What Is A Hernia?
A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue. Hernias can occur in the groin, abdominal wall, pelvis or through a previous incision. Symptoms include a bulge, swelling, or pain; however, in some cases, there are no symptoms at all. Most hernias aren’t immediately life-threatening, but they don’t go away on their own. If you have symptoms of a hernia, or if your physician has diagnosed a suspected hernia, Dr. Turner Lisle can assess and determine the appropriate steps for treatment.
- According to the National Center for Health Statistics, roughly ~5,000,000 Americans experience abdominal wall hernias annually. Of those approximately 2/3 are inguinal and 1/3 are ventral/incisional
- Worldwide there are more than 20,000,000 inguinal hernias repaired annually.
- Over a 1,000,000 of those hernia operations a year happen in the US (Americas Hernia Society data)
- Of the 350,000 ventral hernias repaired (75%/262,500 are primary)
- Approximately 1/3 are incisional and 2/3 are primary.
- Expenditure approximately 2.5-3 billion dollars/year
What Are Hernia Risk Factors?
There are a multitude of patient factors that increase the likelihood of an individual developing a hernia. These risk factors as well can help us anticipate who may experience a recurrence following repair.
- Genetics: It seems for many patients that hernias do run in families however to date there is no clear evidence regarding a genetic predisposition to hernia formation. One exception is the role of collagen vascular disease and the concomitant incidence for hernia development.
- Gender: There is no doubt that we see far more hernias in men compared to women. Perhaps this is due to testicular development or possibly it results from mere physics. The jury is still out.
- Smoking: Tobacco, marijuana, or vaping all increase the incidence of chronic cough. Additionally, the nicotine found in these products contribute to vascular disease which in turn leads to weakened tissues.
- Abnormal intra-abdominal pressure: Abnormally increasing resting abdominal pressure can stress the abdominal wall such that a hernia may develop. Things like repetitive heavy lifting, chronic coughing or sneezing, chronic constipation, obesity and morbid obesity, and pregnancy can cause a hernia. Medical problems can also contribute to this rise in pressure. COPD, asthma, enlarged prostate (benign prostatic hypertrophy), obstructive sleep apnea and ascites (from liver failure) all contribute to abnormally high levels of pressure. This leads to more stress on your abdominal wall.
What Are The Symptoms Of A Hernia?
Symptoms from your hernia can vary greatly depending on its size and location. Your individual experience can range from no symptoms to varying degrees of discomfort and even pain. You may be able to feel a bulge or palpable lump in the area of your hernia. Your discomfort and or pain may be dull, sharp, stabbing, burning and/or constant or intermittent.
What Can You Do To Prevent A Hernia?
Oftentimes hernias are the result of actions outside of our control. For example, if you work construction, chances are you’re going to be making your living lifting heavy things. Thankfully, there are some things in your control that can help mitigate the chances of developing or worsening your hernia. In general, these options involve decreasing the abnormal pressure spikes in your abdomen. They include weight reduction, limiting coughing, limiting straining (both with your bowel movements and urination) and eliminating poor lifting mechanics.
What’s The Deal With Mesh?
- Hernias are very common, with over 1 million hernia repairs performed in the United States each year. Mesh is commonly used to reinforce hernia repairs, and has been shown to be very effective in reducing the risk that the hernia will return (hernia recurrence). Meshes are typically flat “screens” made of various materials that act as additional barriers to prevent organs or tissue from pushing through the hernia defect. While some surgeons and centers have reported good results with non-mesh tissue-based repairs for inguinal (groin) hernia repair, the use of tissue-based “non-mesh” techniques have not worked well for most ventral (abdominal wall) hernia repairs as well as many inguinal hernia repairs.
- The vast majority of patients who undergo hernia repair with mesh heal well without complications and are able to resume activities without new limitations. However, there are potential issues with mesh placement, like any other implantable device (e.g. joint or heart valve replacement, vascular graft, etc.). Potential risks of hernia repairs with mesh may include infections, excessive scar tissue, erosion into other organs, chronic pain and other complications. These complications may be due to surgical technique, the mesh material used, anatomy, inflammation, presence of infection, and other body reactions, or a combination of factors. It is important to recognize that some of these complications are also seen in surgeries that do not utilize mesh. In addition, mesh is also used in non-hernia operations, such as pelvic surgery, and complications seen in those procedures do not necessarily apply to hernia surgery.
- In patients with symptoms that are not clearly caused by a mesh, removal of mesh may not improve the symptoms, and in fact may worsen their condition. Importantly, to date, there is no convincing evidence that mesh placement can cause autoimmune or allergic reactions, and therefore elective removal of mesh in asymptomatic patients is not advisable.
- The Americas Hernia Society (AHS) supports the use of appropriately selected mesh reinforcement for the vast majority of both inguinal and ventral hernias to reduce the risk of hernia recurrence. The AHS encourages a thorough discussion between surgeon and patient regarding the advantages, disadvantages, as well as potential risks of mesh-based repairs. The AHS continues to assess new data regarding mesh materials to guide hernia surgeons in developing the safest and most appropriate mesh choices for their patients.