Hernia Center | Laparoscopic Hernia Repair | Dr. Scott Roth Q&A | Sports Hernias | Complex Hernias
Get answers to your hernia related questions by e-mailing Dr. Scott Roth.
Below are University of Maryland Hernia Center surgeon Scott Roth’s answers to commonly asked questions about hernia disorders and repairs.
This information is not intended to be a substitute for individual medical advice in diagnosing or treating a health problem. Please consult with your physician about your specific health care concerns.
Click on a question below for an answer to a specific question, or scroll down to view the complete list of questions.
Question: What is a ventral hernia, and what procedure is best to correct it?
Answer: A ventral hernia is one involving the abdominal wall. These may be repaired using many different surgical techniques. The laparoscopic repair carries a very low risk of complications and recurrences. This is the best repair for most ventral hernias. This can be performed on an outpatient basis in most circumstances.
Question: My doctor found an inguinal hernia a couple years ago during a routine physical. I've put off surgery because I don't feel any pain and I'm concerned about complications and recovery time. Is surgery inevitable? Is laparoscopic the way to go?
Answer: Laparoscopic inguinal hernia repair is performed on an outpatient basis. Most patients are back to their normal routine in a few days. Complications can occur with any operation, but they are fairly unusual after inguinal hernia repair. Inguinal hernias will never go away. They usually enlarge with time. The danger is the risk of incarceration and strangulation of the hernia, which typically requires an emergency operation. Therefore, it is generally recommended that hernias are repaired once they have been diagnosed.
Question: I have had two hernia repairs; the last one 15 years ago was done with mesh. I am beginning to feel the symptoms of another. Am I a candidate for your laparoscopic procedure?
Answer: Many patients with recurrent hernias are good candidates for the laparoscopic approach. If both prior repairs were done using the open approach, then I would definitely recommend that you undergo a laparoscopic repair for this recurrence. Laparoscopic repairs are clearly advantageous for recurrent repairs.
Question: I am considering having hiatal hernia surgery because I have a bad case of acid reflux and my voice almost always sounds hoarse. Are the hernia operations effective? What questions should I ask my doctor about having the operation?
Answer: It is important to have surgery by someone who does this operation frequently. Ask about the surgeon's success rate for this problem. It should be 95% for heartburn and 70-80% for hoarseness and throat symptoms. Also ask about your postoperative diet and potential for complications.
Question: I have what I believe to be a very small umbilical hernia (located at the top half of my belly button). I am confused over what technique I would like to elect for surgery. I understand that I am a candidate for either the tension free mesh technique or the laparoscopic technique. What are the pros and cons of each method? If one or both methods leave a surgical scar, what can be done about it? Finally, what are the advantages of UM Hernia Center over another treatment center?
Answer: Most small umbilical hernias are best repaired with an open technique. Depending on the size of the defect, the decision is made as to whether or not to place a prosthetic patch. Hernias less than 4 centimeters typically do not require any mesh and can be repaired primarily. The laparoscopic approach is reserved for any patient that requires a mesh repair for their hernia (i.e., greater than 4 cm). All surgery results in scarring. Scars are minimized by using absorbable suture materials, and keeping the incisions as small as possible. However, all surgery causes scarring. Some topical agents such as Vitamin E lotions can be applied to the incision once it is healed to help improve the cosmetic appearance.
The University of Maryland Hernia Center is a multidisciplinary center with vast experience in all types of hernias. Our goal is to provide our patients with the best repair for their individual circumstances. Not all patients are best suited to a single type of repair. Although laparoscopic repairs tend to be less invasive with a quicker recovery in most cases, we perform all types of hernia repairs and tailor the operation to the individual patient.
Question: How will an inguinal hernia be affected by a pregnancy? I had my first surgery at 18 months then I also had a surgery at 14. That last hernia has since recurred. Even if I have the hernia repaired, won't all the weight in my stomach, as well as the extreme pushing during labor, cause the hernia to recur?
Answer: There is not a lot of data on inguinal hernias in pregnancy as they are not as common in women. However, anything that increases your intra-abdominal pressure may increase the risk of hernia recurrence. However, it would be far more devastating to develop an incarcerated or strangulated hernia during your pregnancy. This could put your baby at increased risk. Therefore, I think it would be prudent to have your hernia fixed prior to becoming pregnant again. The overall risk of hernia recurrence is approximately 1%, but no one knows if that risk is increased in pregnancy.
Question: What should I do if a hernia is identified before pregnancy?
Answer: Hernias identified prior to pregnancy may be either electively
repaired or observed.
If the hernia is repaired prior to pregnancy, I would recommend waiting at least
one year from the time of hernia repair to planned conception. The hernia may
recur as a result of the pregnancy. I would recommend avoiding mesh in a woman
who plans to become pregnant.
If the hernia is not repaired, it could potentially become incarcerated during a pregnancy or could become increasinly symptomatic or painful. IF the hernia becomes incarcerated, it would require an emergency operation.
Surgery during pregnancy may result in miscarriage of the fetus during the first trimester, or preterm labor during the third trimester. Although the second trimester is the safest, it would still place both the mother and baby at increased risk and should be avoided in most circumstances.
Question: I’m pregnant and I have a hernia. When should I have the hernia repaired?
Answer: Most of these hernia repairs should be deferred until
after pregnancy. Any incarcerated hernia should be repaired immediately. Reducible
hernias should be repaired 6-12 weeks after delivery. However, if the mother
intends to breastfeed, breast milk will need to be discarded around the time
of the operation due to the medications that the mother will receive to have
the hernia repaired. Hernia repair in some instances can be delayed until completion
of breast feeding. Any operation during the first trimester increases the risk
of miscarriage and operations during the third trimester increase the risk of
preterm labor.
Question: Do hernias preclude vaginal delivery?
Answer: Most patients with a hernia can safely deliver a baby by means of a vaginal delivery. In some circumstances, a cesarean section may be safest. This should be carefully discussed with both the obstetrician and surgeon.
Question: What are the risks of using mesh to repair a hernia if I intend to become pregnant?
Answer: There are many meshes available to perform tension
free hernia repairs. Meshes are permanent prosthetic materials used to repair
hernias. Most meshes will not stretch. During pregnancy, as the abdominal wall
stretches, the mesh could tear from the abdominal wall tissues resulting in
a reoccurrence of the hernia. Large meshes could potentially prohibit the growth
of the uterus and baby. I generally recommend avoiding mesh for the repair of
incisional hernias in women that intend to become pregnant.
Question: Can I do abdominal crunches after my ventral wall hernia repair?
Answer: I would recommend avoiding strenuous abdominal exercises for at least 6-8 weeks after ventral hernia repairs. However, every patient is different and it is important to specifically discuss the details of your operation with the operating surgeon prior to performing strenuous exercises.
Question: How do you feel about hernia belts?
Answer: Hernia belts are a non-operative means for treating hernias. They attempt to hold the hernia in place to minimize the risk of incarceration and strangulation. For many patients, it is a satisfactory treatment. However, they are cumbersome and can be uncomfortable.
Question: I may have an epigastric hernia. I cannot find any in-depth information on this type of hernia. I was wondering if you might be able to direct me further?
Answer: Epigastric hernias are small midline defects located between the umbilicus (belly button) and the xyphoid process of the sternum. They usually only contain fatty tissue. They are often difficult to diagnose as they can be quite small and difficult to palpate. The only treatment is surgical repair.
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