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Patients often ask me if they need to have surgery to repair their hernia. Generally my answer is that at some point you will need surgery to fix your hernia. Hernias don't get better on their own. They generally just get larger over time. So a small hernia may take a long time to develop into a larger symptomatic hernia, but usually at some point a person will need a repair to fix that hernia to prevent further complications from occurring, like developing an incarceration.
Patients often ask me if they need to have surgery to repair their hernia. Generally my answer is that at some point you will need surgery to fix your hernia. Hernias don't get better on their own. They generally just get larger over time. So a small hernia may take a long time to develop into a larger symptomatic hernia, but usually at some point a person will need a repair to fix that hernia to prevent further complications from occurring, like developing an incarceration.
It's important for a patient to have their hernia repaired at some point because hernias can either cause an incarceration (where a piece of intestine gets stuck inside of the hernia) or their hernia continues to get larger and larger and larger, and you can have large amounts of your intestine come out of the hernia and cause a very disturbing visual defect.
In order to have a hernia operation, the patient has to be in relatively good health. Anyone who has a severe illness may want to consult with their physician and consider whether or not they should actually have surgery, as surgery may actually be more dangerous than the hernia itself.
In preparation for hernia surgery, patients are generally asked to not eat or drink anything after midnight the day before the operation. On the day of the operation, the patient arrives and the operation itself typically takes about an hour for the average hernia. After surgery, patients will usually spend about two hours in the recovery room prior to going home. It's important to note that most of these operations are done as an outpatient basis where the person will usually go home the same day of surgery. In terms of pain after surgery, patients usually have pain for about 2-3 days where they may be taking pain medication. By about one week after surgery, most patients feel pretty good and are able to be up and around and even go back to work.
Laparoscopic surgery means that rather than making a large incision (which we used to in the old days), we make these small incisions - usually three incisions - and insert a video camera and we perform an operation using very small instruments through these small incisions. Robotic surgery is a variation of that where we still make the small incisions, but rather than my hands holding these instruments, we have large robotic arms that are holding these instruments. I sit at a console that's about 10 feet away from the patient and look through a 3D high-definition viewfinder. I move my hands in virtual space and that controls the robotic arms and allows me to perform the operation without actually standing next to the patient. People often ask why we would do that and it's because the robotic instruments have not only a great deal of dexterity and finesse, but they also have what we call wristed instruments. Meaning that the instruments themselves, rather than just opening and closing, they have wrists on them like your hands and when you can swing them around and rotate and move around, that allows you to do some really fine motion and it makes operating that much easier.
Minimally invasive surgery (which includes either laparoscopic or robotic surgery) has several advantages over doing what we call an open operation. So if we are specifically talking about hernia surgery, even today in 2017 the vast majority of people when they have an inguinal hernia repair, for instance, that's a hernia that is located in your groin - most people have the traditional open operation where you have an incision made over the area where your hernia is and a piece of mesh is placed in there to sort of bolster the abdominal wall and create the hernia repair. What we do is perform the same type of operation, but rather than doing it from the outside, we are performing it from the inside. So we use these small fine instruments and we go inside of the abdominal cavity and repair the hernia from the inside. We place a large piece of mesh on the inside to cover the hole. A hernia really is just any hole that is in a wall that is supposed to be holding contents in. The analogy for this repair is having a flat tire. The cheap way to fix a flat tire is to plug it from the outside, but the better way to fix a flat tire is to actually remove the tire and place a large patch on the inside to cover the hole. That is exactly what we are doing when we perform the laparoscopic or robotic hernia repair. Now this repair is better in that it results in smaller incisions. Therefore, you have smaller scars, you have less pain, quicker recovery time. It turns out that the complication rates are actually lower when you use this technique, as well. When it comes to how durable the repair is, doing it laparoscopically or robotically is equally as effective as doing it through the standard open technique.
The complications that can occur with hernia surgery are: some of the generic ones which are bleeding and infection, injury to other organs or complications from general anesthesia. Specifically with hernia surgery, the main complication that we worry about is a recurrence of the hernia or the hernia coming back. Fortunately the recurrence rate is very low - it's about 1%.
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