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Fix My Hernia
Incisional Hernias
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What is a Hernia?
Incisional Hernias
Umbilical Hernias
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Should I Have My Hernia Fixed?
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Hernia appearing in a heart bypass surgery scar

What is an incisional Hernia?  An incisional hernia is a hernia where the muscle and fascia from a previous incision have pulled apart and so have created a hole through which other tissues or fluid will bulge.  It is a hernia that occurs in an old scar.
 
What are the symptoms?  The hernia may at first show up as a painless bulge underneath an old scar.  Over time it may become larger and painful to the touch.  If a hernia becomes large enough it may thin out the overlying skins so that it breaks down, creating a wound.  At first it may be reducible which means that the bulge goes away when you lay down or relax.  At this time it only comes out when your cough, sneeze or strain your abdomen.  Over time the hernia may be incarcerated which means that the bulge remains regardless of what you do and can not be reduced or pushed back in.  The mass may become more painful with time.  There may be problems with urinating or moving the bowels if the bladder or the bowels are part of the hernia.  An incarcerated hernia may progress on to strangulation.  Similar to putting a rubber band around your finger, the tissue inside the hernia sac is at risk for dying because of a loss of blood supply.  The mass becomes more painful and the overlying skin may become red, swollen and warm.  Depending on what is in the hernia the person may develop fevers and difficulty moving his bowels or passing his urine.  This a surgical emergency and medical help should be sought immediately.
 
What is in my hernia?  When a hernia is small it may just be some fluid or fatty tissue.  As the hernia enlarges it may contain bowel or other organs.
 
How do you treat a Hernia?  A hernia involves a physical defect in the wall of the abdomen.  It will not get better over time or heal itself.  It must be repaired with surgery.  Today a hernia is typically repaired using a patch made of plastic, similar to patching a hole in a tire.  At one time hernias were repaired by simply closing the hole with sutures; however, this has been shown to have a much higher repair failure rate resulting in a recurrence of the hernia. Hernias may be repaired using either an open technique or a laparoscopic technique.  Using the open procedure the surgeon goes through the old scar to reduce the hernia and repair the defect.  In the laparoscopic procedure the surgeon inflates the abdomen and then uses a special telescope and instruments to look inside the abdomen and repair the hernia.
 
Should I have my hernia repaired?  Almost everyone who is healthy enough to undergo surgery should have it repaired.  Over time as the hernia gets larger the abdominal wall shrinks.  This leads to a loss of abdominal domain so that if the hernia is fixed it may be difficult to get all of the organs back into the abdomen because the volume of the abdomen is smaller.  Persons with significant health problems which would make surgery too dangerous may be better at using an alternative to surgery.  You should consult your Surgeon to see what fixing your hernia would involve.
 
What are the alternatives to surgery?  Wearing a supportive garment such as an abdominal binder or truss may keep the hernia reduced and eliminate some of the symptoms.  If the hernia is incarcerated then the above garment will not be helpful.
 
What are the risks of surgery?  Risks common to all surgeries are bleeding, infection and scar.  Despite the best efforts of your surgeon there is a very small chance of recurrence of your hernia.  This is much more likely should the hernia be repaired without mesh.  There is much less of a chance of recurrence should your surgeon use mesh.  Depending on the complexity of the hernia other potential complications may be present.  These may include in injury to bowel or other intra-abdominal structures and healing with adhesions or scars that can lead to further surgery. 

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Hernia with incarcerated fatty tissue looking from inside the abdomen

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The hernia defect with the fatty tissue reduced

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The hernia defect is now covered with mesh stapled to the abdominal wall

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615