Hernias are commonly associated with sports injuries or overexertion, but not all hernias are caused by injury. Another popular belief is that only men get hernias, but women and children can get them as well.
In this video, San Diego Health host Susan Taylor talks with Scripps surgeon Mark Sherman, MD, a specialist in minimally invasive robotic surgery, about what causes hernias and how they can be treated.
In its most basic sense, a hernia is a hole in the muscle of the abdominal wall that allows tissue or organs on the inside to push through to the outside, creating a protruding bulge or lump beneath the skin. While some hernias are painful, most are not.
There are three main types of abdominal wall hernias:
- Inguinal hernias develop in the groin area and account for 75% of abdominal wall hernias.
- Incisional hernias push through the scar that forms following an incision from a previous surgery.
- Hiatal hernias occur in a small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Hiatal hernias most often affect people who have gastroesophageal reflux disease (GERD), and the symptoms are different than other abdominal wall hernias.
Hernias can have several causes, but a main factor is sudden strenuous effort.
“A lot of times we think about heavy lifting, but it’s really that burst of energy,” says Dr. Sherman. “When somebody lifts something heavy, they do that kind of explosive movement, and that creates tremendous strain and causes some of the tissues to give a little bit. And once it starts to give, it slowly stretches day by day until you see the hernia.”
Even strenuous sneezing or coughing can put enough stress on the abdominal wall to cause a hernia.
Other contributing factors include:
- Physical activities that strain the abdominal wall
- Age, as tissues become weaker over time
- Genetics – if your mother and father had hernias, you’re more likely to develop them.
Hernias will not go away with time, nor can they be treated with exercises or medication. According to Dr. Sherman, surgery is really the only treatment to repair a hernia.
In the past, hernia repair surgery was a major procedure that required a large incision in the abdomen or groin and cutting through muscle to get to the hernia, followed by a hospital stay and several months of recovery and restricted activity.
However, minimally invasive robotic surgery has made this procedure much less complex. Using robotic procedures and minimally invasive techniques, the surgeon can make a few small incisions and perform the procedure using specialized instruments, including a tiny video camera, that fit through the incisions. The instruments are attached to robotic arms, which are controlled by a specially trained surgeon from a nearby computer console. As the surgeon moves their hand, wrist and fingers, the robotic arms perform the same movements; moreover, they can bend and rotate in ways a human hand cannot, allowing for greater precision and control.
“In addition, the video camera provides a three-dimensional view of the abdominal wall instead of just two dimensions, so it allows us to not just see the hernia, but even inspect other areas,” explains Dr. Sherman. “There are times that we look inside and find additional small hernias that we couldn’t feel from the outside. This allows us to repair all of those at the same time.”
The surgeon gently guides the protruding organ back into place, then closes the opening. In some cases, surgical mesh material may be used to reinforce the weakened area and help prevent another hernia in the same location, called a recurrent hernia.
In many cases, minimally invasive robotic hernia repair surgery can be performed as an outpatient procedure, with patients going home the same day. Recovery also tends to be shorter and easier, with a faster return to activities.
“If you have a lump or bulge in the abdomen or groin area, really just a good exam by your physician will tell you whether you have a hernia or not,” says Dr. Sherman. “These surgical techniques really make hernia repair much easier, so patients shouldn’t be afraid of the procedure or the recovery.”