In general, people will wait until they are in pain before consulting a surgeon regarding a hernia. Why? Reasons can range from the incorrect assumption that if it doesn’t hurt, it can’t be that bad, to the recent recall of and legal challenges of certain mesh products used in hernia surgeries.
Dr. Guillermo Portillo is a general laparoscopic and bariatric surgeon with the Baptist Medical Center in San Antonio. He specializes in many advanced and complex diseases, and he offers his advice on when, and how, to proceed with hernia repair surgery.
TXMD: What exactly is a hernia?
Dr. Portillo: A hernia is a condition that occurs when an organ or fatty tissue protrudes through a weak spot in the surrounding muscle. Abdominal hernias can occur anywhere there is a weakness in the abdominal wall, but they are most common in the navel and groin areas. They can also occur along areas where a previous surgical incision was made.
TXMD: What are the symptoms of a hernia?
Dr. Portillo: The symptoms can range from a painless bulge, which may occasionally disappear, to a firm, painful lump, which does not resolve and is more serious. If a segment of intestine becomes trapped in the hernia, it can lead to obstructive symptoms including severe abdominal pain, bloating and vomiting.
TXMD: What are the most common causes of a hernia?
Dr. Portillo: Hernias are caused by increased abdominal pressure being placed on a weak area of the abdominal muscle.Obesity, over exertion in lifting heavy objects, chronic constipation, coughing, sneezing, and urinary retention can all cause excessive pressure on the abdominal muscles over time.
TXMD: Are there treatment options other than surgery?
Dr. Portillo: Aside from those occurring in infancy, hernias will not resolve spontaneously and will only become larger and usually more symptomatic with time. A patient can wear a compressive garment called a hernia truss, which keeps the bulge reduced or flat, to relieve discomfort. However, the truss is not a recommended long-term substitution for definitive repair, and it may cause the condition to progress. The only way that definitive repairs of hernias can be accomplished is through surgical repair of the defect in the muscle, usually with mesh.
TXMD: There is some controversy surrounding the use of mesh. Is it a safe material?
Dr. Portillo: The great majority of synthetic mesh is extremely safe, and the use of mesh has significantly reduced the recurrence rate of hernias when compared with the primary closure of the hernia defect without mesh. The majority of hernia recurrences after mesh repair are likely multifactorial and not the result of a defective mesh product.
TXMD: What is involved in a hernia repair surgery?
Dr. Portillo: The majority of hernia surgeries can be accomplished as an outpatient, especially when the hernia is diagnosed and treated early. It can be performed in the traditional method, where an incision is placed directly over the hernia and a synthetic barrier is used to patch, or by the less invasive, laparoscopic method. More recently, robotic surgery is being utilized in hernia repair and may be associated with less post-operative pain.
“Poor nutrition, smoking, and deconditioning can all weaken muscles and make hernias more likely”
TXMD: What are the risks or complications of hernia surgery?
Dr. Portillo: In general, hernia surgery is very safe and carries minimal risks. Rarely, complications can include minor issues such as post-operative fluid collections or wound infections. When diagnosed and treated in a timely manner, there are usually no long-term side effects should those complications arise.
TXMD: What is the recovery time and protocol?
Dr. Portillo: Most people can return to desk work, driving, and other light activities within a few days of surgery. Any heavy lifting or activities that place strain on the abdominal wall should be avoided for two weeks. After that time, the patient can slowly resume normal activities.
TXMD: Are certain people more at risk for hernias than others?
Dr. Portillo: Poor nutrition, smoking, and deconditioning can all weaken muscles and make hernias more likely. Anything that causes an increase in pressure in the abdomen — including obesity, heavy lifting, diarrhea or constipation, or persistent coughing and sneezing — can then cause a hernia. People who have had prior abdominal surgery are also at risk.
TXMD: If a person suspects a hernia, what should they do?
Dr. Portillo: In general, all hernias, whether symptomatic or not, should be evaluated by a surgeon to determine if repair would be beneficial. Many patients with painless hernias do not seek treatment. However, pain usually indicates progression of the hernia, and it can be a sign of severe complications requiring a more emergent and extensive surgical procedure. These complications are easily preventable through a straight-forward, low-risk surgery when the hernia is treated early.
Dr. Portillo specializes in advanced laparoscopic surgery, advanced minimally invasive surgery, bariatric surgery androbotic surgery. For more information call 210.228.9605 or email him at gxportil@baptisthealthsystem.com.
For more information on BHS Physicians Network, please contact Julie Minnick at jaminnic@baptisthealthsystem.com.
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