One the the most dangerous hernias is an umbilical hernia. We are born with those defects because that’s where the umbilical cord was attached in development. It is a fixed defect and the risk of incarceration is 15%. An incarcerated hernia is when contents of the abdomen go through the defect and can’t get back into the abdomen. If there’s too much pressure at the hernia, then 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.

The decision to repair the umbilical hernia laparoscopically versus open repair is made based on the size of the hernia hole. A large opening requires a larger piece of mesh and the surgery would be performed laparoscopically. If performed laparoscopically, typically patients require one to two nights in the hospital. Small defects can be repaired using mesh placed through a small incision and that is referred to as an open repair. Small defects can be repaired on an outpatient basis.

Laparoscopic repair verses open repair through an incision

For inguinal hernias in young physically active males, the likelihood for long term discomfort is lower with a laparoscopic repair than an open repair. That’s not true for older individuals. For those who have had other operations, their outcomes are very good with an open procedure. And then there are certain patients who may not have a laparoscopic procedure because of previous abdominal surgery such as a hysterectomy, prostatectomy, or colon surgery. A good hernia surgeon needs to know how to repair a hernia both laparoscopically and by open procedure. One operation doesn’t fit all hernias.