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Hernias

What is it?
A hernia is a weakness or tear in the wall of the abdomen.

The abdominal wall consists of layers of muscle, fat, and other tissue that surround your abdomen. Hernias are caused by wear and tear of the abdominal wall over time as muscles break down due to stretching or lack of use. Hernias may also result from a weakness in the abdominal wall that is present at birth. As the abdominal wall weakens a loop of intestine or fatty tissue may push against the inner lining of the abdomen. A bulge may be noticed as intestine pushes into the sac. If this bulge flattens when you lie down or push against it means you have a reducible hernia. While this does not present an immediate danger, you will need hernia repair. If the intestine becomes incarcerated (trapped) you won't be able to flatten the bulge. This is a nonreducible hernia which is often painful and prompt surgery is required. The intestine may become incarcerated (trapped) or strangulated (tightly trapped), where it loses its blood supply and dies. A strangulated loop of intestine can also block digestion. It can cause severe pain. Emergency surgery is required to relieve the blockage and repair the hernia.

Symptoms
Hernias are often fairly easy to notice as a bulge under the skin. You may also feel localized pain when you lift, cough or strain during urination or bowel movements. Pain associated with hernias are varied. The pain may be sharp, sudden, or even a dull ache, burning or tingling feeling. Pain also tends to increase near the end of the day or after standing a long time.

Diagnosis
See your doctor for a medical evaluation to confirm whether you have a hernia and to prevent future complications. The evaluation will identify which type hernia you may have based upon its location in your abdominal wall. The evaluation will also help determine which surgical approach is the most appropriate to repair your hernia. The normal types of hernias include:

  • Direct inguinal hernia occurs in the groin area near the internal inguinal ring. These are more common in men and most often occur after the age 40.
  • Indirect inguinal hernia occurs in the groin area at the internal inguinal ring. These are the most common hernias.
  • Femoral hernia occurs high in the thigh just below the groin.
  • Umbilical hernia occurs in the umbilical hernia ring around the navel.
  • Incisional hernia occurs at the site of a previous surgical incision, anywhere on the abdomen.
  • Recurrent hernia occurs at a site of a previous hernia.
  • Bilateral hernias occur on both the left and right sides.

Treatment
Hernia repair is often same-day surgery, so you may be able to go home within several hours. The two surgical approaches used to repair hernias are the laparoscopic or the open repairs.

The laparoscopic approach uses a laparoscope inserted through a small incision in the umbilical area to view the hernia site. Other surgical instruments are inserted through other small incisions and mesh is placed directly over the abdominal wall weak spot. The mesh is secured using surgical staples or sutures. These stay in place permanently and are not harmful to your body.

The open approach involves an incision being made directly over or next to the hernia site. The sac containing the hernia is placed back into the abdominal cavity. The weakened area is reinforced either by a synthetic mesh or closed with staples or sutures of the abdominal tissue. The skin incision may be sutured or stapled.

For either surgery complications are rare but include:

  • Bleeding
  • Infection
  • Numbness or pain in the groin or leg
  • Urinary retention
  • Bowel or bladder injury
  • Recurrent hernias
  • Deterioration of testes
  • Risks of anesthesia


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