Do you experience any of these symptoms?
• Swelling or a lump in your groin?
• Weakness, pressure or a feeling of heaviness in your groin?
• A dull ache or pain in your groin when you cough, bend over or lift something heavy?

If so, you might have a hernia.

“Even if the symptoms don’t seem like a big deal, you shouldn’t ignore them. That small bulge that doesn’t hurt now will only get larger and become increasingly painful over time. It can even become life-threatening,” general surgeon Dr. Kyle Marthaller of Boulder Valley Surgical Associates warned during a free health lecture held at the Boulder Jewish Community Center.

It’s best to see your doctor if you have a bulge or any groin-area discomfort you can’t explain.

Inguinal Hernia: The Most Common Type
A hernia occurs when an internal organ or tissue bulges through a weakened spot in a muscle wall.

“Although there are many different kinds of hernias, about 75 percent of them occur in the inguinal region – the groin area,” explained Dr. Marthaller. “With an inguinal hernia, it’s usually a part of the intestine that pushes through a weakness in the lower abdominal wall.”

Groin-region inguinal hernias most often happen in men. “In fact, over the course of a lifetime, the chance of a man getting this type of hernia is 25 percent, while for a woman it’s about 5 percent,” said Dr. Marthaller.

Inguinal hernias become a medical emergency if the intestine becomes trapped in the abdominal wall and blood flow to the intestine becomes blocked. Dr. Marthaller said this loss of blood flow is called strangulation and requires emergency surgery.

Femoral Hernia: Dangerous and More Common in Women
A femoral hernia also occurs in the groin. However, women are more likely than men to suffer from them. Although uncommon, they can be very dangerous.

According to Dr. Marthaller, most femoral hernias do not cause bulge. “Often you feel very little. Maybe a vague pelvic discomfort. This is why they tend to be so dangerous – there are often no symptoms until they strangulate and come to light as emergencies.”

Symptoms of strangulation from a femoral hernia include severe belly pain, fever, nausea or vomiting. If you have these symptoms, seek medical help immediately.

When to Have a Hernia Surgically Repaired
If you’ve been told by a health care provider that you have a hernia, you could be wondering whether to have surgery right away or wait.

Your doctor might suggest just keeping an eye on it as long as the hernia is small and not causing problems. While watchful waiting is safe, Dr. Marthaller typically recommends surgical repair sooner rather than later.

“A hernia will not seal or fix itself. Over time, a small hernia will start to become larger, because of exercising, lifting or physical activity,” he said. “The earlier the repair, the more surgical options you’ll have, the lower the risk of strangulation, and the easier the surgery will be.”

Dr. Marthaller also pointed out that by repairing your hernia early on, you can get back to your normal exercise routine, instead of putting limits on your activities from the condition.

Surgical Options: The Pros and Cons
Dr. Marthaller went on to review the pros and cons of each type of hernia repair:

Traditional open repair
This is the oldest, most traditional method for repair. Today’s techniques typically are tension-free, meaning they entail using a mesh implant to cover and reinforce the weak muscle area.
Pros: Can be done under local anesthesia and sedation. This is sometimes the best option for those in poor health and who should not be given general anesthesia.
Cons: Requires a large incision — typically 3 to 6 inches — that tends to have a longer and more painful recovery than other options.

Laparoscopic hernia repair
Laparoscopic surgery involves inserting special instruments through tiny incisions in the abdomen.
Pros: Incisions are smaller, which means less discomfort after surgery, little to no scarring, and a quicker return to normal activity. Unlike an open repair, the surgeon can place a larger piece of mesh behind the hernia opening instead of in front of it. This has the mechanical advantage of using the muscle wall to support the mesh for a more durable repair.
Cons: Always done under general anesthesia. The surgeon secures the mesh in place with tacks, which might increase post-operative pain.

Robotic hernia repair
da Vinci robotic surgery for hernia repair uses the same principles of laparoscopic repair: small incisions for a shorter recovery and the placement of a larger mesh for a more durable repair.
Pros: Allows the surgeon to position the mesh with sutures, offering the advantage of less post-operative pain, which reduces the need for pain medication.
Cons: Requires general anesthesia.

When asked which repair is best, Dr. Marthaller replied, “All offer excellent outcomes, but not every technique is right for every patient. We look at the technique that will provide the strongest repair while minimizing risks and discomfort and the quickest return to normal activities.”

To schedule an appointment with Dr. Kyle Marthaller, call Boulder Valley Surgical Associates
at (303) 443-2123.

Click here to view PowerPoint slides from Dr. Marthaller’s lecture on “Hernia Symptoms You Shouldn’t Ignore.”

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