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Procedure
Surgery is the best treatment for a hernia. The physician may advise that a supportive corset or truss be worn until you have the operation, but this is usually only a temporary measure.
Surgeons today perform a variety of techniques to repair hernias. It is important that you discuss with your doctor the type of repair that is right for you. Some of the more common techniques are described below:
The conventional method: This procedure is called herniorrhaphy and involves giving a local or general anesthetic, making a small incision over the hernia, pushing the bulging tissue back into place and removing the hernia sac. The muscles or similar tissues are then sewn together firmly over the hernial orifice.
Typical recovery time to return to normal activities is four to six weeks for hernias resulting from stress or strain. The chance that the hernia will reappear can be as much as 10-15 percent. The surgery is usually performed on an outpatient basis, but sometimes the physician will recommend a one or two day stay.
If the surgery is elective, the patient is usually in good physical condition so there are no specific preoperative measures to follow. The routine preoperative preparation will be provided. If necessary an I.V. (intravenous) line will be started and you will be given analgesics for pain. Many physicians do prescribe perioperative antibiotics prophylactically to reduce the risk of postoperative infection.
The tension-free mesh technique. Under local anesthesia, a small incision is made over the site of the hernia. The bulge is returned to where it belongs and a piece of mesh is placed at the opening of the tissue. This is firmly held in place and the outer incision closed. Over time the muscles and tendons send out fibrous tissue which grows around and through the mesh.
This surgery is also an outpatient procedure, and usually takes less than an hour. After about 45 minutes it is quite common for the patient to be able to get up, go up and down stairs, go for a walk, and even ride an exercise bicycle.
Returning to normal activity depends upon a number of factors. Typically the patient can return to "office" routines in about three days and "physical" occupations within two (2) weeks.
The tension-free mesh/plug technique: This technique is performed under local anesthetic and through a small incision the surgeon inserts a mesh/plug combination. The tapered shape of the plug fills the hole like a cork in a bottle. A second piece of flat mesh is placed over the plug to help prevent future hernias at the same site. Like the tension-free mesh only technique, the tissues will grow around and through the mesh.
The laparoscopic method: The procedure requires only two small punctures of the abdomen at a site remote from the defect. Then the surgeon insufflates the abdomen with carbon dioxide or nitrous oxide, creating a balloon-like space in which to work. Then he inserts the laparoscope (a tube with a small camera on the end) through the navel by using a trocar (an instrument that withdraws fluid) and cannula (a tube). The surgeon locates the hernia and inserts a stapling device through a second cannula. The device has forceps to grip and immobilize the hernia orifice and a stapling mechanism to seal the orifice. After complete closure with as many staples as required, the instruments are removed and the abdominal puncture wounds closed with one or two sutures.
This procedure can be done on an outpatient basis, in contrast with the traditional operation which required an hour of operating time, one or two day in-patient stay, and six weeks until full recovery.
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