Have a Hernia? When to Have Surgery

A hernia is a painful medical condition that affects 10-20% of the population. If you’re one of them, Jared Funston, MD, FACS, a board-certified hernia surgeon at AdventHealth Tampa, says it’s important to know what to look for — and when surgery is needed.

What’s a Hernia?

According to Dr. Funston, we’re built like an Oreo cookie — we have layers of skin, fat and muscle. Between fat and muscle, we have fascia, a band of connective tissue that supports your muscles and holds your organs in place. But when the fascia breaks down, holes can develop.

“The fascia is kind of the glue that goes around everything and gives our abdomen its strength,” he says. “When we get a hole in the fascia, that’s when we get a hernia.”

Fat, your intestines or your stomach can push through that weak spot. When that happens, you get a visible bulge that can cause symptoms from a dull ache to a sharp, sudden pain, or what patients often describe as pressure.

Hernias are rarely emergencies. But they also don’t go away.

Different Types of Hernias

Hernias come in different sizes, and they can appear in different parts of your abdomen. The most common hernias are:

• Hiatal hernias develop when the muscle that helps you breathe (your diaphragm) relaxes around your esophagus and your stomach squeezes into your chest.
• Inguinal hernias develop when your intestines push through a weak spot in your abdominal wall into your groin.
• Ventral hernias, like incisional or umbilical hernias, develop in the front of your abdomen. Incisional hernias happen when tissue pushes through incisions from previous surgeries. Umbilical hernias happen when your intestines poke out through your abdomen—and resemble an “outie” belly button.

Is Surgery Always Necessary?

“The vast majority of hernias will grow,” Dr. Funston explains. “Since your body doesn’t have a natural way to fix a hernia on its own, it will just naturally get bigger.”

Depending on how big your hernia is, you may be able to delay surgery. But you’ll eventually need to fix the hole. You can push smaller hernias back in, and that sometimes works for a short time. However, leaving a hernia untreated increases your risk of infection. And trapped tissue can lose blood flow and die, though it’s rare.

When Is It Time to Schedule a Procedure?

Knowing when to have hernia surgery is a real-life Goldilocks situation, Dr. Funston says. Small hernias rarely present problems. They can hurt, but generally only bits of fat can squeeze through. With a large hernia, you need surgery, but your intestines are less likely to get stuck if they slip through the hole.

“Middle-size hernias are where we run into issues. Your intestines can pass through the hole, get stuck and lose their blood supply,” he says. “Blood can back up, and that part of your intestines can die. These are the hernias where we really recommend surgery.”

Dr. Funston says you should also consider surgery if:

• Your hernia is growing
• Your hernia is 2cm or larger
• Your pain and discomfort are getting worse

“The real tipping point is when you start to notice that your symptoms are interfering with your lifestyle,” he says. “If you’re avoiding going to the gym or you’re not taking that longer walk around the neighborhood — that’s what I don’t want to happen.”

What Does Surgery Look Like?

If you need surgery, your doctor can help you choose the right procedure for you. The most appropriate surgery will depend on your overall health, and the type and location of your hernia.

Dr. Funston recommends consulting a board-certified hernia surgeon in your area for procedures such as inguinal hernia repair, ventral hernia repair, and hiatal hernia surgery.

Depending on your unique condition and needs, they will likely recommend one of these types of procedures at a surgery center near you:

• Open hernia surgery: Your hernia surgeon will make an incision over the affected area, pushing the fat or tissue back inside and closing the hole in your fascia.
• Laparoscopic hernia surgery: After making a small incision, your surgeon uses a laparoscope (a long, thin tube with a camera at the end) and small tools to repair your hernia.
• Robotic hernia surgery: Your surgeon uses a computer console and robotic arms to fix your hernia.

Most of these surgeries are minimally invasive procedures that offer numerous advantages, including reduced pain and scarring, and are performed at outpatient surgery centers, which means you won't need a hospital stay.

Full recovery takes four to six weeks. But you should be able to walk around after surgery if you feel up to it, eat regularly and even take a shower the next day. Really, your only post-surgery restriction is avoiding lifting anything over 20 pounds for several weeks.

Don’t Ignore a Hernia

Even though most hernias aren’t medical emergencies, you shouldn’t ignore them forever. In fact, the sooner you talk to your doctor and surgeon about treatment, the easier your repair will be, Dr. Funston says.

The expert and caring team of general surgeons and hernia surgeons at AdventHealth Tampa is ready to help you feel whole again with the most advanced procedures available today to relieve your discomfort.

Schedule an appointment to discuss your hernia symptoms today.

About Dr. Funston

Jared Funston, MD, is a board-certified general surgeon. Dr. Funston believes that medicine is not one-size-fits-all, and that the unique background and perspective of every patient must be incorporated into treatment planning for the best-possible outcomes.