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Hernia Repair

Overview :

Hernia repairs are performed in a hospital or outpatient surgical facility by a general surgeon. Depending on the patient's age, health, and the type of hernia, patients may be able to go home the same day or may remain hospitalized for up to three to five days.

There are two types of hernia repair. A herniorrhaphy is used for simpler hernias. The intestines are returned to their proper place and the defect in the abdominal wall is mended. A hernioplasty is used for larger hernias. In this procedure, plastic or steel mesh is added to the abdominal wall to repair and reinforce the weak spot.

There are five kinds of common hernia repairs. They are named for the part of the body closest to the hernia, or bulge.

Femoral hernia repair

This procedure repairs a hernia that occurs in the groin where the thigh meets the abdomen. It is called a femoral hernia repair because it is near the spot where the femoral artery and vein pass from the leg into the trunk of the body. Sometimes this type of hernia creates a noticeable bulge.

An incision is made in the groin area. The tissues are separated from the hernia sac, and the intestines are returned to the abdomen. The area is often reinforced with webbing before it is sewn shut. The skin is closed with sutures or metal clips that can be removed in about one week.

Inguinal hernia repair

Inguinal hernia repair closes a weakness in the abdominal wall that is near the inguinal canal, the spot where the testes descend from the body into the scrotum. This type of hernia occurs in about two percent of adult males.

An incision is made in the abdomen, then the hernia is located and repaired. The surgeon must be alert not to injure the spermatic cord, the testes, or the blood supply to the testes. If the hernia is small, it is simply repaired. If it is large, the area is reinforced with mesh to prevent a recurrence. External skin sutures can be removed in about a week. Patients should not resume sexual activity until being cleared by their doctor.

Umbilical hernia repair

This procedure repairs a hernia that occurs when the intestines bulge through the abdomen wall near the navel. Umbilical hernias are most common in infants.

An incision is made near the navel. The hernia is located and the intestines are returned to the abdomen. The peritoneum is closed, then the large abdominal muscle is pulled over the weak spot in such a way as to reinforce the area. External sutures or skin clips can be removed in about 10 days.

Incisional hernia repair

Incisional hernias occur most frequently at the site of a scar from earlier abdominal surgery. Once again, the abdomen is opened and the intestines returned to their proper place. The area is reinforced with mesh, and the abdominal wall is reconstructed to prevent another hernia from developing. External sutures can be removed in about a week.

Hiatal hernia

A hiatal hernia repair is slightly different from the other hernias described here, because it corrects a weakness or opening in the diaphragm, the muscle that separates the chest cavity from the abdominal cavity. This surgery is done to prevent the stomach from shifting up into the chest cavity and to prevent the stomach from spilling gastric juices into the esophagus, causing pain and scarring.

An incision is made in the abdomen or chest, and the hole or weakness in the diaphragm is located and repaired. The top of the stomach is wrapped around the bottom of the esophagus, and they are sutured together to hold the stomach in place. Sometimes the vagus nerve is cut in order to decrease the amount of acid the stomach produces. External sutures can be removed in about one week. This type of hernia repair often requires a longer hospital stay than the other types, although techniques are being improved that reduce invasiveness of the surgery and the length of the hospital stay.

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