Where the abdominal wall is weak, the intestines or other soft tissue can protrude and create a bulge, called a hernia, under the skin. Hernias vary in size, visibility and the degree of discomfort they cause. Medical options range from observation to open surgery.
Watchful Waiting
For certain small hernias with a low risk of complications and no pain or discomfort, the physician may decide not to intervene. A 2006 study in the "Journal of the American Medical Association" conducted by Dr. Robert J. Fitzgibbons Jr. and others concluded, "Watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias." However, hernias grow over time, and a larger hernia carries higher risks of complications.
Truss
Years ago doctors routinely recommended wearing a truss or special belt to keep the hernia from bulging. Medical experts today discourage the long-term use of a truss for hernias. According to the Mayo Clinic, "A truss won't protect against complications or correct the underlying problem, although your doctor may recommend wearing one for a short time before surgery." With long-term use, a truss causes scar tissue to form around the hernia, making surgery more difficult. But for frail patients with high-risk diagnoses whom no surgeon would think of operating on unless the hernia became life-threatening, a doctor might prescribe a truss.
Laparoscopic Surgery
In laparoscopic surgery, a tube with a tiny video camera on its end is inserted through a centimeter-long incision in the abdomen. The camera image appears on a monitor. By inserting miniature surgical instruments through another tiny incision, the surgeon can repair the hernia without opening up the abdomen. Surgical repair of a hernia involves moving the protrusion back into the abdominal cavity and repairing the weak area in the abdominal wall. Often the repair is made by inserting a rolled-up piece of synthetic mesh through the incision, unrolling it inside the body and stitching it into place behind the hernia to reduce tension on the abdominal wall, much like patching torn clothes. As healing takes place, tissue grows around the mesh and forms a stronger bond, reducing the likelihood that the hernia will come back. Laparoscopic surgery usually doesn't require overnight hospitalization and scarring is minimal.
Open Surgery
Some hernias can be repaired only with an open surgery, and some laparoscopic surgeries are converted to open surgeries mid-procedure if the surgeon can't get a good view through the camera. In open surgery, the surgeon makes a long cut through the abdominal wall. After manipulating the protruding tissue back into place, the surgeon reinforces the abdominal wall with mesh and closes the incision with sutures. The resulting wound is much larger than in laparoscopic surgery and will require dressing changes and aggressive pain management. Patients undergoing open surgeries typically take longer to recuperate and will need to spend several days in the hospital.
