Abdominal Hernia Repair, What Is The Best Surgical Method and How To Recover

Abdominal Hernia Repair, What Is The Best Surgical Method and How To Recover

I suffered from a incisional abdominal wall hernia when I was an adolescent. My appendix burst, and later exploratory surgery had to be performed to drain abscesses. The incision left me with a massive scar and a weak abdominal wall. I then developed an incisional hernia and had an artificial mesh repair to fix the issue. I remember that before I was officially diagnosed that I looked pregnant even though I only weighed 130 pounds. I am lucky; I do not have the major issues associated with hernia mesh repair. You have probably seen the commercials about people having a hernia mesh repair and suffering from severe pain, inflammation, infection, and even rejection. Many people have become severely disabled from the surgeries and some have died. There are better hernia repair techniques then having a synthetic mesh to reinforce a hernia. So, if you have an abdominal hernia what are the differences in the surgeries and what can be done to help you recover?

All About Abdominal Wall Hernias1 2 3

An abdominal wall hernia is a weakness of abdominal muscles or the abdominal connective tissues that may cause many health issues in those who suffer from them. Hernias either can be congenital (from birth) or acquired (from injury or disease). There are three different types of known abdominal wall hernia’s, umbilical, epigastric, and incisional.

  • Umbilical hernias occur around the navel. Many babies have a small umbilical hernia because the opening for the umbilical cord blood vessels did not close completely. In younger children, doctors monitor umbilical hernias they can sometimes close on their own and do not require surgical intervention. Some adults develop umbilical hernias from too much abdominal pressure. Umbilical hernias occur because of obesity, pregnancy, or ascites (excess abdominal fluid).
  • Epigastric hernias form through small defects in the midline of the upper abdominal wall (above the navel). Epigastric hernias can occur from increased abdominal pressure and weakness of the upper abdominal wall. Umbilical hernias generally occur because of obesity, pregnancy, severe coughing gits, heavy lifting, sports injuries, and strenuous physical labor.
  • Incisional hernias sometimes form through a surgical incision in the abdominal wall. The main cause of incisional hernias is prior abdominal surgery.
  • The risk factors for developing an abdominal hernia include being male, old age, and inherent abdominal weakness. Other risk factors include if you frequently lift very heavy objects, weight lifting, prior invasive abdominal surgery, chronic cough or vomiting, constipation, sports injuries, and general accidents. Symptoms of an abdominal hernia include protruding or bulging hard skin/muscle mass in the abdomen, pain or occasional numbness in the abdominal area (rare because most hernias are asymptomatic for quite some time, more likely for strangulated hernias). Obstructive hernias may cause nausea, vomiting, and fever if the herniated tissue blocks the functioning of the intestines. Strangulated hernias and obstructive hernias are medical emergencies in some cases because of the potential loss of blood supply to specific areas or bowel obstruction.

    Abdominal hernias are treated with surgical repair by mesh repair method, older tension repair methods, tension-free repair method, and the Shouldice repair method. As someone with a hernia abdominal mesh repair performed more than ten years ago, I would recommend the Shouldice repair procedure if all possible.

    Abdominal Hernia Repair Methods

    Tension Repair

    Tension repair was the first hernia surgery method to be developed in the late 1800’s. During a tension repair, parts of the herniated tissue are pushed back in their proper place. Layers of the herniated tissue are then sutured or stapled together to the surrounding muscle tissue. The abdominal muscles are then slid over the hernia hole and are sewn together to reinforce the area without the use of any mesh. All materials used in a standard tension repair stay in the body and are not absorbed. These materials are left to put “tension” on the hernia to keep the tissue in place.4 5 6

    This form of repair can be more painful and require longer recovery time than the other procedures because of the permanent tension in the herniated area.7 8

    Mesh Repair

    There are many different types of mesh repairs. During a standard mesh repair, plastic mesh is placed over or inside the herniated tissue to reinforce and patch the affected area. Most plastic meshes are made from polyethylene, polypropylene, polyester, or a mixture. A proper plastic mesh repair depends on scar tissue to grow into the mesh properly, forming a large layer of scar tissue to help reinforce the repair. The scar tissue will eventually shrink, and sometimes creates a mass of fibrous tissue compressed together with a plastic mesh that may cause many complications including strangulation and chronic pain. Polypropylene meshes are estimated to contract between 30% to 50%. Woven artificial meshes and the use of sutures are associated with less shrinkage than tacks. Polypropylene and polyester meshes can erode into the bowel causing severe obstruction and inflammation if they are not lined. Dexon mesh material and Vicryl sutures should not be used if possible, hernia reoccurrences have been noted as 100% within three to six months. Most mesh repairs are laparoscopic surgeries.9 10 11 12 13

    During a laparoscopic hernia repair with mesh, three small openings are made in the abdomen. The abdomen is then filled with carbon dioxide gas so that the surgeon can see the abdominal organs through different tiny cameras that display the images on the screen. Other medical instruments are inserted through the openings and are used to insert dissolvable staples/screws to anchor the mesh to the herniated tissue in the repair of a hernia. Most of the staples or screws dissolve in a few weeks, but the mesh always remains. Although a laparoscopic repair is described as a minimally invasive surgical procedure, it does require three incisions and deep surgical intervention that may cause significant scar tissue and tissue trauma. 14 15

    Biological meshes developed from human donated, bovine, or porcine tissue are newer and may have fewer issues associated with synthetic meshes. The biological meshes seem to reinforce the herniated tissue so that it can heal with fewer scar tissue formation and adhesions. Biological meshes are associated with less mesh erosion, meaning the mesh is less likely to erode through skin, tissues, and organs, causing exposure or perforation. Biological meshes do have a few issues including human grafts to be more prone to eventration (protrusion of a hernia) and xenografts (grafts from animals) linked to reoccurrences if used as a bridge. The biological mesh’s also either partially dissolves or fully dissolves. The organic meshes have not been out on the market long enough yet for me to make a full recommendation, but I believe they are better than most artificial meshes.16 17

    Mesh repairs are associated with many additional complications compared to other repair procedures. If a severe infection, inflammation, or chronic pain develops, the meshes in most cases must be removed. Artificial meshes are more associated with chronic inflammation because of a non-biological foreign object being embedded in the body. In some cases, the body rejects the mesh, which leads to severe pain, obstruction or strangulation, and requires immediate surgery.18 19

    Shouldice Repair

    The Shouldice repair is performed in a specialized hospital in Canada. Specially surgeons trained mainly in the procedure also perform the surgery. During the Shouldice repair, the herniated tissue is repaired by overlapping and reinforcing each affected muscle layer. The reinforced herniated tissue is then stapled together with absorbable sutures for a short-term tension repair.

    During the procedure, they also search for hernias in the localized area and repair them, as well. This procedure is known for faster recovery times, lower instances of hernia recurrence, and less postoperative pain and complications. Surgical recovery occurs within a week.

    Abdominal Hernia Surgery Recovery Protocol

  • L-glutamine – 20,000 – 40,000 mg daily for one week after surgery. Then, take at least 10,000 mg daily for a month after surgery. Then, take 4,000 mg daily for a few weeks. Take with divided meals throughout the day do not take the full doses at one time (use with caution if you have a sensitivity to glutamic acid, deficiency in the neurotransmitter GABA (gamma-aminobutric acid), upper gut dysbiosis, or severe leaky gut and brain).
  • Florastor probiotic – follow supplement-boxed instructions; take while on an antibiotic. Do not use if you have yeast overgrowth or histamine sensitivities.
  • GOS – take one scoop daily mixed with filtered water. Use with caution if you have yeast overgrowth or Th2 elevated issues.
  • Thorne curcumin – follow the general supplement bottle recommendations.
  • N-acetylglucosamine – follow the general supplement bottle recommendations. Do not use if you have yeast issues.
  • Pure Encapsulations zinc carnosine – take one capsule with a meal, twice daily.
  • Supplement with collagen.
  • For three months: magnesium glycinate – take 600 mg, before bed.
  • Follow the Perfect Health Diet. Ingest proper amounts of Omega 3’s to reduce inflammation and improve recovery.
  • Use a Squatty Potty to prevent increased abdominal pressure when defecating and to reduce constipation. Work with a physical therapist and your physician to strengthen your abdominal core.
  • Make sure your vitamin D blood levels are optimal. Make sure copper regulation which is important for the proper production of collagen is normal.
  • L-glutamine is the most abundant amino acid and helps rebuild both the stomach lining and the gut.20

    Probiotics help protect the gut from opportunistic bacteria.

    Curcumin is to reduce inflammation and improve the integrity of the mucosal barrier.21 22

    The body makes N-acetylglucosamine to increase mucus production in the stomach and gut and to make a protective barrier.

    The zinc carnosine should help repair the stomach lining.

    Collagen might help your intestines recover from the surgery faster.

    Vitamin D is important for proper regulation of the immune system and in preventing leaky gut.

    1. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
    2. Tamparo, Carol, Lewis, Marcia. Diseases of the Human Body, F. A. Davis Company, Feb. 11, 2011.
    3. Smith, Margaret, Morton, Dion. The Digestive System: Systems of the Body Series, Churchill Livingstone, November 18, 2011.
    4. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
    5. Tamparo, Carol, Lewis, Marcia. Diseases of the Human Body, F. A. Davis Company, Feb. 11, 2011.
    6. Smith, Margaret, Morton, Dion. The Digestive System: Systems of the Body Series, Churchill Livingstone, November 18, 2011.
    7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306028/
    8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477030/
    9. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
    10. Tamparo, Carol, Lewis, Marcia. Diseases of the Human Body, F. A. Davis Company, Feb. 11, 2011.
    11. Smith, Margaret, Morton, Dion. The Digestive System: Systems of the Body Series, Churchill Livingstone, November 18, 2011.
    12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306028/
    13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477030/
    14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306028/
    15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477030/
    16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306028/
    17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477030/
    18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306028/
    19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477030/
    20. https://www.ncbi.nlm.nih.gov/pubmed/11533310
    21. https://www.ncbi.nlm.nih.gov/pubmed/26007179
    22. https://www.ncbi.nlm.nih.gov/pubmed/28249988
    1 Comment
    1. Hi John, thanks for the informative article on the different types of hernias and various surgical approaches to dealing with them (did you, by chance, accidentally leave out inguinal hernias?). I agree with you that hernia mesh is best avoided if possible, and that the Shouldice method is preferred. I wrote a blog post of my personal experience with hernia mesh and wanted to share in the hope that it might be of value to others: https://www.gutresolution.com/hernia-mesh-a-story-of-deception-tragedy-and-hope/

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