A hernia repair surgery is usually very safe but several risk factors determine patient’s morbidity and mortality. Incarceration and strangulation are some of the common complications of hernias. The surgery complications include infections, fascial dehiscence, recurrence, visceral injury, and mesh erosion preset by many risk factors.

Strangulation and Incarceration:

A strangulated hernia occurs when the blood supply to the affected tissue has been cut off. This situation forces to release toxins and infection into the bloodstream, which could lead to sepsis or death in some cases. An incarcerated hernia occurs when herniated tissue becomes trapped and cannot easily be moved back into place. This state can lead to bowel obstruction.

Surgical complication:

As compared to laparoscopic surgery, an open approach has higher chances of complications. Most of the serious complications occur while accessing the abdominal cavity. Most common injuries occur to the small bowel and the iliac artery. Patients with past abdominal injuries or abdominal surgeries are more prone to severe complications.

As per the available evidence, surgical repair is the only current effective way to treat a hernia and it could be of two types – conventional and non-invasive. Hernia surgery can assist relieve pain, return the hernia abdominal organs to their exact place thus reinforcing the weak muscle area. A hernia operation usually takes around an hour as a day case procedure. It is a routine procedure, but as with all surgeries, there are risks of complications.

The conventional procedure being the open procedure whereas the non-invasive method includes laparoscopy. Though the hernia surgery is termed as “safe”, however, all surgical procedures come with certain risks. Probable risks involved in a hernia surgery could be:

• Wound Infection at the cut- Despite the latest technologies and advancement in the surgical procedure, post-operative infection is still the leading cause of complications in hernia surgery. Infections can occur due to various reason including sutures, mesh that fails to suit the human body.
• Recurrence of hernia- This state is occurred due to deep infection or when there’s extra pressure on repaired site or when a person resumes to physical activities much earlier than suggested by the doctor. However, it is preventable by mesh implantation.
• Post-operative risk- This occurs as a direct result of fascial tissue failure to heal post laparotomy. Factors that can add to the misery is excessive smoking, obesity, age, malnutrition etc.
• Blood clot formation due to prolonged bed rest.
• In some cases, an open hernia procedure may lead to nerve damage and the patient can develop chronic pain in the affected area post-surgery.

The recovery process may depend on the surgical procedure itself. Majority of patients undergoing open hernia surgery can return home the same day and the estimated recovery time frame is proximately 3 weeks to 1 month. Depending upon your nature of work, total recovery may require one to six weeks. In the case of laparoscopic hernia surgery, the patient can return home the same day and estimated recovery period is about 1 to 2 weeks. One must wait for a month before starting any heavy exercises or activities that may cause strain.

Usually, the faster you return to your regular lifestyle, the better is the recovery rate. However, consult your surgeon before making any assumptions yourself because a prolonged approach can also lead to several complications. Your doctor may suggest that you wear a corset or a truss to lessen the pain. These supportive undergarments apply gentle pressure on the hernia and hold it in place. They may relieve any kind of discomfort or pain and are used only for temporary relief.

Among surgeries, a laparoscopic procedure is preferred because it shortens the duration of recovery post-surgery. However, a hernia recurrence post-surgery is not uncommon. A recurring hernia can be identified as a lump, sometimes painful, appearing at or near the site of the initial hernia. It can lead to major complications if the recurrence is progressive.

There could be various reasons adding to the factor such as infected hernia wound, resuming heavy physical activities soon after surgery, chronic cough, and obesity. Other common predisposing factors are smoking, old age, and muscle weakness. Hence, it’s always advisable to practice a certain healthy lifestyle which includes maintaining a healthy body weight, avoid lifting heavy objects without supervision and eating a fiber-rich diet to make bowel movements softer and easier to pass

Hernias are rather usual and can confound anyone. However, how can you know that you have developed one? There are various causes of hernia such as straining of muscles due to heavy weight lifting, multiple pregnancies, congenital reasons or you can get one even from a recent accident. Additionally, lifestyle variables such as obesity, smoking, and not having a nutritious diet can cause a hernia.

The abdomen is the most common area for developing a hernia, however, it can also be seen in the upper thigh or chest. A hernia can take time to show symptoms and sometimes those symptoms can lead to intense pain thus leading to surgery. The conventional symptom of a hernia is the appearance of a bulge in the groin area. You may observe a lump in the pubic region if you have an inguinal hernia whereas hiatal hernia has more characteristic symptoms such as heartburn, chest pain, breathing, and swallowing problems etc. In many cases, a person may not complain of any symptom at all and it may be accidentally detected during a routine examination. As your hernia grows, discomfort may grow as well.

Early signs of a hernia may include:

• A bulge in the groin area or scrotum or swelling in the scrotum.
• Pain or discomfort in the affected area which worsens during bending or heavy lifting.
• Heaviness in the abdomen and burning or aching sensation in the bulge.
• Pain or aching sensation while passing stools or urinating.

• Pain in the abdomen, typically during evenings after you have remained standing for most of your day.
• In case of a strangulated hernia, you may also have a fever, vomiting, nausea, and severe abdominal cramps.

While a hernia may begin as an innocuous lump, it can get bigger and begin to trouble with time. In some cases, it can even be perilous. So regardless of whether it doesn’t appear to be a serious deal, it’s ideal to see your primary care physician in case you have indications of a hernia, similar to a bump or lump you can’t clarify.

Seek medical attention immediately if you have a hernia and these symptoms:

• The bulge appears to be dark, purple, or red.
• You can’t pass stools.
• You have a high fever.
• The pain quickly worsens.
• You’re throwing up or have an upset stomach.

The diagnosis of a hernia is generally a clinical one, which implies that your doctor will go through a history of your symptoms followed by a brief physical examination. In the great majority of cases, where there is a conspicuous swelling in the groin/abdominal area, which increases in size on standing, straining or coughing, a clinical diagnosis of hernia is made and no tests are needed. More challenging diagnoses are best performed by hernia specialists.

Usually, your doctor can determine if you have a hernia with just physical examination. They may ask you a variety of questions along with cross-checking your medical history. During this diagnosis of a hernia, your doctor may ask you to perform activities like standing and coughing to confirm the possibility of a hernia.

Furthermore, your doctor will confirm that you have a hernia by prescribing some tests such as ultrasound of your abdomen, A CT or MRI scan which is like X-rays. Your doctor may also ask you to undergo an endoscopy; a non-surgical procedure used to examine a person’s digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view pictures of your digestive tract on a colour TV monitor.

For adults, particularly if the medical procedure could be dangerous for you, your primary care physician may propose simply watching out for it as long as the hernia’s small and not creating any serious issues for you. However, in some cases, you can always lower your odds of getting a hernia by following simple steps such as following a well-balanced diet and staying at a healthy weight, quitting smoking, talking to your doctor if your cough won’t go away, and using the correct form while doing any physical activity (bend from your knees instead of the waist while weight lifting).

If you think getting your surgery done is the last piece of the puzzle then you may be wrong because you might still have to show some resilience till the time your stitches or sutures don’t come off or are dissolved as instructed by your surgeon. Though getting done with the surgery covers the majority of the procedure, adequate post-operative care of your stitches or sutures is still an important aspect that needs to be managed well to avoid any future problems. Before moving on to the post-operative management of the wound, let us first understand more about sutures or stitching.

Sutures and stitches are used for the same purpose – to close wounds or surgical incisions. For sutures, professionals use a thread or strand of material to perform wound closure. The term ‘stitches’ refers to the surgical procedure of closing a wound with the help of sutures. There are basically two types of sutures, absorbable and non-absorbable. Absorbable sutures don’t require your doctor to remove them, while the Non-absorbable sutures will have to be removed at some point in time by your doctor. The kind of material to be used for sutures will completely depend on your doctor’s observation and analysis of the wound and the material type that’s appropriate for the wound or procedure. From piles to bariatric surgery to a hernia repair surgery, suturing is a part of most of the surgeries with incisional cuts and has to be performed with utmost precision and accuracy. Sutures are used for maintaining tissue contact until optimal healing is achieved to provide internal wound strength. When it comes to hernias, the selection of suture and suturing technique is based on the type of underlying hernia, its dimensions and the operative technique used for a hernia repair.

Though there’s no clear evidence that says one particular type of suture is better than others, it is important to care for your sutures irrespective of the material type so that it helps the healing process. Any negligence can slow down the recovery process and cause a lot of pain to the patients.

Below are some of the common symptoms that indicate that your wound has split or is damaged.

• Inflammation
• Bleeding from the wound
• Broken suture
• Pain near the wounded site
• Swelling
• Fever
• Puss formation

Open wounds often require immediate attention and doctors usually opt for antibiotics or debridement (removal of dead tissue from the wound). It is always advisable to get in touch with your doctor in case any such symptoms are observed. Classically, your sutures require to stay in play for some days to even 1-2 weeks, as per the severity of the incision and its location. Usually, as your sutured wound starts to heal, your doctor will instruct you to take proper care of your sutures, which includes cleaning, dressing and drying your wound.

How to care for your sutures/stitches

Moisturise: Applying moisturizing creams with high Vitamin and Aloe vera content can help the wound’s faster recovery

Massage: Massaging the wound gently over time can help in reducing the scar and also increases the blood flow near the wound which can help in faster recovery. However, the pressure applied should be moderate and should not initiate any pain or discomfort near the operated area.

Avoid activities that expose the wound:It is advisable to avoid exposing the wound to any physical activity that adds pressure on the wound or makes it dirty, increasing the chances of an infection.

During the removal of your stitches, your doctor will analyze, observe the state of your wound and then only give a go-ahead. Removing sutures is a much quicker procedure than applying one. You might simply experience a minor pulling sensation and some pain which is due to your body trying to guard itself against organisms trying to enter inside through the cut. As a protective mechanism, the body releases chemicals for aiding your WBCs to fight against infections. As a result of this mechanism, you will feel pain and inflammation due to your nerve stimulation in the area.

If the pain is intense and you are not able to tolerate it, you can take paracetamol as a pain-killer. Avoid take aspirin, ibuprofen or any NSAID to relieve pain, as they may make it difficult for your blood to clot during wound healing. Or else, you may place an ice pack to decrease your pain and inflammation at the affected area for 15 to 20 minutes every hour. This procedure can also reduce bruising. Also, remember that removing stitches on your own is not a good idea. When doctors remove stitches, they look for multiple signs such as infection, state of healing, and wound closure. But when you try to do it on your own, you skip this final observation step which could be lethal for you in the coming future. 

Considering a hernia surgery? Let’s take you through this article that will help you explore different treatment options for a hernia surgery.

Hernias do not heal on their own. Though they can remain asymptomatic for a long time and cause no trouble, they also have high possibilities of getting worse with time. Usually surgical repair is recommended for treating hernias but your doctor may prescribe OTC (Over-the-Counter) antacid medicines at times to reduce the risk of your hernia or may ask you to wear a supporting truss. It is important to understand that hernias in most cases are not immediately life-threatening but it does require treatment as they normally do not get better on their own. Apart from an umbilical hernia in infants, the nature of treating a hernia normally depends on symptom presence. If an adult has the same, surgery is usually recommended because the complications are most likely to increase with time.

As per available evidence, surgical repair is the only current effective way to treat a hernia. To prevent the hernia surgery is performed to return bulging tissue to its proper place, and then repair the defect in the abdomen with stitches or a mesh patch. There are generally two types of a hernia surgery- open repair and laparoscopic repair.

1) Open Hernia Repair

A single long incision is made in the groin area for this kind of repair. The weak spot in the muscle wall is then fixed by sewing the edges of healthy muscle tissues collectively for the contents to be pushed back into the abdominal cavity. This approach is suitable for more diminutive hernias that may have been present since birth, and for healthy tissues without addressing stress on the tissue. This type of surgery can be performed under general, spinal, and local anesthesia.

What to expect after the open hernia surgery?

• In most of the cases, patients are able to go home the same day. However, recovery time is usually about 3-4 weeks.
• You can most likely return to performing light activities after 3 weeks.
• Strenuous tasks must wait until after 6 months of recovery.
• Avoid tasks that may cause severe pain.

2) Laparoscopic Hernia Repair

Laparoscopic hernia repair uses a laparoscope, a thin, telescope-like instrument that is inserted through a small incision at the umbilicus (belly button). This procedure is usually performed under general anesthesia and before the surgery, you will have an evaluation of your general state of health and an electrocardiogram (EKG). The laparoscope is connected to a tiny video camera that projects an “inside view” of your body onto television screens in the operating room. After the procedure is completed, the small abdominal incisions are closed with the help of stitches or surgical tapes.

What to expect after a laparoscopic hernia surgery?

• In most of the cases, patients are able to go home the same day itself however, recovery time is usually about 1-2 weeks.
• You can most likely return to performing light activities after 1-2 weeks.
• Strenuous tasks must wait until after 4 months of recovery.
• Avoid tasks that may cause severe pain.

Recent studies have revealed that in the short term, laparoscopic repair is superior to open repair in terms of less blood loss, fewer operative complications, and shorter hospital stay. Long-term outcomes such as recurrence rates are yet unexplained. However, a hernia can reoccur even after the surgery. And, which is why patients are advised to adapt a healthy lifestyle post a hernia surgery. While not much can be done to prevent muscle weakness, one can reduce pressure on the abdomen, and thus reduce the risk of incurring a hernia. Maintaining a healthy body weight can reduce the risk of getting a hernia as your extra body fat can put pressure on your abdomen. Likewise quitting smoking, avoiding lifting of heavy objects can also help in reducing the risk of getting a hernia. Also, staying aware of any symptoms is the key to identifying and treating a hernia on time. It is important to keep in mind that hernias do not go away on their own and will need medical attention at some point of time.

It is said that anything that causes an increase in pressure in the abdomen can cause a hernia. It is usually innocuous and painless, however, time and again it can bring utmost pain and discomfort especially on doing certain activities which we will discuss further in the blog. Though, anyone can develop a hernia at any age, adults are more likely to have an inguinal hernia. Among adults, the chances of having an inguinal hernia increase with age. Hence, it becomes important to follow certain precautionary measures in order to avoid getting one. Adults who frequently find themselves doing strenuous sports and physical activity, particularly weight-lifting, can develop an inguinal hernia. However, hernias are not just caused by lifting heavy weights, but could be congenital or may also be caused by a bad adult lifestyle i.e. smoker’s cough, and other conditions like COPD that cause heavy coughing, which exerts pressure on the abdominal wall. It is always recommended for both males and females to not ignore any type of hernia and seek immediate medical attention if any discomfort stays for a long period.

Now let’s go deeper in understanding exact reasons that contribute to the causes of hernia in adults.

In simple terms, hernia is a protrusion of the inner organ or part of the organ through a weak muscle area. Although there are multiple reasons for a hernia, below are some common contributing factors of muscular weakness or tension that can cause hernia in adults.

• A congenital condition – a defect that may be present during infant development but is detected during adulthood.
• Muscular weakness due to advanced age or as a result of an injury or surgery. Reasons such as obesity, smoking, and an unbalanced diet can lead to the weakening of muscles in the abdominal region which can cause a hernia.
• Constantly recurring respiratory disease or coughing can put strain on the weak muscles.
• Performing heavy exercises or frequent lifting of heavy objects.

• Multiple pregnancies (twins, triplets and more) can cause a hernia. Pregnant women have a higher risk of getting one due to an increased pressure on the abdomen during pregnancy.

• Longstanding chronic constipation and pushing hard for a bowel movement can be a big cause of hernia in adults.
• Accumulation of more fluid (>25 ml) in the abdomen area could be a cause of hernia in adults due to the increased pressure of fluids.
• Obesity/ overweight is another factor because it increases the strain and pressure on the abdominal muscles, therefore making them weaker and more prone.

Each kind of hernia has various causes in adults, which implies that the measures you take to intercept them will also be moderately different. However, consuming a high fiber diet, maintaining a healthy weight, and quitting smoking can help curb a hernia. Please note that not all of them are preventable and it’s always advisable to seek proper medical care to avoid severe consequences as they cannot heal on their own. And, just in case you’re experiencing any discomfort while sitting, walking or performing any routine physical activities then contact your primary care provider as soon as possible and request an appointment.