Ask the Doctor: Hernia repair for
outpatients, and advice for runners
This is the first of a monthly question-and-answer session with a Henry Ford Cottage Hospital physician on a specific health issue. This month, Dr. Tom Knuth, a general surgeon and head of the Henry Ford Cottage Hospital Hernia Center, talks about hernias. More than a half million hernia repairs are done in the United States each year. The hernia center in Grosse Pointe Farms opened last year.
What is a hernia?
It is a weakness or tear in the muscles of the abdominal wall that allows tissue
or an organ such as the intestines to protrude through the muscles in the abdominal wall. It can cause a noticeable bulge under the skin and produce significant pain and discomfort. Hernias occur most commonly in the groin (inguinal hernia), the navel (umbilical hernia) and at the incision site of a previous surgery.
What causes a hernia?
A weakness in the abdominal wall can happen at birth in the umbilical area or may develop when:
- a muscle pulls or tears in the groin following surgery
- violent or chronic coughing or sneezing is frequent
- heavy objects are lifted
- a person is obese or pregnant
- there is straining during bowel movements or urination.
I’ve seen it happen when runners cough a lot while they run. It is much more common in males than females. Eighteen percent of men will have a hernia in their lifetime while they happen to only 1 percent of women.
What are the symptoms of a hernia?
Symptoms can include pain and discomfort and/or a bulge under the skin. If you have pain or a bulge that does not get smaller, go to a doctor immediately because the herniated tissue or intestine can have a decrease in the blood supply due to an obstruction in the blood vessels.
How are they treated?
The only treatment is surgery. We fix them when we find them because we would rather fix them electively than wait for an emergency.
What should I ask my doctor before having hernia surgery?
Ask when you can safely go back to work; ask about the reoccurrence rate and how painful the procedure will be.
What does surgery involve?
Hernia surgery is typically an outpatient procedure. The oldest type of most common hernia surgery is tissue repair. One type of tissue repair is a tension-free repair that involves sewing up the rupture and reinforcing the area with a mesh patch.
What procedure do you use?
I use the PROLENE Hernia System, which can be done under local anesthesia, takes less time than traditional procedures, is less costly and can have you home and back to work or athletic activities in minimal time. The PROLENE system uses a small, device consisting of an underlay mesh patch that goes inside, behind or under the abdominal wall; a small plastic connector and another patch that fits over the abdominal wall. The connector between the two layers of mesh provides a strong barrier to recurrence. A 3-inch scar will result. Henry Ford Cottage’s Hernia Center uses skin glue called Dermabond, a liquid plastic that allows patients to shower after surgery. Only a few surgeons in the Henry Ford Health system use this system.
How long is recuperation?
In most cases, you can return to full, unrestricted activity in about two weeks.
How bad is the pain after surgery?
We give patients the On-Q pain pump. It's a rubber bulb that contains local anesthetic connected to tubing that steadily drips into the incision for 48 hours after surgery.
How do you prevent getting a hernia?
If you are a weightlifter or do a lot of heavy lifting, you can wear a belt that changes the distribution of pressure. There are also some lifting techniques. But lifting 200 pounds doesn’t cause as much pressure as coughing. The worst thing you can do is cough while jumping up and down. I tell athletes and runners to try not to cough while running or to avoid running with a cold when they are coughing a lot.
What makes your hernia center different than other hospitals'?
Everyone in our center – nurses, anesthetists, surgeons – is trained in hernia repair and the processes we use. Patients can be seen in our clinic within 24 hours of their call for an appointment. Surgery can be scheduled within seven days after the initial visit. This impacts the whole experience for the patient.
How often does a hernia reoccur?
With the PROLENE system, the chance of recurrence is about 2 in 1,000.
