We have established that having a hernia does not necessarily require surgical repair. However, we also know that surgery is the only way to repair a hernia. When they find out about a hernia, many patients wonder whether it needs to be repaired urgently or ever. This decision is often a personal one that needs to be made with the patient’s loved ones and their medical team.
There are certain cases where repairing a hernia is not an urgent situation – this is especially true for older patients as well as those with asymptomatic hernias. Patients with larger hernias have a lower risk of complications than those with smaller ones. However, for most patients, the decision whether to undergo a hernia repair is not quite as black-and-white.
There are several potential scenarios that a patient must consider when deciding whether they will repair the hernia surgically or not:
First is continued discomfort and possible pain. Typically, when a patient comes to our office suspecting a hernia, it is because they either feel a bulge somewhere in their abdomen or they have pain – commonly caused by abdominal contents getting stuck in the hernia. This pain and discomfort tends not to go away and patients may be mildly or severely limited in the activities they can perform as a result. Depending on the degree of discomfort, this may or may not be an important consideration to the patient
The fact that hernias are progressive also makes the decision more complicated. While losing weight and placing less the strain on the abdomen is a good way to reduce hernia-causing abdominal pressure, an existing hernia will not get better, it will only get worse. As it progresses, the surgical process for repairing it becomes more complicated and the risks increase.
A small number of patients will suffer from what is known as incarceration or strangulation of the hernia. This is where the abdominal contents become stuck in the hernia. Incarceration is somewhat less emergent then strangulation as the latter means that blood flow is cut off to the tissue stuck in the hernia – usually intestinal tissue. Both require immediate medical care and swift surgery to avoid potential complications including the necrosis or death of strangulated tissue. Waiting in a situation such as this can lead to serious surgical complications and even death.
Younger patients in good health and with smaller hernias are often recommended for surgery as their surgical risk is typically very low and their outcomes are often very good. Older patients who present with larger hernias and have her lower risk of strangulation, may be able to choose their preferred course of action with fewer potential consequences.
One common hernia – a femoral hernia – that affects women more often than men, almost always requires prompt surgical care as femoral hernias have a very good chance of strangulating and can cause serious consequences if not treated quickly.
The best way to learn about your hernia repair options is to visit a hernia specialist like Dr. Lublin. After diagnosing the hernia and understanding its characteristics, you and your surgeon can decide whether a repair is right for you, now or in the future. It is important that all patients understand the risks of surgery versus the risks of doing nothing about their hernia.