What is a hernia? A hernia is a result of weakness or tearing in the tissue of the abdominal wall. When this happens, soft tissue makes its way through the structures of the already compromised area in the wall of the abdomen. This can occur in men, women, and children.

There are two main types of hernias:
1. Aquired: Caused by the weakening of tissue over time, and
2. Congenital: Birth defect of the abdominal wall.

Some patients believe that a hernia will heal over time on its own, but this never happens. This is only possible in newborns with an umbilical hernia, and even then, the necessary measures must be implemented immediately after birth. Usually I tell my patients that the best time for treatment is when the hernia is small and the option of minimally invasive surgery is still available. Unfortunately, in most cases, patients come in only when things have become too advanced, when the classic operation is the best option.

Why do I always recommend elective surgery for a hernia? Because when the operation is urgent, it means that there is a high probability that the condition is so advanced and the range of complications is so vast that surgery could result in a less-favorable outcome. For instance, studies show that the mortality rate in emergency hernia surgeries is dozens of times higher than  in elective surgery.

Most people are able to assess whether they have inguinal hernia before coming to my office. An obvious sign of this is a lump under the skin in the groin. This swelling can increase in size over time. Those afflicted can experience pain when lifting heavy objects, coughing, or when going to the bathroom. Other types of hernia may involve difficulty swallowing or breathing, chest pain, heartburn, anemia, and frequent „heart crisis”. If you have these symptoms, you just need to be examined for a hernia which requires operation. It is possible for such symptoms to be caused by different factors, but a specialist should make the final decision.
Risk Factors

Obesity can increase your risk of hernia. Excessive weight puts extra strain on the body, especially while performing manual labor or playing sports. This additional stress can lead to the weakening of the abdomen wall over time, which can lead to a hernia. This is very important, so monitor your weight in order to avoid the unnecessary risk of hernia and many other weight-related health problems. But obesity is not the primary cause; in fact, very thin people also suffer from this problem. Based on my surgical experience, I would say that hernias occur most often after rapid weight loss or gain.

Classical operation

As I have already mentioned, hernia operations happen every day. It is the most common abdominal surgery. During the operation, I will return the abdomen structures to their place and strap in the loose muscles. This is usually accomplished by sewing the muscles to each other in places where they are loose. Frequently, synthetic plastic netting is used in this area to strengthen the abdominal wall. The wound is closed with sutures or staples.

This type of operation usually takes between thirty minutes and two hours. Patients usually spend the night in the hospital after surgery. This is currently the best practice in Bulgaria. The next morning, after practicing walking, and if gases and urine pass without difficulty, the patient can return home.

Laparoscopic hernia repair

Newer surgical techniques are less invasive than traditional open surgeries when it comes to hernia operations. Laparoscopic surgery uses three small incisions that are each 5 to 10 mm long to access the stomach. Open surgery requires a longer 5- 7-cm incision. This operation must be performed using mesh reinforcement of the abdominal wall and must be carried out under general anesthesia. There are several advantages of laparoscopic compared to open surgery. They are: more esthetic and less tension operation performed as a result, shorter recovery time, less pain and discomfort, and a much lower probability of infection at the site of incision.

However, it is important to note that the period of recovery and the full recovery is the same for both types of operations. This begins at the time at which the netting is embedded in the tissues and a new abdominal wall is built. After that, for 30 to 45 days the patient must refrain from anything that could strain the abdominal wall or increase abdominal pressure: lifting and carrying, lifting weights, chopping wood, beating carpets, or digging, etc.

Men will better understand me: Imagine that you are making a concrete slab. First, the mold is made, then the valve is placed and finally the concrete is poured. However, the mold is not removed on the next day. You must wait for the concrete to dry. It is the same with the netting: Put it in place, but wait 30 to 45 days for it to sprout its own tissues through its holes and become "concrete.”

Please consult with me in choosing the best type of operation as many other factors are also very important. These are age, general health, preexisting conditions, and the stage of development of the hernia. All these and other factors will be weighed carefully before we make a specific recommendation.

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