Emergency Surgery For Hernia? Not Always

May 3, 2016

Updated May 2020

Many inguinal hernia repairs are considered elective procedures, because patients often have the option of when to schedule surgery. This does not mean that these surgeries are not necessary or cosmetic. There is always a chance that a hernia could become strangulated, leading to emergency hernia surgery. Most of the time, people have warning signs before their hernia becomes an emergency. Patients who have worsening pain, intestinal or urinary symptoms should have their hernia repaired more urgently to avoid emergency hernia surgery.

An inguinal hernia occurs when there is a weakness or defect in the abdominal wall that allows the contents of the abdominal cavity to protrude outside. The majority of these hernias can be described as reducible – meaning that can be pushed back in, or returned to the abdominal cavity. Reducible hernias are not life threatening. A small percentage of hernias cause a situation where emergency hernia surgery is necessary every year.

We evaluate about 1200 new patients every year for a suspected hernia.  We feel that most patients fall into one of 4 categories:

• Groin strains – About 15% of the patients we see have pain and no bulge. This is often due to a groin strain and requires physical therapy in conjunctions with strength training.
• Asymptomatic hernias – Some patients have a reducible, painless bulge. These patients are able to do all activities with no discomfort at all.  For asymptomatic inguinal hernias, the risk for becoming strangulated is only 0.1-0.2% per year. We typically let these patients continue with their everyday life and follow up when they become symptomatic. 
• Symptomatic hernia – Many patients present to us with pain at the site of hernia, pain in the abdomen, intestinal or urinary issues. Some patients are able to perform daily activities, but not exercise. Symptoms can become severe enough to restrict patients from going to work, standing or sitting for long periods of time. Patients in this category need surgery to resume their daily lives, improve their quality of life and avoid emergency hernia surgery. A hernia specialist can help determine when a hernia requires more urgent surgery to avoid an emergency. Waiting too long to have a symptomatic hernia fixed can lead to longer and more complicated surgery. 
• Incarcerated hernia –  Some patients show up with a hernia that can not be pushed back in, with or without severe pain.  Patients without severe pain can have urgent surgery within a few weeks.  Patients with severe pain often need emergency surgery and are best evaluated in an emergency room. When an inguinal hernia is no longer reducible, the abdominal contents – specifically if these including intestine – are permanently stuck outside of the abdominal cavity. When an incarcerated hernia becomes strangulated, the piece of intestine stuck outside of the abdominal cavity no longer receives adequate blood supply. As the tissues spend longer periods of time with little or no blood supply, they begin to die. This strangulated hernia is a surgical emergency, and requires surgery to save the dying tissues.

It’s important follow up with a hernia surgeon any time there is an increase in the pain you are experiencing from your hernia. If this pain is not relieved by the usual methods, then you should be evaluated to see if more urgent surgery is required. Waiting too long can lead to more problems down the road. Emergency surgery for inguinal or umbilical hernia can be serious and sometimes life threatening. If you have symptoms from a hernia it is important to meet with a surgeon who has expertise with hernia surgery in order to schedule surgery.  You can learn more from our hernia glossary or about the minimally invasive approach we utilize.

Knowing When a Hernia Becomes an Emergency Situation

October 4, 2021

It’s a hernia. What’s so bad about that? Well, from an urgency standpoint, there are two different kinds of hernias, non-emergency and emergency and it is impossible to predict when a “run of the mill” hernia turns into an emergency. However, in this blog, we discuss the signs are of a hernia emergency that requires a trip to the ER or dialing 911, when you should speak to your doctor and how you can manage your hernia appropriately.

How does a hernia become an emergency? To understand this, you must know the anatomy of a hernia. The contents of your abdomen are kept in place by a thin but strong layer of tissue known as the fascia. When there is a weak point in the fascia, abdominal contents can push through. This hole in the fascia is what we know as a hernia. Contents of the abdomen pushing through the hernia defect in and of themselves are not an immediate concern other than the pain and potential lifestyle limitations that they may cause. However, if the hernia contents get trapped in the defect, known as incarceration or if their blood supply is cut off, known as strangulation, we have an emergency.

When blood is cut off to the contents of the hernia, they can die very quickly. If this happens, not only must the hernia be repaired, but the diseased portion of the abdominal contents must be removed too. This can be fat tissue or even part of the colon (large intestine). The bottom line? Emergency hernia surgery often comes with a higher risk of complications and may even lead to multiple surgeries to correct several follow-on issues.

Signs and symptoms of an incarcerated or strangulated hernia

Most patients with symptomatic hernias may feel a bulge or pain around the hernia. The pain can create a burning sensation, heaviness, dull throbbing pain or even sharp stabbing pain. Most often, the hernia retracts back into the abdomen when the patient lies down or takes pressure off the abdomen. When the hernia contents become incarcerated, they will not push back into the abdomen. In other words, there will be a permanent bulge and often significantly more pain than before.

While incarceration is problematic, strangulation is the biggest concern. When the abdominal contents become restricted to such a degree that blood flow is cut off, they begin to die. This usually causes significant, excruciating pain, redness in area of the hernia, fever and other general symptoms – fatigue, nausea and more. Incarceration and strangulation require a visit to the ER or a call to 911 as soon as possible to reduce the hernia and restore blood flow.

When should you visit your doctor?

If you have the signs or symptoms of an incarcerated or strangulated hernia, or any other potentially emergent situation, do not call your doctor, go straight to the ER or call 911. However, if the hernia reduces into your abdomen and is only mildly symptomatic, you should make a call to your general surgeon as soon as possible to schedule a consultation and understand the nature of the hernia. Your primary care physician may refer you to a general surgeon such as those here at MIIS. You can also contact us directly to schedule a consultation with one of our surgeons to learn more about your treatment options.

Which hernias are most problematic?

While incarceration and strangulation may seem very scary, they are generally quite rare. The most common hernias, including inguinal hernias, usually strangulate at a rate of about 1 to 2%. In other words, the chances of strangulation are quite low. However, a visit to your surgeon is still important as surgical correction may be recommended, especially if you are young and healthy, your lifestyle is being impeded by the hernia and/or you’re experiencing pain. Older patients with less abdominal musculature may be recommended for watchful waiting to see if the hernia worsens. Femoral hernias, those that extend into the thigh are the most likely to strangulate. In fact, approximately 20 to 30% of these hernias, left untreated, may strangulate. If you are diagnosed with a femoral hernia, you will be recommended for surgery as soon as possible to eliminate the risk of strangulation.

Ultimately, speaking to your doctor at the first signs of a hernia is the best way to ensure a proper diagnosis and repair. Hernia surgery performed electively and on your own schedule is often safer and more effective, with fewer postoperative concerns. Emergency surgery generally comes with a higher risk of complications. For more information or to get a diagnosis for a suspected hernia, please contact us and schedule a consultation with one of our surgeons.

Related Topics:

• Exercises To Do and Avoid If You Have a Hernia
• Does A Hernia Always Need to Be Repaired?

Hernia repair with mesh implants, prices for surgical treatment of hernia with mesh endoprostheses in St. Petersburg clinic

Prices Doctors Popular questions Our centers

Hernia repair with mesh implants is the “gold standard” in the world practice of abdominal wall hernia treatment. It is this technique that has replaced the tension plastic with one’s own tissues, and it is it that is recommended by the European Society of Herniologists. Doctors of the Center for Surgery “SM-Clinic” – highly qualified specialists – are fluent in modern technologies and successfully operate on hernias of any complexity using mesh endoprostheses.

Transaction methods
Indications Contraindications Preparation Period

Mesh repair is the “gold standard” for the treatment of abdominal wall hernias in the world
practice. This technique is recommended by the European Herniology Society and has replaced tension plasty
patient tissues.

Features of hernioplasty with tension-free mesh

The hernial orifice is closed with a special mesh implant and not with the patient’s own tissues.
SM-Clinic specialists use materials from world-famous manufacturers – Ethicon, Covidien,
bard. Grids are made of modern composite and synthetic materials. They are reliable
completely safe and not rejected by the body.

The operation takes an average of 30-60 minutes. The time depends on the type and size of the hernia, the general condition of the patient and
other factors. If a laparoscopic technique was used, then the next day after the operation, you can
go back home. The mesh reduces pain and reduces the rehabilitation period to 2-3 weeks.

Benefits of mesh implants

1

Slight pain after surgery because the tissues
bodies are not stretched, injured or stitched together.

2

The minimum probability of recurrence is less than 1%.
For comparison, plasty with local tissues gives 6-14% of relapses.

3

Short and easy rehabilitation. In the hospital
it only takes 1-3 days. After a week, you can return to normal life. Complete
recovery takes 1 month.

Types of nets

• Standard implants. Meshes can be non-absorbable, absorbable and partially
  absorbable, they are made from composite or synthetic materials. Grid shape –
  rectangular, elliptical or round, the product can be stretched to take the optimal
  provisions. Such meshes are used to repair almost all types of hernias.
• 3D implants. These are advanced meshes for inguinal hernia repair. They are created with
  the anatomy of the area, which made it difficult to place conventional meshes because they are difficult to
  place in the groin.

Operating methods

Laparoscopic hernioplasty

Instead of incisions, three punctures less than 1 cm long are made. Special instruments are inserted through them and
optical equipment. This is the most minimally invasive technique. The risk of recurrence is reduced to almost zero,
the recovery of patients is as fast as possible, and the time spent in the hospital is only 1 day.

Open hernioplasty

To access the hernial sac, an external soft tissue incision is made. The mode of the abdominal operation
– the most sparing, that is, the cuts are only the minimum necessary, and the seams are cosmetic.

Indications for hernioplasty with mesh implants

• umbilical hernia;
• inguinal hernia;
• hernia of the linea alba;
• hernia of the Spigelian line;
• femoral hernias;
• incisional hernias.

Contraindications

• bleeding disorder;
• diabetes mellitus;
• diseases of the respiratory and cardiovascular systems;
• large and giant inguinal-scrotal hernias;
• chronic diseases in the stage of decompensation;
• common infections in the body.

Preparing for surgery

The patient needs to undergo a standard preoperative examination: pass urine and blood tests, do an ECG
and fluorography, visit a surgeon, therapist and anesthetist. Additional methods may be assigned
diagnostics.

Promotion! Free consultation with a surgeon about surgery

Take advantage of this unique opportunity and get a free consultation about elective surgery.

Recovery period

Depending on the type and extent of the intervention, you need to spend 1-3 days in the hospital. Throughout the month
you can not play sports, lift weights, load the press. There is no risk of mesh rejection because
Implants are made from modern materials. After a week, patients can already return to
habitual lifestyle with minimal restrictions.

What we treat

Laparoscopic Hernioplasty

Laparoscopic hernioplasty is performed without incisions, through three small punctures less than
1 cm each. Due to the use of special instruments, endoscopic surgery is the most
low-traumatic method of hernia treatment. Laparoscopic hernia repair practically does not give relapses
and ensures the fastest possible recovery of the patient after surgery – in the hospital, the patient
spends only 1 day.

The operation is performed using mesh implants.

Read more

Open hernioplasty

In open hernioplasty, the doctor performs an external skin incision to access the hernial sac and
fabrics. When performing abdominal surgery, our doctors perform it in the most gentle mode:
minimally necessary incisions, cosmetic suture, use of modern suture
material. Our surgeons do everything necessary to effectively repair a hernia and get good results.
aesthetic results.

The operation is performed using mesh implants.

Read more

FAQ

Answered questions: Mikhailov Aleksey Gennadievich Surgeon, oncologist, mammologist, endocrine surgeon.

The choice of mesh depends on the approach that the surgeon determines when performing surgery. In the treatment of umbilical hernia using a laparoscopic technique, three-dimensional meshes will be used. When performing surgical intervention in the classical way, traditional, non-absorbable types of mesh are used. They are attached to tissues with special medical staples. If we are talking about removing a small umbilical hernia, while the muscles in the abdominal area are in sufficient tone, it is possible to install absorbable meshes that prevent the formation of cicatricial fibrosis in the future.

If the doctor has correctly selected the mesh, installed it correctly, taking into account all the anatomical features of the patient’s hernia, no complications after surgery should occur. The network will take root safely. In rare cases, even taking into account the fact that the meshes are hypoallergenic, the body can reject the prosthesis and form inflammatory, allergic reactions. The risk of hernia recurrence with mesh is less than 10% and is usually due to defective operation, improper mesh sizing, or improper mesh placement. In addition, problems are possible if patients do not adhere to the doctor’s recommendations in the postoperative period.

Depending on the type of surgery, healing takes place over several weeks. With laparoscopic surgery, the sutures are removed after a week, with open surgery – after two weeks. All this time it is necessary to treat the surgical wound. The mesh setting area is gradually taking root, during the first half of the year a sparing regimen is needed to prevent relapses. From about 7-8 months, general strengthening therapy is carried out, aimed at increasing muscle tone, strengthening the abdominal wall.

Such a complication is extremely rare, especially if the operation is performed by an experienced surgeon and in compliance with the technology. If the endoprosthesis is still rejected by the body, inflammatory reactions may occur at the site of the mesh with swelling, pain, and poor wound healing. Perhaps fever, general malaise, headache, nausea. The second option – no less rare, is the development of allergic reactions. They are manifested by burning, itching at the site of the mesh, pain and swelling of the tissues.

All types of mesh endoprostheses are sterile thin meshes, which are made of polypropylene mono-filaments, which are non-reactogenic and biologically inert. They do not lose elasticity, remain strong under the influence of various biological fluids, actively resist infection and external mechanical influences. They can be non-absorbable, that is, after setting they remain in the body for life without causing rejection. The second option – absorbable – they gradually disintegrate as tissues and muscles are restored.

Specialists in this field 20 doctors

Leading doctors 7 doctors

Senko Vladimir Vladimirovich

Head of the Center for Surgery and Oncology

Work experience: 23 years

Dunaisky, 47

m. Dunayskaya

Marshal Zakharov, 20

Metro station Leninsky pr-t

Vyborgskoye shosse, 17

metro station Prosveshcheniya

Make an appointment

Salimov Vakhob Valiyevich

Surgeon, oncologist

Work experience: 13 years

Vyborgskoye shosse, 17

Prosveshcheniya

Dybenko, 13k4

Dybenko street

Make an appointment

Aramyan David Surenovich

Surgeon, coloproctologist, oncologist, mammologist

Work experience: 13 years

Malaya Balkanskaya, 23

Kupchino m.

Work experience: 17 years

Dybenko, 13k4

m. Dybenko street

Make an appointment Work experience: 19 years

Danube, 47

m Dunaiskaya

Malaya Balkanskaya, 23

Kupchino metro station

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Mikhailov Aleksey Gennadievich

Surgeon, oncologist, mammologist, endocrine surgeon

9000 2 Work experience: 22 years

Udarnikov, 19

Metro station Ladozhskaya

Marshal Zakharov, 20

Metro station Leninsky pr-t

Vyborgskoye highway, 17

Metro station Prosveshcheniya 90 003

Make an appointment

Alexander Bakhytovich Khangireev

Surgeon, oncologist, coloproctologist

Work experience: 13 years reception

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+13 doctors

Other doctors 13 doctors

Bogushevich Irina Gennadievna

Oncologist, mammologist, pediatric surgeon

Work experience: 10 years

Vyborgskoe shosse, 17

m. 8
Grinevich Vladimir Stanislavovich

Surgeon, oncologist, mammologist, coloproctologist

Work experience: 27 years

Vyborgskoe shosse, 17

m. Prosveshcheniya

Make an appointment

Dubskikh Natalya Alexandrovna

Surgeon

Work experience: 5 years

Dunaysky, 47

Dunayskaya metro station

Make an appointment

Zadorozhny Nikita Sergeevich

Pediatric surgeon, pediatric surgeon-urologist

Work experience: 7 years

Vyborgskoye shosse, 17

metro Prospekt Prosveshcheniya

Make an appointment

Karapetyan Zaven Suren

Coloproctologist, surgeon and phlebologist

Work experience: 15 years

Dunaisky, 47

Dunaiskaya metro station

Marshala Zakharov, 20

Leninskiy pr- t

Make an appointment

Klyuev Andrey Nikolaevich

Operating proctologist

Work experience: 16 years

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

Lopatin Ivan Mikhailovich

Operating surgeon

Work experience: 5 years

Dunaisky, 47

Dunayskaya metro station

Make an appointment

Maslennikov Dmitry Yurievich

Surgeon, proctologist, mammologist

Work experience: 16 years

Udarnikov, 19

Ladozhskaya metro station

Dybenko, 13k4

m. Dybenko street

Make an appointment

Nekrasov Roman Alexandrovich

Coloproctologist and surgeon

Work experience: 8 years

Udarnikov, 19

Ladozhskaya metro station

Marshala Zakharov, 20

Leninsky Prospekt metro station

9000 2 Make an appointment

Pfanenshtil Anatoly Viktorovich

Surgeon, mammologist and oncologist. Doctor of the highest category.

Work experience: 15 years

Dunaisky, 47

Dunayskaya metro station

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

Sokolova Anna Sergeevna

Coloproctologist, surgeon. Candidate of Medical Sciences.

Work experience: 13 years

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

Khokhlov Sergey Viktorovich

Surgeon, oncologist, coloproctologist

Work experience: 28 years old

Vyborg highway, 17

m. Prospekt Prospection

Sign up for reception

8
Shishkin Andrey Andreevich

Surgeon, phlebologist, proctologist. Candidate of Medical Sciences

Work experience: 13 years

Dunaisky, 47

Dunayskaya metro station

Make an appointment

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Our branches in St. Petersburg

6 branches

Center for Surgery Dunayskaya metro station

47 Dunaisky prospect

Dunaiskaya metro station

daily from 09:00 to 22:00

Surgery Center Ladozhskaya metro station

Udarnikov Avenue, 19/1

Ladozhskaya metro station

daily from 09:00 to 22:00

Center for Surgery Metro station “Leninsky Prospekt”

st. Marshal Zakharov, d.
daily from 09:00 to 22:00

Center for Surgery m. “Prospect of Education”

Vyborgskoe shosse, 17 building 1

metro Prospekt Prosveshcheniya

daily from 09:00 to 22:00

Surgery Center m. “Kupchino”

street Malaya Balkanskaya, 23

m. Kupchino

daily from 09:00 to 22:00

Center for Surgery Dybenko Street

Dybenko Street, 13k4

Dybenko Street

daily from 09:00 to 22:00

Removal of a hernia of the abdominal wall free of charge under compulsory medical insurance

Abdominal hernia is one of the most common reasons for visiting surgeons: it occurs in 6-7% of men and 2.5% of women during their lifetime [1]. Many people put off hernia treatment, but in vain: high-tech methods allow you to recover in a matter of days after surgery. Dmitry Sergeevich Gavrukov, head of the surgical department No. 4 of the GKB named after I.I. S.S. Yudina

What is a hernia and why does it occur?

A hernia is a disease in which the contents of the abdominal cavity exit through a hole formed in the abdominal wall. A hernia consists of a hernial sac, hernial contents and hernial ring. The gate is the defect of the abdominal wall through which the contents come out into the subcutaneous fat. This content can migrate to the hernial sac and back – and so on throughout the day back and forth.

How to understand that there is a hernia of the abdominal wall?

The patient usually finds it himself. There is some protrusion on the abdomen or in the groin. It can independently retract into the abdominal cavity and do not disturb for some time, and then reappear. A person may notice the asymmetry of the anterior abdominal wall, experience pain. Usually it has a jerking, cramping character and is stopped by self-reduction of the hernial protrusion.

Types of hernias of the abdominal wall

Localization of hernias most often occurs in the groin (inguinal hernia), in the navel (umbilical hernia), in the projection of the white line of the abdomen (hernia of the white line of the abdomen). There is also a postoperative hernia (usually in the projection of the postoperative scar).

In what situations is surgery required?

Hernia itself is an absolute indication for surgery. An exception is the expansion of the umbilical ring up to 1 cm, in which the contents of the abdominal cavity do not stick out – that is, this is not yet a hernia. But if the defect of the abdominal wall is more than 1 cm, this is an indication for surgical treatment.

How is abdominal wall hernia repair performed?

Two options: open operation and laparoscopic intervention.

Open operation

Open operation is the most traumatic: the incision can be 8-10 cm, depending on the size of the hernia. But there are situations when an open operation is indicated. For example, at a high risk of increased intra-abdominal pressure, in aged patients with severe concomitant diseases, in the case of previous multiple abdominal operations. The latter is a relative contraindication, since here the factor of the surgeon’s professionalism, his skills, as well as the level of equipment in the operating room are of particular importance.

Laparoscopic intervention

Laparoscopic intervention is performed without going into the abdominal cavity. We work in the retroperitoneal space. The anterior abdominal wall, like a sandwich, consists of several layers, and we need to be in the right one in order to approach the hernia from the inside. The operation uses a 10mm port to enter the abdominal cavity and two 5mm ports to expose the hernia. Total – three cuts with a total length of 2 centimeters.

The surgeon visualizes the hernial protrusion on a large high-resolution monitor, which allows you to perform a high-quality operation and eliminate the risk of complications.

Next, we isolate the hernial sac and bring its contents into the abdominal cavity. A mesh implant is installed on the hernia gate, which closes the space between the layers. We do not sew anything, we do not cross, we do not injure the layers of the anterior abdominal wall. Generally speaking, there is nothing to get sick after the operation.

How is recovery going?

After laparoscopic surgery, the patient spends up to three days in the hospital, taking into account the examination. Within two weeks it is necessary to refrain from physical activity, since excessive exercise can lead to damage to tissues that have not fused together. You can return to your usual work activity in a week if you work in an office. Of course, if the work is physically demanding (for example, if you are a loader), then it will take a month to recover.

What are the contraindications for surgery?

Contraindication is the presence of oncological diseases – in the case of planned treatment. In emergency situations, they operate even if they are available. Also, contraindications are diabetes mellitus in the stage of decompensation, the constant use of blood-thinning drugs – anicoagulants and desogregants (but with their correct cancellation, surgical treatment is possible), as well as the presence of purulent-septic disease. During pregnancy, the operation is not performed in a planned manner.

What happens if the operation is not performed?

There is a superstition that a hernia can go away on its own. This is impossible. But a number of complications are likely. The most dangerous complication is strangulation of the hernia. Against the background of increased intra-abdominal pressure – for example, when lifting weights – several intestinal loops come out into the hernial orifice. Then they close, and the contents of the hernial sac are infringed. This is an extremely dangerous condition that requires emergency hospitalization. If a person is in the operating room within the next few hours, the organ can still be saved. If not, the tissues become necrotic. Life can be saved, but part of the intestine has to be removed. This is urgent surgery with all the ensuing complications.

Is it possible to perform an operation to remove a hernia in Moscow for patients from other cities?

Our center is known as one of the leading herniological centers in the country, where patients come from all over Russia.