Questions and Answers about HerniasWhat is a hernia?
A hernia is a weakness or defect in the abdominal wall. It may be present
from birth, or develop over a period of time. If the defect is large enough,
abdominal contents such as the bowels, may protrude through the defect causing a
lump or bulge felt by the patient. Hernias develop at certain sites which have a
natural tendency to be weak; the groin, umbilicus (belly button), and previous
surgical incisions.
Why should hernias be repaired?
Once a hernia has developed, it will tend to enlarge and cause discomfort. If
a loop of bowel gets caught in the hernia, it may become obstructed or its blood
supply may be cut off. This could then become a life-threatening situation.
Since hernias can be repaired effectively and with minimal risk, most surgeons
therefore recommend that hernias be repaired when diagnosed, unless there is
serious medical problem which makes it too risky.
How are hernias repaired?
The standard method of hernia repair involves making an incision in the
abdominal wall. Normal healthy tissues are cut until the area of weakness is
found. This area, the hernia, is then repaired with sutures. Often a prosthetic
material such as Gore-Tex, or another plastic material, is sutured in place to
strengthen the area of weakness. Finally, the skin and other healthy tissues
that were cut at the beginning are sutured back together to complete the repair.
How does the laparoscopic method differ?
In the laparoscopic repair, the defect in the abdominal wall is repaired from
the inside of the abdominal cavity. Instead of closing or patching the repair
from the outside, the patch is secured in place from the inside. This eliminates
the necessity of cutting the skin and normal tissues to get down to and repair
the hernia.
How is this done?
First a laparoscope, a surgical telescope, is inserted through a small
puncture in the abdominal wall. Two additional narrow tubes are inserted through
the abdominal wall to allow placement of surgical instruments. Under the
guidance of a video camera attached to the laparoscope, the hernia is identified
and repaired by stapling a patch over the defect in the abdominal wall.
Is laparoscopic hernia repair experimental?
Laparoscopic hernia repair has only been done for several years. The
technique is still evolving. Methods originally tried have already been
abandoned. In fact, there are several types of laparoscopic repair being done.
Early studies have shown that laparoscopic hernia repair can be done safely and
with recurrence rates which are acceptably low. Long-term results are still not
available. Most insurance companies recognize laparoscopic hernia repair as
being standard and not experimental; therefore it is covered by most
policies.
What are the advantages and disadvantages of the two types of repair?
The standard repair has several advantages. It can be done under local
anesthesia, which is safer that the general anesthesia. The standard repair has
been done for many years, and is generally considered to be safe and effective.
The laparoscopic repair has several disadvantages. It requires general
anesthesia because of the inherent nature of the laparoscopic procedure. Some
patients, such as the elderly, may be at increased risk for complications when
given general anesthesia. There are also complications of which go along with
laparoscopic procedures such as risk of puncturing the bowel or blood vessels,
and formation of adhesions or scar tissue in the abdominal cavity. The
laparoscopic repair may also be more difficult in patients who have had previous
lower abdominal surgery.
The laparoscopic repair also has some striking advantages. Because the
incisions made for the repair are so small, recovery from the repair is
extremely rapid; most patients have minimal pain and return to normal activities
in less that a week. This difference is especially great for patients with
bilateral hernias (both left and right sides). With the laparoscopic repair,
both sides can be fixed at the same time with no additional incisions, and
little if any additional discomfort. Patients with recurrent hernias are also
good candidates for the laparoscopic repair, since the standard repair for
recurrent hernias is known to have a much higher risk of complications such as
re-recurrence, nerve injury, and injury to the blood supply of the testicle (in
men).
Finally, laparoscopy allows access to the abdominal cavity where other
problems may be diagnosed and treated at the same time. Examples of procedures
that could be done at the same time include removal of the gallbladder or
voluntary sterilization (tubal ligation or vasectomy).
What type of repair is best for me?
Everyone is different, and each person must weigh the relative advantages of
the two procedures. I would probably recommend the standard repair for an
elderly retired person with a single-sided primary hernia. On the other hand, I
would probably recommend the laparoscopic repair for a young man with bilateral
or recurrent hernias who was anxious to get back to work as soon as possible.
Your doctor can help you decide which repair is best for you.
Hernia RepairHernia repair is the surgical correction of a hernia. A hernia is the
protrusion of internal organs or tissues through muscles and tissues that
normally contain them.
Your doctor may recommend hernia repair:
- if you have a hernia that is painful and cannot be pushed back into place,
or
- to prevent your hernia from obstructing the proper functioning of the
bowels or other vital organs.
If you have been diagnosed with a hernia and surgery has been recommended but is
not an emergency, it is important to make sure you are prepared. You may benefit
from taking the time beforehand to improve your physical condition to minimize
the chances that your hernia will come back:
- if you are overweight, lose weight.
- if you smoke, make every effort to quit as soon as possible.
- and be sure to get treatment for and let your doctor know about any other
medical conditions you have.
You also should take the time to find a surgeon who is skilled in hernia repair
to perform your surgery. In most cases this will be a general surgeon.
When surgery is scheduled, you may be asked to come in briefly the day before
for some laboratory testing. If general anesthesia is used, you will be asked to
refrain from eating or drinking for eight to twelve hours before surgery.
The average time it takes to repair a hernia is thirty minutes for children
and sixty minutes for adults. Therefore, many hernias are repaired on an
out-patient basis. This means that the patient can go home the same day the
operation is performed.
The type of anesthesia used during hernia repair depends upon the patient's
preference and physical condition. Types of anesthesia used in hernia repair
include:
- local anesthesia, which numbs the immediate area of the hernia;
- epidural anesthesia which is also called a spinal anesthetic that numbs a
larger area or region of the body containing the hernia; and
- general anesthesia, which causes the patient to become completely
unconsciousness and to have no memory of the surgery.
In general, a patient recuperating after hernia repair can expect to be able to:
- walk and exercise lightly soon after surgery, and
- return to work as soon as he or she feels able.
However, it is important to avoid:
- strenuous physical activity, including lifting for three to six weeks;
- getting the incision wet for two days;
- constipation or straining to have a bowel movement;
- air travel for up to ten days after surgery or until the incision has
healed and is no longer oozing or bleeding; and
- any forceful coughing unless you are reinforcing the incision area with
your hand.
Complications, which are usually only temporary problems, occur in a small
percentage of people who have hernia repair surgery and can include:
- infection of the area around the incision,
- respiratory problems, and
- inability to urinate.
In addition, some men develop:
- a black and blue scrotum,
- swollen testicle, and
- shrunken testicles.
Also, there is a small possibility that the hernia will return.
Hernia repair may not be recommended for patients who have:
- severe heart disease,
- a terminal illness in an advanced stage, or
- cirrhosis of the liver.
In addition, there has been some controversy about the benefit of hernia repair
in very young children. However, studies have shown that young children have
fewer complications and better results than older children.
The benefits of hernia repair include:
- preventing the hernia from becoming an emergency or bursting, which can be
life-threatening, and
- eliminating the pain caused by the hernia.
Alternatives to hernia repair surgery are few and only alleviate symptoms. They
do not fix the hernia. These alternatives include:
- holding the hernia in with your hand when coughing; and
- wearing a truss or binder to keep the hernia from bulging out.
Hernias
Hernias in men are common. Exercise, weight control, and a
good diet make them less likely. While they can sometimes be treated
without surgery, hernias do not repair themselves and can lead to serious,
even life-threatening, conditions. So if you have a hernia, it's important
to see your doctor.
A hernia is like an inner tube bulging out of a hole in an
old tire. One part of the body slips through the outer wall, usually of
the abdomen, into another part of the body. Hernia is more likely with
age, obesity, muscle weakness, and hereditary factors. Hernias are
especially common in men, infants, and pregnant women. For men, the inguinal
hernia, in the lower abdomen on one side of the groin, is most
typical.
If you have a hernia, you'll probably know it. There will
be a bulge which you can see and feel under the skin. It may hurt when you
try to move or lift something heavy, cough, or strain while moving your
bowels.
The best strategy for hernia is prevention.
- Eat more fiber. This keeps bowel movements regular, which
helps you avoid straining. (Fiber also helps prevent colon cancer).
Fiber, or roughage, is contained in whole grains, fresh fruits, and
vegetables.
- Stop smoking. Constant smoker's cough, which often goes
unnoticed, can make hernia more likely.
- Manage your weight. If you are overweight, take steps to lose
weight. Extra poundage in men usually settles around the abdomen,
stretching the peritoneum (the inner tube-like membrane),
making hernia more likely.
- Exercise regularly. Stronger muscles help prevent hernias.
- Learn how to lift right. Be careful about lifting and moving
heavy objects. Bend your knees, not your back. Don't strain: if it's
too heavy for you, don't move it!
If you think you have a hernia, see your doctor for
diagnosis and treatment. He may recommend surgery, but always feel free to
get a second opinion. A truss may be helpful. If you do have surgery, it's
usually a minor procedure. Untreated, a hernia can lead to serious
conditions. Prevent hernias by eating more fiber, losing weight, and not
smoking. See your doctor if you have a hernia, for the best protection and
care.
WILL MY HERNIA GO AWAY?
An untreated hernia will not get better on its own, although it may not get
worse for months or even years. A hernia that can be easily pushed back or
flattened (reducible hernia) is generally not an immediate danger to your
health, although it can be painful. A non-reducible hernia, however, can become
life-threatening if part of the intestine gets trapped, or strangulated, in the
opening. This is also called an incarcerated hernia and in an emergency
situation may require immediate surgery.
WHAT CAN I DO TO FEEL BETTER?
Limiting activity or eliminating excess weight may provide temporary relief.
Wearing a truss or binder has also offered temporary relief. The only cure,
however, is surgery. There are two reasons for hernia surgery: to correct or
prevent a dangerous strangulated hernia, and to eliminate the pain that may be
interfering with your normal activity. Although there are always risks and side
effects associated with surgery, today's surgical techniques provide patients
with treatment options that offer minimal post-operative discomfort, speedy
recovery, and lasting relief.
IS SURGERY RIGHT FOR ME?
Whether you should have surgery is a question only your doctor can help you
answer. Your doctor can tell you more about your condition and treatment options
for painful and life-threatening hernias. There is no need to suffer in silence.
Your doctor is there to help.
Inguinal hernias are protrusions of soft tissue, such as a portion of the
intestine, through a weak spot in a muscle, usually in the abdominal wall.
Inguinal hernias occur where the abdomen meets the thigh in the groin region.
Anyone can have an inguinal hernia. Men, women and even children of all
ages experience hernias. Hernias are weaknesses or tears in the wall of the
abdomen; sometimes they are referred to as ruptures. They typically occur two
ways: first, by wear and tear over time (acquired hernias) and secondly from a
weakness in the abdominal wall that is present at birth (congenital hernias).
Although many people "live" with hernias for years before they
even know it or they become a problem, over time they often get worse due to
physical stress or aging. Children's hernias usually are congenital and are
present from the time they're born.
Hernias produce different symptoms or feelings. Sometimes you'll notice a
protrusion in your groin area between the pubis and the top of the leg or feel
pain when you strain during urination or a bowel movement or when you lift a
heavy object. The pain can be sharp and immediate. Other times you'll just
feel a dull aching sensation, a vague feeling of fullness, nausea or
constipation; these feelings typically get worse toward the end of the day or
after standing for long periods of time and may disappear when you lie down.
And, while persons certainly can live for years with hernias, without
treatment they will not disappear.
If the hernia can be pushed back into the abdominal cavity, it is referred
to as a reducible hernia, which while not an immediate health threat, will
require surgery to disappear. If it cannot be pushed back, it is nonreducible.
This is a condition that may lead to dangerous complications such as the
obstruction of the flow of the intestinal contents or intestinal blood supply
(strangulation), leading to tissue death. Intestinal obstruction produces
nausea, vomiting, loss of appetite, and abdominal pain and usually requires
immediate surgery. A strangulated hernia is very painful and requires
immediate surgery.
Over 70% of all hernias occur in the groin area between the pubis and the
top of the leg known as the inguinal region of the abdomen, that's why they
are called Inguinal Hernias. Here, an abnormal opening occurs in the large sac
containing the internal organs, causing some of the organs to protrude. When
an abnormal opening or defect occurs on both sides of the groin, it is called
a bilateral inguinal hernia. While most hernias are easily treated, in about
one in ten people, even after treatment they may return and need to be
repaired again. These are called recurrent inguinal hernias. Recurrent hernias
are not an indication of your surgeon's ability, but indicate poor tissue
healing or trauma to the site of the repair.
Who's Likely to Have This Type of Problem?
Every year, more than half a million American men, almost one in twenty,
will have a hernia that needs surgery. And while the number of women who have
problematic inguinal hernias is much less, they are on the rise. Typically men
are about 10 times more likely to get an inguinal hernia than women.
What Causes Hernias?
Hernias are caused
by congenital (defects at birth) or age-related weaknesses in the
abdominal walls. In males, they are caused by an improper closure of the
abdominal cavity during the body's development in the womb. They can also be
caused by an increase in pressure within the abdominal cavity due to heavy
lifting, straining, violent coughing, obesity or pregnancy.
Signs and Symptoms
Lump in groin area when standing/straining &
disappears when reclining
Pain at the site of the lump, especially when lifting
a heavy object
Swelling of the scrotum
Excruciating abdominal pain (if you have
strangulation)
Nausea, vomiting, loss of appetite & pain (if
intestinal obstruction occurs)
Take our One Minute Health
Quiz to see if you have many of the symptoms commonly found in
persons with this medical problem.
Learn More About How Physicians Are Diagnosing
and Testing For Inguinal Hernias and the Latest Techniques
Being Used to Treat This Health Problem. If you think you have an
inguinal hernia or you feel your hernia is not being effectively treated,
you'll want to see your doctor for a medical evaluation. This is really the
only way to accurately diagnose your problem and evaluate other forms of
possible treatment.
Your evaluation will include having a physical exam, completing a medical
history form or questionnaire, and talking with your doctor about the problem.
Other complications that are resulting from your condition will also be
evaluated. You will be asked to have a series
of diagnostic tests, if you have not had them recently to provide
necessary information for your physician to help evaluate your current medical
condition.
During your medical evaluation, your doctor will conduct a physical exam
and review the results of your diagnostic tests to help evaluate what course
of treatment is best, whether surgery will help improve your medical problem
and whether your surgery can be done laparoscopically or will have to be done
using traditional methods.
New surgical
techniques are being used today to treat Inguinal Hernias. Your
doctor first will determine whether your inguinal hernia is in an advanced
stage and is no longer responding to medical therapy. Then he/she will conduct
a series of tests to determine if you will benefit from surgery and evaluate
which type of surgery would be best for you to have.
A recommendation for surgery for the treatment of an inguinal hernia should
only be given after a comprehensive assessment and under strict guidelines to
assure the most successful outcome. Today new advances are being made, but the
procedures are still being refined; research
has initiated to evaluate the outcome for utilizing this type of
surgery for the successful treatment of inguinal hernias. With this research,
physicians are evaluating know how long the results will last, who will
benefit or who will be at highest risk for complications.
Dr.
McKernan is a recognized leader in the field of endoscopy. He not
only uses the procedures, he has spent years perfecting them, developing
surgical instrumentation for their use, and been involved in teaching fellow
surgeons the procedures and perfecting the techniques for a wide range of
procedures.
Dr. McKernan not only has been well trained in these modern techniques of
surgery , he is currently one of the world leaders in endoscopic surgery and
was one of the original pioneers in perfecting the procedure. He continues to
develop advanced endoscopic surgical procedures, training fellow surgeons both
nationally and internationally and publishes regularly on this topic.
Due to specific patient conditions, not all surgery can be performed
laparascopically. To insure you have the option to have your surgery done in
this manner, it is important to be sure to check
with your physician to see if he/she routinely performs
procedures utilizing this technique.
Hernia Center in Fresno, California
Hernia Center in Pasadena, California
, phone (877) 243-7642
============================================================
Stephen Rakower, M.D.
Gender: Male
Age: 57
Foreign Language: Spanish
In Practice Since: 1974
In Area Since: 1986
Office Locations
Address: Telephone: Days/Hrs Open:
16300 Sand Canyon
Suite 911
Irvine, CA 92718 (714) 453-9060
2621 South Bristol Street
Suite 308
Santa Ana, CA 92704 (714) 434-0500 M-F 9-5:00 p.m.
Specialties
Surgery - General
Surgery - Vascular
Education & Training
Internship University of Pennsylvania
Medical School University of Pennsylvania
Special Areas of Interest
Hernia
Insurance Accepted
Pacificare (HMO)
============================================================
Stanley Carson, M.D.
Gender: Male
Age: 58
Foreign Language: Spanish
In Practice Since: 1976
In Area Since: 1987
Office Locations
Address: Telephone: Days/Hrs Open:
11100 Warner Avenue
Suite #318
Fountain Valley, CA 92708 (714) 545-8077 9-4pm
Specialties
Surgery - General
Surgery - Vascular
Education & Training
Internship Northwestern University Med
Medical School Northwestern University Med
Residency Northwestern University Med
Special Areas of Interest
Hernia
Insurance Accepted
Pacificare (HMO)