The General Surgery Clinic’s hernia surgery is under the direction of board-certified and fellowship-trained surgeon Bulent Cetindag MD, FACS.
Dr. Cetindag specializes in complex abdominal wall reconstruction and hernia surgery. Watch a video to learn more about Dr. Cetindag.
What is a hernia?
A hernia is a defect in the abdominal muscle or tendons that allow intra-abdominal content, such as intestines and fatty tissue, to protrude through the tissues under the skin.
What causes a hernia?
Ultimately, all hernias are caused by a combination of pressure and weakness of muscle or fascia. The pressure pushes an organ or tissue through the opening or weak spot. Sometimes, the muscle weakness is present at birth, as in some groin and umbilical hernias; more often, it occurs later in life.
Hernia Risk Factors
Besides the natural weak points of the abdominal wall, the other risk factors that significantly contribute to formation of primary hernias include:
- Smoking – cigarette byproducts cause a weakening in the abdominal wall due to an unequal balance of growth and breakdown within the tissue. This is similar to how cigarettes cause skin damage in smokers.
- Obesity – causing strain on the abdominal wall.
- COPD or chronic cough – causing strain on the abdominal wall.
- Poor nutrition – an unequal balance of growth and breakdown of the tissue.
- Injured muscles – causing tears on the abdominal wall.
- Previous surgical incisions – creating weakened points on the abdominal wall.
- Pregnancy – causing strain on the abdominal wall.
- Chronic heavy lifting – causing strain on the abdominal wall.
- Enlarged prostate and other urinary tract obstructions – caused by pressure on the abdominal wall when there is a chronic urge to urinate.
- Chronic constipation – causing strain on the abdominal wall.
Types of Hernias
There are many types of hernias, and most are named based on their location within the body.
- Inguinal Hernia
Occurs as a bulge in the groin area and is more prevalent in men. It is rare for an inguinal hernia to become incarcerated (see the “Symptoms of a Hernia” section for more information).
- Femoral Hernia
Occurs as a bulge in the groin area, is more prevalent in elderly women and has a higher likelihood to become incarcerated. (See the “Symptoms of a Hernia” section for more information).
- Ventral Hernia
Occurs on the anterior (front) of the abdominal wall.
- Incisional Hernia
Occurs on a previous incision line of the abdominal wall.
- Umbilical Hernia
Occurs around the umbilicus (belly button).
- Complex Hernias
A hernia that is involved with other problems, such as a fistula, chronic mesh infections, stoma and multiple recurrences. All complex hernias have a higher reoccurrence rate.
Symptoms of a Hernia
Inguinal, femoral, umbilical and incisional hernia symptoms may include:
- Generally, the first symptom is a visible bulge beneath the skin of the abdomen or the groin. It may disappear when lying down or when gentle pressure is applied to the protruding area.
- The area may be tender and there may be a heavy feeling in the abdomen that is sometimes accompanied by constipation or blood in the stool.
- A dull and aching sensation.
- Pain and/or pressure in the abdomen or groin that may occur after heavy lifting or straining.
- Vague feeling of fullness.
If a hernia site becomes suddenly painful and may be accompanied by nausea, vomiting and bloating, this may be the sign of incarceration and/or strangulation. Incarceration and strangulation occur when the intestine gets trapped within the hernia pouch and is unable to be pushed back, cutting off blood supply to the intestine. This condition is uncommon; however, if it occurs, seek immediate medical care at the nearest emergency room.
Hernia Surgery Team
Mercy General Surgery Clinic’s four board-certified general surgeons perform a variety of hernia surgery based on the needs of each individual patient. The group performs open, laparoscopic and robotic hernia repairs.
Bulent Cetindag, MD, FACS, is the area’s only fellowship-trained surgeon that specializes in complex abdominal wall reconstruction and hernia surgery. Read more about our general surgeons:
- Bulent Cetindag, MD, FACS
Dr. Cetindag, brings his expertise in all aspects of hernia surgery, including advancement flaps for repair of complex and large abdominal wall hernias.
- Sajida Ahad, MD, FACS
Dr. Ahad is a minimally invasive surgeon with expertise in abdominal, inguinal and hiatal hernias.
- Imran Hassan, MD, FACS, FASCRS
Dr. Hassan is a colorectal surgeon that provides added expertise on complex stoma site hernias and hernias with fistulas.
- Nora Royer, MD, FACS
Dr. Royer performs open and laparoscopic repairs of inguinal and abdominal wall hernias.
- William Albright, MD
Dr. Albright is a plastic surgeon who partners with the Mercy hernia team when plastic surgery expertise on complex cases is needed.
It’s recommended to have any type of hernia eventually repaired, dependent on the patient’s health. However, if a hernia has minimal- to-no symptoms, the patient and his or her physician may choose to monitor the hernia first, allowing time to treat the underlying causes of the hernia while minimizing risk factors for surgery. (See the “Risk factors” section above for a list of modifiable risk factors that contribute to the formation of hernias.)
There are two steps in the treatment of hernias:
Step 1: Eliminate Risk Factors
Quitting smoking, weight loss, regulation of diabetes, improving nutrition, eliminating active infections anywhere in the body, and treatment for medical conditions that cause chronic strain on the abdominal wall are important first steps when preparing for hernia surgery. Smoking, for example, can increase surgical complications by up to four times, leading to future relapse or infection. Due to this reason, smoking cessation is an important part of treatment for high-risk hernias.
Step 2: Surgical Treatment
Surgery is most often the best solution in treating a hernia. A hernia may be repaired with the use of sutures (stitches) or mesh. Mesh is used in a majority of surgeries as it provides an added layer of reinforcement to the weakened area where the hernia is located and can help decreases the rate of recurrence. To determine which method would provide the best outcome for your hernia type and individual risk factors, discuss surgical treatment methods with your surgeon.
There are 3 surgical options:
- Open approach – requires a larger incision and longer recovery, but for some patients it may be a better option compared to the less invasive approaches due to type, size, risk factors and complexity of the hernia.
- Laparoscopic approach – less invasive than an open approach as it requires smaller incisions to access the hernia. This approach has a faster healing time and is initially associated with less pain. Indications are also dependent on the size, risk factors, and type of hernia.
- Robotically-assisted laparoscopic approach – a less invasive option utilizing the da Vinci® robot. The surgeon is able to perform more complex procedures that are difficult to do laparoscopically. The robot provides tools for more intricate procedures and provides the surgeon with a three-dimensional view.
To determine the best surgical procedure that would provide the best outcome for you, the following is taken into consideration: the type of hernia, the size of the hernia, the complexity (first-time hernia or a recurrent), your risk factors involved, and your own personal goals for this surgery.
Pre-Operative Surgery Instructions
Prior to surgery, patients will be required to meet the following criteria:
- Quit smoking and attend a smoking cessation course three weeks prior to surgery and eight weeks after surgery.
- Management of diabetes - stable hemoglobin A1C of 7 or less.
- Weight loss - Body Mass Index (BMI) of 35 or less.
- Skin condition – no active skin issues or infection at the surgical sites.
These criteria are associated with better results after any surgery, especially hernia surgery. Because hernias are typically elective procedures, we strive to meet these pre-operative goals with our patients to ultimately achieve the overall best outcome.