Hernia Repair Expert Forum
When is it time to have hernia repair surgery?
About This Forum:

This is a place to ask questions about hernia repair and receive a personal answer from a highly qualified doctor. You will also find support from other members who share your interest in hernia repair. A hernia occurs when part of an internal organ bulges through a weak area of muscle. Most hernias occur in the abdomen. Types of hernias, include, Inguinal, in the groin; Umbilical, around the belly button; Incisional, around or through a scar; Hiatal, in the diaphragm; Congenital Diaphragmatic, caused by a birth defect.

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When is it time to have hernia repair surgery?

Hi,

After having numerous surgeries (several heart; complicated appendectomy a few years ago) I've developed a hernia in my abdomen.  Are their guidelines re: when it's time to see a surgeon?  It doesn't bother me, other than it protrudes a little and can be seen if I'm wearing a golf shirt.

Thank you

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Hi Jack 615,
The decision to repair a hernia can depend on many factors such as the hernia’s location and size, the patient’s other medical problems and how much the hernia is affecting one’s quality of life.  I will generally recommend repair of most hernias when I see them, as they do not get better on their own and generally just get larger and more problematic with time.  There is good evidence to suggest that an inguinal (groin) hernia that is without any symptoms and is simply noted on an exam can be safely watched and not repaired until it causes discomfort.  However, these hernias are usually small and more easily repaired rather than waiting until they become large or problematic.  Although some patients may choose to not have a minimally-symptomatic hernia repaired, in my practice, I more strongly recommend repairing a hernia when it meets one or more of the following criteria:

1. It causes pain or significant discomfort
2. It cannot be reduced (easily pushed back in or flattened out)
3. It is growing in size or is large enough such that it interferes with daily activities
4. There are skin changes overlying the hernia (such as thinning or discoloration).
5. The hernia contains intestine that could become entrapped in it.  You can only know this for sure after  being examined by a doctor and possibly having a CT (CAT) Scan

That being said, it’s probably best to be examined by a general surgeon or a hernia specialist to see if you meet any of the above criteria.  Even if the 2 of you ultimately decide to not repair your hernia at this time, he/she can at least discuss with you the danger signs to look out for that would suggest a problem such as entrapped or blocked intestine.  Hope this helps!
Dr. Pierce
5 Comments
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Hello Dr. I have been having bad abdominal pain right and left side of my stomach. My doctor says I have a big size hiatal hernia. Its causing my digestive system to go bad, everything hurts me from the front to the back. I have alot of gas pain also. The pain is also in my left rib cage.  How long is it time to get hernia repaired. I return to my gastro doctor on Friday, August the 10th.
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If you’re already having significant pain and GI discomfort from your hiatal hernia, then you’re probably nearing the time at which you should have it repaired, although some additional workup will be necessary before you undergo an surgery.  I’m assuming you’re already on a strong antacid medication (such as Nexium, Prevacid, Dexilant, etc.) that is not giving you much relief.  If not, this is often the first step.  If your gastroenterologist has not yet performed an upper endoscopy (EGD), then this is probably in order to fully assess the size of your hiatal hernia and make sure you don’t have any stomach ulcers or other concerning lesions.  In my practice, I always order both a 24-hour pH study to look at how much acid reflux you’re having as well as a high-resolution esophageal manometry to make sure you’re swallowing function is OK.  This latter test is extremely important if you have any difficulty or pain with swallowing.  If your hiatal hernia truly is large, then surgery is really the only way to correct it.  This generally involves a laparoscopic (tiny incisions) procedure to repair the hernia and then fashion the stomach in such a way to prevent further reflux through a procedure known as a fundoplication.  If your gastroenterologist agrees that you probably need such a surgical procedure, you should go to a surgeon who has expertise in this operation and in laparoscopic surgery in general.  One quick word of warning – your gas pains can actually be made worse by this operation, but some over the counter Gas-X several times per day usually helps the situation quite a bit.  Your surgeon should also discuss other surgical risks and side effects prior to any operation. Hope this helps,
Dr. P.
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Thanks Dr. Pierce, I had and upper GI done with my gastro doctor. The test came back he didnt see a haital hernia, he said unless it was a sliding hernia, what's the different. My Ct scan said it was a large haital hernia, how could it disappear. I had another test done to check for gallbladder on Aug. 13, 2012.
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I have 10 hernias and I am 17 weeks pregnant. My insurance approved me to have an abortion which I am against but I feel the need to have it done based on whats going on. They will have to take the baby from my side and there are many risks because of that. My insurance will NOT approve the hernia surgery because it is in Portland which is 4 hours away from me. I get approx. 70 bubbles a day (where I have to push them back in). They are getting harder to push back in. I cannot walk, cough, sneeze, laugh, lift my 1 yr old or play with my 5 year old, I am sick all the time, I get very hot when they pop out, I have to lay a jug of juice or water on my tummy and lay flat to pop them in, I throw up, pass out - it goes on and on. I have to eat very little so that I dont get them, if I have to use the rest room and I cannot use it right then and there I get sick, when I eat anything it seems to go threw me... I have appealed it, raised hell about it, when to lots of doctors, etc. I have only a few more weeks left before I cannot have the abortion. I am scared fro my life and scared for the well being of my kids. Any advise?
Oh, How I got them... I have lost a lot of weight (after I had my 2nd child in Aug of 2011, I lost 134 lbs in 4 months. Before that i have weighed a LOT. My highest weight was 807 lbs.I am 400 now.) I have done it all on my own and I am slowly getting the rest off (or will be after baby or surgery). The weight that I lost left little cushion for my tummy causing the hernias. They saw them when I delivered my 2nd son by c-section but never told me I had them, just documented them. it took me 4 months after I had him to find out that I had them then it took my county 8 months before I could see anyone just to find out that no one will see be because I am pregnant. I am on bed rest and a single mom on my own. This is getting really hard especially since I am not even 1/2 way threw the pregnancy and unable to be mobile. Please advice, I am out of resources now...
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