Do I have to have my hernia fixed?
It depends on the type of hernia, a patient’s symptoms, whether bowel occupies the hernia space and the risk of anesthesia during the repair of the hernia.
When did you develop a special interest in hernia repair?
In the mid 90’s, I decided to refresh my knowledge of hernia repairs. I realized I was still performing the procedure as I had learned in residency. I learned that materials and techniques had both advanced in hernia repair.
Along with tutoring from other surgeons, I began attending Hernia Meetings and became an active member in the American Hernia Society.
I now present at the American Hernia Society meetings proctor other surgeons. Manufacturers request my input regarding mesh development, insertion, technique and mesh fixation.
How do you get a hernia? Or Did I do something that caused my hernia?
Most inguinal, epigastric and umbilical hernias are inherited abdominal wall defects. Incisional hernias are acquired.
Which hernias need to be repaired?
An incarcerated hernia is when contents of the abdomen go through the defect and can’t get back into the abdomen. If there is too much pressure at the hernia, than it chokes or strangles whatever contents have gotten through there. Strangulation means loss of blood flow and if it’s bowel that is strangulated, then the bowel loses blood flow and that section of bowel dies. Those hernias at risk for incarceration are the most dangerous when strangulation occurs. We hope to prevent that by encouraging the repair of those hernias on an elective basis, prior to strangulation.
In terms of dangerous hernias, there is an interesting hernia in the groin called the femoral hernia. It occurs in 3% of males and 5 to 8% of females. A femoral hernia goes through the pelvic bone along the vessels going down the vessels of the leg. Because it is a fixed defect, the risk of entrapment is about 20%. All of those have to be repaired.
The next most dangerous hernia is an umbilical hernia. We are born with those defects because that’s where the umbilical cord was. It’s also a fixed defect and the risk of incarceration is 15%.
The risk of incarceration for groin hernias is exceedingly low, only about 1 in 1,200 for inguinal hernias and a similar risk for abdominal hernias.
How long will my recovery last?
When mesh is implanted and properly fixated, there are no restrictions for any patient. I liken a hernia repair with mesh to patching a tire. A tire with a defect is patched from the inside, re inflated and put in use immediately. The tire can be used! However, tires don’t experience pain. In humans, once the hernia is repaired with mesh, the body is prepared to perform any activity: lifting, coughing, and exercising. However, humans as a result of the operation, experience the pain of the procedure. The recovery time is based on the ability to heal from the post operative pain. There is no medical justification for reducing activities or to reduce lifting for patients who want to do those activities. My observations are that patients who commit to being as active as they can be, progressing more each day, recover sooner than those that reduce their activity. My goal is that each post operative day, the patient is more active than the previous day.
In years past, surgeons advised patients not to lift for 6 weeks after hernia repair. Is that true today?
That advice was handed down generation to generation for years and years without any medical basis at all. In the years where the hernia hole/defect was closed with suture and mesh was not used, it was believed that time and restricted activity was necessary for the repair to heal. Today, better mesh with more overlap has reduced the need for any restriction of activities. Some patients with belly button hernias or hernias in the groin may be fully recovered in 3 days after their repair. Whereas, larger repairs for recurrent hernias or hernias in the abdominal wall where an incision was made for a past surgery, those patients may experience pain for up to two to three weeks. But it’s the patient that restricts the activities. Not the surgeon.
Do you repair hernias with mesh?
For inguinal hernias, the recurrence rate is 10-14% if mesh is not used.
On incisional hernias, the recurrence rate is 15% if mesh is not used.
We would like to get those recurrence rates under 5%. Hopefully, 1 to 2%.
And that’s what mesh does- by reinforcing the repair.
The American college for surgeons has stated that the standard for hernia repairs requires a piece of mesh.
Will I have long term pain after my hernia is repaired?
When surgeons first began using mesh, the end point was whether or not there was a recurrence. What we’ve learned is that using lighter weight materials can offer people low recurrence rates in addition to reducing the amount of pain long term that might occur as a result of scar tissue, mesh contracture and pain from the operation. So today’s goal is not only to maintain low recurrence rates, but to make sure that the operation itself and the materials used do not create pain.
How soon can I make an appointment?
We strive to see patients within a 2 week window.
How soon after I see Dr. Doerhoff could I schedule surgery?
We strive to schedule patients within a month of seeing the Dr. Doerhoff in consultation.