Hernia Surgery—Is It Time to Have It Done?
INTRODUCTION
Hernias are a peculiar thing in terms of treatment options. While most aren’t life-threatening, surgery is usually the best solution. One of the complicated realities patients face, though, is the fact that you don’t necessarily have to undergo hernia surgery right away--unless, of course, you are dealing with an incarcerated or, what's much worse, a strangulated hernia.
In fact, many people can safely postpone having surgery for a while. The longer you postpone surgery, however, the bigger the chance that complications will set in or that the hernia will become bigger or more serious.
The questions you need to answer (preferably with the help of a physician) are: “Should I undergo hernia surgery ASAP?” and/or “For how much longer can I safely postpone surgery?”
WHAT BENEFITS SHOULD YOU EXPECT?
Of course, there are many benefits for having your hernia surgically repaired. Beyond the peace of mind of knowing that your hernia won’t get worse, there are the many problems that you can avoid.
Firstly, having surgery will greatly relieve the heaviness, swelling, burning, discomfort and tugging that usually accompany hernias. You should also see a reduction in the complications that may accompany hernias. In the case of hiatal hernias, for example, you should see an improvement in GERD symptoms.
While there are many effective medicines against GERD, medications used to treat it can have serious side-effects and complications. Proton inhibitors, for example, can negatively affect the heart over time. Having surgery to remove/fix a hiatal hernia may obviate the need to keep taking these medications.
WHAT COULD HAPPEN IF I DELAY GETTING SURGERY?
Even if the hernia isn’t presently giving you a hard time, just by moving around, lifting even lightweight things, bending over, or engaging in light physical activities, you may slowly be making the problem worse. At the very least, the hernia will keep growing in many cases.
Unfortunately, the bigger the hernia becomes, the more difficult it is to fix surgically. This also increases the chances of something going wrong (i.e., nerves, veins, arteries & tissue getting damaged from the friction of displacement, etc.).
In general, surgeons recommend having a hernia taken care of in the early stages, before they become cumbersome and medically challenging to treat. Is the hernia, for example, preventing you from getting a normal amount of exercise? If so, you have a good reason to have it treated.
Some of the things that can complicate a hernia, usually by weakening the abdominal wall or increasing the pressure inside the belly, include:
- Chronic, chest-shaking coughing
- Cystic fibrosis
- Chronic constipation that may lead to straining
- An enlarged prostate
- Being overweight
- Bad nutrition
- Smoking
AT WHAT POINT WILL I NEED TO HAVE AN EMERGENCY HERNIA REPAIR?
One of the reasons surgeons prefer to operate on a hernia is so that serious complications can be avoided. These may include intestinal tissue getting trapped after it is pushed outside of its usual cavity. This is called “incarceration.”
If, however, such “trapping” leads to blood being blocked from reaching the tissue, necrosis and gangrene can develop. This form of escalation is called “strangulation.” Hernia strangulation, by the way, can be fatal.
On a lighter note, hernia surgery can help relieve the many unpleasant symptoms that accompany a hernia, including frequent discomfort, pain and frustration. The problem is that, in most cases, hernias can’t heal on their own.
After getting thoroughly checked out (to make sure your hernia isn’t life threatening or at a critical stage), you might be able to safely put off surgery. But please understand that this option is, at best, a stop-gap, temporary measure.
Postponing surgery won’t stop the abdominal wall from getting weaker; nor will it stop the hernia from growing or getting worse.
In some cases, low-key, painless and small hernias may never require surgery, but those types of hernias are not the norm.
KEY POINTS TO REMEMBER
--Hernias, unlike a sore or a small cut, rarely resolve themselves, which is why surgery is so important.
--You may in some cases get away without surgery, but only after medically advised that this option won’t put you in harm’s way.
--As the tissue holding back the hernia weakens (and this is almost inevitable), all hernias tend to get bigger or worsen in severity.
--Surgery is sometimes essential, especially if complications have arisen, the hernia is seriously affecting your life, or you are risking an infection, nerve/tissue damage, tissue incarceration, or, worst of all, strangulation.
--Trusses and corsets often don’t do more than delay the inevitable and downplay the symptoms; don’t depend on these things, especially without consulting a doctor.
--It’s okay to have a hernia repaired even if just for aesthetic reasons; don’t force yourself to put up with anything that interferes with your full enjoyment of life.
--Some people (i.e., pregnant women who choose to have their babies delivered first) have excellent reasons to put off surgery, if that decision has been okayed by a doctor.
--It may be a good idea to consider surgery if a hernia is preventing you from engaging in everyday normal activities, like work, full exercising routines, traveling, etc.
--Trusses & corsets can place harmful pressure on the skin and the bowels, cover up important signs & symptoms of incarceration & strangulation, and can even contribute to peripheral or ancillary injury. In some rare occasions, they may be recommended by a physician. Only then should you trust in any potential efficacy they may impart.
--Although hernias can sometimes be operated on an emergency basis, it’s best if they can be surgically managed before they get to that stage.
--All hernias showing signs of incarceration or strangulation need to be evaluated ASAP by a surgeon. This is especially true if the patient isn’t doing well medically.
--Many factors help a surgeon decide when, if and how to operate on a hernia. A surgeon, therefore, is the best-equipped person to make a final determination.
--Both adults and children in relatively good health may qualify for hernia surgery, if such is warranted.
--Significantly frail, obese, elderly or ill persons may not be suitable candidates for surgery.
AT WHAT POINT WILL A DOCTOR RECOMMEND SURGERY?
--If tissue (e.g., intestinal “tissue”) gets lodged within the abdominal wall. This is referred to as “incarceration;” untreated, it can lead to strangulation.
--If there are any signs/symptoms of strangulation. A process that may involve loss of blood supply to the tissue, possibly resulting in gangrene and/or necrosis (irreparable tissue damage), strangulation is a worst-case scenario for a hernia. Accordingly, it should be dealt with immediately!
Symptoms to watch out for include a hernia turning dark, purple or red, nausea, fever, or sudden, worsening pain. Lack of treatment may be fatal.
--If the hernia is now causing too much discomfort or pain, is growing significantly larger, and is interfering with your daily routine activities.
--If you are suffering from the following types of hernias. Because of their potential to lead to tissue incarceration, the following classes of hernias should generally be repaired surgically: Spigelian, inter-parietal, supra-vesical, obturator, lumbar, perineal and sciatic.
It should also be noted that a Richter hernia may succumb to strangulation even though no evidence emerges of either obstruction or incarceration.
Your doctor may recommend postponing surgery if you can still painlessly push the hernia back in place, the hernia goes back on its own after you lie down or relax, or the hernia is still relatively small and, at present, poses no discernable problem or discomfort.
CONCLUSION
Even if your hernia isn’t a life-threatening situation, that is still no reason to not take it seriously. By all means, do what you and your doctor think is best at this time.
If the time comes, however, when you are told that postponing surgery is no longer a safe or wise option, go ahead and have surgery performed.
In most cases, people that have this type of surgery undergo no major complications. In fact, they not only feel better but often forego the negative repercussions that can easily follow.
Copyright, 2018. Fred Fletcher. All rights reserved.
References
https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/HerniaSurgicalMesh/default.htm
https://www.medstarwashington.org/our-services/surgery/conditions/hernia/recurrent-hernia/
https://www.uwmedicine.org/health-library/pages/repair-of-ventral-incisional-hernias.aspx
https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=za1162
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