Hernias / Abdominal Wall Reconstruction
The term "hernia" refers to a 'hole'. They can be in various locations of the abdomen (ventral hernia), the groin (inguinal or femoral), or at previous surgical sites.
The risk of any hernia regardless of location is incarceration or strangulation. That implies something from within the abdominal cavity has gone through the hole and has gotten stuck. This can then choke off the blood supply to whatever has gotten through the defect. Whether or not a patient decides to have surgery for a hernia, at least in part, should be dependent upon symptoms. Pain in the site of the bulge or intermittent nausea are the most common symptoms.
All hernias,when repaired, should be reinforced with some type of mesh. Most mesh materials are synthetic; they work very well in incorporating your tissue with them. However, there are situations where synthetic meshes cannot be used. Containdications for synthetic meshes are active infections, contaminated cases (ie. bowel perforations), or certain previous infections due to the high risk of infecting the new mesh. For these patients, biologic materials can be used. These are primarily porcine dermis products ('pig skin'). These products will not prevent an infection from occuring, but if one occurs, most of the time these products will not have to be removed.
No one technique is ideal for all patients. Some repairs can be done laparoscopicaly, others can not. A thorough discussion with you surgeon is extremely important regarding your lifestyle, activity level, and overall risk factors(obesity, smoking, COPD, and the number of previous repairs).
Frequently Asked Questions
- What is a Hernia?
- A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.
- I have an inguinal hernia. It doesn't hurt and I'm very active. Do I need to have this repaired?
- Not really. Your risk of developing a strangulated hernia requiring emergent surgery is extremely small. However, hernias will not go away and evetually may cause discomfort, so there is nothing wrong with getting it fixed electively at your convience
- I underwent surgery for colon cancer and developed a large, symptomatic incisional hernia. After my surgery, I developed a bad wound infection as well. I would like to have this repaired but I'm afraid of getting another wound infection.
- The problem with previous abdominal infections is that patients are much more likely to develope subsequent infections following surgery(up to a 30% increase) This is a bigger problem in hernia repairs where mesh needs to be placed. The usual mesh we use is a synthetic mesh and not a good option in patients with previous infections. If you get a recurrent infection when a synthetic mesh has been placed,that mesh will have to be removed in the majority of cases. A better repair alternative for reinforcement is a biologic material. Porcine dermis(pig skin) seems to work the best in both prevention of reoccurrences and being able to weather an infection without removal.