Hernia FAQsShomaf Nakhjo, DO Advanced Minimally Invasive Surgery

The abdomen has multiple layers. A true hernia is a defect in the fascia, which is the strength layer. When the abdominal contents come through the hole in the fascia, this can lead to complications. Unfortunately, no matter how many core exercises you do, nothing can fix the defect in the fascia. Surgery is necessary to fix a true hernia, but there are different ways to do this, by either closing the hole with sutures, or if it is a large defect mesh may be used. We specialize in all aspects of hernia repairs, so make an appointment to see how we can help you!

Patients go home the day of surgery and are encouraged to ambulate. We advise regular daily activity for the first two weeks and no lifting greater than 20 pounds. This allows the tissues to heal and prevents complications such as damage to the repair increasing the risk of recurrence. For the Shouldice repair, since we close the defect with multiple layers of sutures and no mesh, it takes 3-4 weeks for the majority of the area to heal. After 4 weeks you can slowly begin increasing activity and lifting, but making sure to pay attention to your body. If you experience pain or any severe pulling sensation, you should ease off. After 6 weeks you should be back to yourself and no limitations!

Most patients may return to office type work or jobs with light duty within 1-3 days. For example, if your surgery is performed on a Thursday, you can return to work the following Monday. Generally speaking, we usually will provide you with an up to 2 week off from work note for office/light lifting jobs. Jobs that require heavy lifting will often require 4 weeks off. Our staff works quickly and efficiently to get your paperwork done if short term disability needed.

So this depends on the type of surgery that is required. Open hernia surgery will require an incision on the outside of the abdomen; however, we pride ourselves on making incisions as small as possible for our patients. Open inguinal hernia incisions are about 4 cm located in the groin. Open umbilical hernia incisions are about 2 cm in the belly button. For laparoscopic hernia surgery, we make two incisions, one 10 mm and one 5 mm in the left upper quadrant of the abdomen. All incisions are closed with absorbable sutures, so no need to remove them!

For many people, the thought of having surgery can be very overwhelming. To put our patients at ease we give them the facts. Patients who undergo surgery with us have less than 0.5% chance of chronic pain after surgery and less than 1% chance of recurrent hernia. When you go to a surgeon you trust with years of experience in hernia surgery, rest assured you will have a great result! And we are here to support you every step of the way!

Many patients come into our office because they are interested in a mesh-free hernia repair. Complications from mesh can and do happen, around 10% of cases. They can cause chronic pain or even possible infections as the mesh is considered a foreign body. We specialize in the Shouldice Procedure which is a mesh-free option to repair an inguinal hernia. The strength layer comes from a 5-layer complex closure. There is no increased risk or recurrence with the Shouldice Procedure vs a mesh for hernia repair. You’ll be back to everyday activities in as little as 1-3 days! Come in to see if you’re a candidate for our mesh-free hernia repair!

Our office offers a free telehealth consultation to answer any questions you may have prior to meeting with Dr. Nakhjo. In order to make it convenient for our patients, our Physician Associate, Madison Keppeler, can call you before coming into the office to see what procedure you would benefit from, if you truly have a hernia, or just answer any questions you may have! We treat each of our patients on an individual basis and understand that it can be difficult to come into the office. We strive to make the process easy and stress-free!

The simple answer to this question is no; even though inguinal hernia surgery is in close proximity to the spermatic cord, we use a safe technique that protects the reproductive and sexual anatomy. Occasionally there is some decrease or loss in sensation at the incision site along the groin, but rest assured, nothing is altered with sexual function.

There are different ways inguinal hernias can be diagnosed. Some patients are sent by their primary care physicians, or the patient may feel a bulge on their own. The bulge is usually felt in the groin area, but some people experience it in the scrotum (near the testicle). Some patients experience pain or a dull ache, others have no pain at all, they just notice a bulge. Usually, inguinal hernias grow over time, however, some patients notice a bulge after a certain event, such as heavy lifting.

It is important to see a surgeon who specializes in hernias, to make sure this is the correct diagnosis, which can usually be identified on a physical exam. If there is any question after seeing a patient, further imaging studies such as a CT scan is a definitive way to diagnose an inguinal hernia; however, this is usually not necessary.

If a patient has a hernia, it can usually be determined on physical exam by asking a patient to bare down or cough. Some hernias are obvious with the patient standing. It is important to determine if the hernia is reducible (contents of the hernia can be pushed back into the abdominal cavity), because if not, this puts a patient at higher risk for incarceration. An incarcerated hernia is a medical emergency, and therefore, surgery is performed immediately.

If there is no bulge felt on physical exam, this can be a sign of a groin strain or an early hernia or “pre-hernia”. You can think of a pre-hernia as a “dent in the abdominal wall” vs a true hernia which is a “hole through the abdominal wall’”. If an early hernia is diagnosed, you can watch and wait with close observation. If a noticeable bulge appears or pain develops then surgery is indicated.

To diagnose a muscle strain, we can have a patient lay on the exam table and mobilize different muscle groups to re-create their discomfort. Most patients with groin strain state that the pain gets better with an non-steroidal anti-inflammatory (such as Advil). They usually feel better in several days.

A hernia occurs when there is a hole in the fascia of the abdominal wall. This allows for abdominal contents to bulge through. In the case of an inguinal hernia there is a defect in the inguinal canal. The inguinal canal contains blood vessels, spermatic contents, and nerves that travel to the testicle. A hernia can cause compression of these structures, leading to pain. Patients usually describe the pain in the groin area, or it may even radiate down to the scrotum. In addition, usually patients state more of an ache toward the end of the day as prolonged standing can increase the pressure, but laying down tends to relieve this pain (allowing the abdominal contents to be reduced).

By allowing the hernia to be reduced usually resolves the pain. There are multiple ways this can be accomplished. Most patients can reduce their hernias by laying down, allowing the abdominal wall to relax, and the abdominal contents stuck in the hernia can return to their natural location, no longer compressing the surrounding structures. Many patients also use a hernia belt or hernia truss because again, this keeps the abdominal contents where they belong. Lastly, surgery can relieve the pain people have from their inguinal hernias for good! This is why being evaluated by a skilled hernia surgeon is so important.

Many of our patients are surprised by the minimal amount of discomfort they experience after surgery. We contribute this to a long-acting pain medication called Exparel that can last up to 72 hours. We also perform a specific nerve block, called a TAP (transverses abdominal pain) block with Exparel that works extremely well for our patients. Many of them tolerate the procedure and only need Advil and or Tylenol after surgery. There is now a medication that combines acetaminophen (Tylenol) with ibuprofen (Advil) in which you can just take this one medication every 6 hours as opposed to alternating the two. In cases where patients have more severe pain, we always give a prescription of Tramadol; however, we limit the quantity, therefore preventing any type of opioid addiction. We also advise our patients to ice the area is this will help with post-operative pain.