HC, Pandolfino JC. Approaches to the diagnosis and grading of hiatal hernia. Best Practice & Research Clinical Gastroenterology. Volume 22, Issue 4, August 2008, pp 601–616.
- Lomanto D, Shabbir IA, Cheah WK. Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surgical Endoscopy and Other Interventional Techniques. July 2006, Volume 20, Issue 7, pp 1030–1035.
- Pediatric Umbilical Hernia Repair. American College of Surgeons Division of Education. Reviewed April 2013.
- Mudge M, Hughes LE. Incisional hernia: A 10 year prospective study of incidence and attitudes. British Journal of Surgery. January 1985, Volume 72, Issue 1.
- Inguinal hernia repair: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved November 09, 2016, from https://medlineplus.gov/ency/article/007406.htm
- Kovachev, L.S. (2014) The Femoral Hernia: Some Necessary Additions. International Journal of Clinical Medicine, 5, 752-765.
- Pluta RM, Burke AE, Golub RM. Abdominal Hernia. JAMA. 2011;305(20):2130.
- Jones D. Anatomy and pathophysiology of hernias. In: Fischer J, ed. Hernia: Master of techniques in surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:1-6.
- Incarcerated and Strangulated Hernias in Children. A Statistical Study of High-Risk Factors Arch Surg. 1970;101(2):136-139.
- Fitzgibbons Jr RB, Ramanan B, Arya S. Long-term results of a randomized controlled trial of a non-operative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Annals of Surgery. Volume 258(3), September 2013, pp 508–515.
- de Sá Ribeiro, F.A., de Araujo Fernandes, B. and de Araujo Simões Corrêa, J.P. (2014) Inguinal Hernia Repair with Local Anesthesia in the Outpatient—10 Year Experience. International Journal of Clinical Medicine, 5, 644-649.
- Nawaz T, Ayub MW, Murad F, Ali Q, Khan A, Anwar I. Comparison of laparoscopic total extra peritoneal (TEP) techniques versus transabdominal preperitoneal (TAPP) technique for inguinal hernia repair 2005, Issue 1. Journal of Rawalpindi Medical College (JRMC); 2015;19(3):220-222.
- Tran H. Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. Journal of the Society of Laparoendoscopic Surgeons. 2011;15(1), pp 47-52.
- Arcerito M, Changchien E, Bernal O, Konkoly-Thege A, Moon J. Robotic inguinal hernia repair: technique and early experience. Am Surg. 2016 Oct;82(10), pp 1014-1017.