Dr. Ferzli's Procedures
Specializing in Minimally-Invasive Surgery
What is a hernia?
A hernia is an opening in the body between two spaces that should not normally be connected. This might be on the abdominal wall or between the abdominal cavity and the chest cavity. Hernias can be uncomfortable or unsightly but, most importantly, a hernia can be dangerous if bowel or some other organ gets trapped in it.
Hernia describes a condition when abdominal contents bulge through a weakened area of the abdominal wall & analogous to a bicycle inner tube protruding through an opening in the tire. Hernias are often associated with heavy lifting. When it occurs in the groin it is called an inguinal hernia. This weakness occurs in the area where the femoral artery and vein cross the inguinal ligament. Inguinal hernia can occur bilaterally.
How do I know if I have an inguinal hernia? If you feel a bulge in the groin area, that may or may not go back when you push it, you should have your doctor evaluate it.
What is done to repair the hernia? Many inguinal hernias can be repaired using laparoscopy. In this operation, three small incisions (1 cm or smaller) are made to insert the instruments, then the hernia contents are gently dissected, pushed back into the abdomen. A permanent synthetic patch is anchored over the weakened area to maintain the strength of the abdominal wall.
When can I return to work? Most patients can resume normal activity witin the first two weeks following minimally invasive surgery for hernia repair. However, depending upon the individual's condition, the surgeon may recommend that the patient wait 6 weeks before attempting any strenuous exertion.
What else? Abdominal organs may herniate through the site of a previous operational incision. Usually, there is a definite, exterior bulge in the area of the incision while standing. With minimally invasive surgery, the incisions are made adjacent to the defect. The final repair involves placement of the mesh patch to strengthen the abdominal wall.
Some people have a physical distortion of the lower esophageal sphincter that prevents it from building up enough pressure to keep it closed. A hiatal hernia is a condition where the stomach protrudes up through an abnormally large opening in the diaphragm. The condition has been estimated to exist in 40% of Americans, and is usually of no significance in people who don't have heartburn. While it does not always cause GERD, a hiatal hernia may cause LES incompetence in some individuals, especially when the hernia is severe. Over 90% of patients who present with severe esophagitis will have a hiatal hernia.
It is important to look for other causes of GERD like poor esophageal clearance, medical conditions such as scleroderma, certain medications, and prior radiation treatments to this area of the body. Finally, delayed gastric emptying will also produce GERD. This may due to a weakening of the stomach action due to diabetes or an obstruction at the outlet of the stomach.
Patients with long-standing GERD, may develop scarring of the lower esophagus making their GERD even worse.
More than 2 million people in the U.S. each year undergo abdominal surgery. Between 3% and 20% will develop a ventral incisional hernia. These are hernias that occur at the site of an abdominal surgical incision. These incisional hernias can grow very large and become painful and unsightly. More importantly, the intestine can get caught in the hernia. This is known as incarceration. An incarcerated hernia can lead to a strangulated hernia, where the blood supply to the bowel becomes severely limited and the bowel can die. This is a life-threatening emergency.
A number of surgical techniques have been developed to repair incisional hernias. Most surgeons use a mesh to help create a stronger repair. A surgeon may choose to repair a hernia as an "open" procedure, or laparoscopically. In laparoscopic repair a few small incisions are used to place and fix a mesh inside the abdomen to repair the abdominal wall. Most data agree that an open repair and a laparoscopic repair have about the same outcome in terms of recurrence of the hernia. Recent publications show an improvement in the laparoscopic technique versus the open technique in terms of complications. Also there is a clear improvement in terms of pain and return to activity with the laparoscopic technique.
An umbilical hernia is a hernia that occurs at the umbilicus or "belly button". This hernia can be present at birth or can develop gradually over time. About ten percent of infants are born with an umbilical hernia. Most of these "congenital" hernias will close by age five. If it does not close by this age, it should be surgically repaired to prevent complications from the hernia. Adults can develop umbilical hernias as well. These develop from wear and tear and pressure on what is a naturally weak area of the abdominal wall. These hernias can be asymptomatic or they can become painful and can enlarge. The ultimate danger of an umbilical hernia is that tissue or bowel can become trapped or "incarcerated" in the hernia. An umbilical hernia that becomes acutely painful, firm and red is an emergency and should be seen by a doctor immediately. All patients who have an umbilical hernia should have it evaluated by a doctor.
For further information, you can ask Dr. Ferzli.