Hernia surgery: what you need to know

Michael G. Svestka, MD, FACS, is a board-certified general surgeon who specializes in hernia surgery at Inova. His practice focuses on complex hernia repairs, and he is a high-volume abdominal wall reconstruction specialist with experience in both open and minimally invasive robotic-assisted surgical approaches. He sees patients in the office at Fairfax, Virginia.

There are a lot of misconceptions when it comes to hernias – what they are, how they happen and what options are available to fix them. Here are answers to a few of the most common questions patients ask about hernias and hernia surgery.

What do people misunderstand about hernias?

Many people don’t know what a hernia is. A hernia is a hole (where there shouldn’t be a hole) in the muscles and connective tissue that make up the abdominal wall. Some hernias can become dangerous if the intestines become trapped, which can lead to an emergency. However, not all hernias need to be fixed. In certain cases, it’s better to monitor the hernia over time, a strategy called “watchful waiting.” Because every hernia is different, I encourage anyone who knows or suspects they have a hernia to meet with a hernia surgeon for an initial evaluation and consultation.

What are the symptoms of a hernia?

Hernias occur when an internal part of the body, such as fat or an organ, pushes through a weak spot in the surrounding muscle or tissue. Common symptoms include a visible bulge or lump, especially when standing or coughing, along with pain or discomfort that worsens with physical activity. Some people may also experience a feeling of pressure, burning sensations, or weakness in the affected area. In severe cases, such as when a hernia becomes strangulated, symptoms like nausea, vomiting, and intense pain may occur, requiring immediate medical attention. If you notice any of these signs, it’s important to seek medical advice for proper diagnosis and treatment.

Are there ways to prevent a hernia from occurring (or from coming back)?

For incisional and ventral hernias, obesity is the number one modifiable risk factor. Other risk factors for these hernia types include smoking, uncontrolled diabetes, prednisone or other steroid use, and liver cirrhosis.

Other types of hernias, such as umbilical hernias, are quite common. Up to 50% of humans develop some kind of umbilical hernia because the connective tissue, where the umbilical cord separates at birth, does not fully close.

Another common type of hernia is an inguinal hernia, or groin hernia. Up to 25% of men develop these types of hernias, and risk factors include chronic constipation and a family history of hernias. 

What is the role of mesh in hernia surgery, and should patients be concerned?

There have been many misconceptions about the safety of mesh throughout the years as specific products have been recalled. While a small number of older products were taken off the market by the U.S. Food and Drug Administration because of mechanical defects, the mesh we use today has been studied extensively and is considered safe and effective.

The advertisements patients may see regarding mesh are looking specifically for these recalled products, which were implanted in repairs performed many years ago and are not used anymore. We have known for over 20 years that the use of mesh prevents hernias from coming back, and it is generally the standard of care, with a few exceptions.

Can a hernia come back after hernia surgery?

In patients who have minimized any modifiable risk factors (obesity, diabetes, steroids, smoking), the recurrence rate for most hernias is low, under 5%. If a hernia repair is performed as an emergency, or if the patient has several of the risk factors mentioned above, the risk for the hernia coming back is higher.

What are the different surgical approaches available for hernia surgery? What are the advantages and disadvantages of each approach?

There are a number of approaches to hernia repair that have been studied for many decades. Depending on the hernia’s size and shape, the patient’s risk factors, and the patient’s prior surgical history, an open, laparoscopic or robot-assisted laparoscopic approach may be appropriate. Which surgical option to use is often determined on a case-by-case basis. I tell patients that it’s best to discuss your options and get specific recommendations by meeting with a hernia surgeon for a consultation.

What is the typical recovery time after hernia surgery? How do you support patients during their recovery process?

Straightforward inguinal, umbilical and other small abdominal wall hernias are typically outpatient, same-day procedures that can often be performed under sedation in less than one hour. Most patients undergoing straightforward, outpatient hernia:

• Are sore for about a week
• Can walk and go up and down stairs on the same day of the procedure
• Can shower and drive the day after surgery
• Can resume low-intensity aerobic activity after two weeks
• Will not be able to lift heavy things for six weeks

As hernias grow in size, a stepwise approach is taken, as larger hernias require more invasive surgeries. Other factors that may indicate a larger operation include a history of prior hernia repairs or abdominal surgeries, prior mesh usage, or a hernia surgery performed as an emergency. When a larger reconstructive procedure is required, patients may need to stay in the hospital for one to three days, physical therapy both in and out of the hospital to get mobility back.

What are the latest advancements in hernia surgery techniques and technologies?

Hernia surgery has been studied for decades, and many recent developments have made these procedures safer and more effective. Inova’s comprehensive approach aims to integrate these practices in addition to recent advances in the field of prehabilitation and postoperative rehabilitation to offer patients the forefront surgical care.

• The innovation of laparoscopic surgery in the 1990s allowed for a minimally invasive approach, as surgeons are able to operate inside the abdominal cavity through small ports
• The minimally invasive concept has been augmented over the past 15 years with the development of robotic-assisted surgery, which enhances precision of movement and dissection capabilities
• Newer surgical techniques have been developed over the past 15 years with respect to the layers of the abdominal wall and the placement of mesh

Every hernia is different. That’s why it’s smart to schedule a consultation with a hernia specialist. While surgery may not be needed right away, treating a hernia when it is small can give patients a wider range of less invasive options. Inova’s hernia experts use the latest tools and technologies to repair hernias, from simple to complex. Inova’s hernia specialists are committed to providing exceptional care every step of the way. Learn more about our comprehensive, compassionate surgical care.