Patient education: Abdominal wall hernia repair (The Basics)

What is an abdominal wall hernia? — The internal organs and tissues in the belly are held in place by a tough outer wall of tissue called the "abdominal wall." An abdominal hernia is an area in that wall that is weak or torn. Often, when there is a hernia, organs or tissues that are normally held in place by the abdominal wall bulge or stick out through the weak or torn spot.

There are many different kinds of abdominal wall hernias (figure 1).

What is abdominal wall hernia repair? — This is a way to fix a hernia with surgery. Not all hernias need repair, but many do.

Abdominal wall hernia repair can be done in 2 ways:

●Open surgery – During an open surgery, the doctor makes 1 large cut near the hernia to repair it.

●Minimally invasive surgery – "Minimally invasive" surgery allows the doctor to make smaller cuts in the skin. They insert long, thin tools through the cuts. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery).

You might be able to return to normal activities sooner if you had minimally invasive surgery than if you had an open surgery.

Most, but not all, hernia repairs are done using a piece of mesh. This can lower the risk of the hernia coming back. But it can also cause pain or other problems in some people. If you are concerned about hernia mesh, talk to your surgeon. Minimally invasive hernia repair must be done with mesh.

How do I prepare for abdominal wall hernia repair? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might order tests, such as:

●Lab tests

●Electrocardiogram ("ECG") – This test measures the electrical activity in your heart.

●CT scan – A CT scan is a special kind of X-ray.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Fasting – This means not eating or drinking anything for a period of time. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during abdominal wall hernia repair? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get general anesthesia medicines. This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●You might get a small tube in your nose. This tube goes down to your stomach to drain out any food or fluid.

●You might get a thin, flexible tube called a "catheter" in your bladder. This is to drain urine during the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make an incision (cut) near the hernia:

•If you are having minimally invasive or robotic-assisted surgery, you will have several small incisions. The doctor will put a laparoscope with a tiny camera through 1 of the small incisions to look at the tissue that is stuck in the hernia. The doctor will put small tools through the other incisions to do the procedure. If you are having robotic-assisted surgery, the doctor will use a surgical robot to control the tools.

They will also use carbon dioxide gas to inflate your abdomen during the surgery. This makes it easier for them to see and use the tools.

•If you are having open surgery, you will have just 1 incision.

●The doctor will look at the tissue that is stuck in the hernia. If it is healthy, they will gently push it back into place. Sometimes, a piece of tissue needs to be removed.

●Next, the doctor will sew the layers of the abdominal wall back together, so that nothing can bulge through. In some cases, doctors will also patch the area with a piece of mesh. The mesh takes some of the strain off of the abdominal wall, so the hernia is less likely to happen again.

●The doctor will close your incisions and cover them with clean bandages. They will also use a numbing medicine on the incision so you have less pain.

What happens after abdominal wall hernia repair? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Usually, people can go home the same day. But in some cases, you might need to stay overnight in the hospital.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a tube in your nose, it will be removed.

●If you had a catheter in your bladder, it will be removed.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of abdominal wall hernia repair? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●Bleeding

●Blockage in the intestine

●Pneumonia

●Blood clot in the legs

●The hernia returning

●Fluid collection ("seroma" or "hematoma")

●Ongoing pain where your mesh is stitched into place

●Damage to organs, such as your bladder or intestines

●Problems with the mesh, if you got mesh – These can include the mesh moving to the wrong place in the body, breaking down, or becoming infected. If this happens, you will need another surgery to remove the mesh.

What else should I know? — In some cases, a hernia might come back even after surgery. You can help lower the chance of this happening if you:

●Keep a healthy body weight.

●Keep other health conditions, like diabetes, under control.

●Avoid lifting heavy objects after your surgery.

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