Dr. J. Scott Roth explains minimally invasive surgery and hernia repair on Channel 27, WKYT.
One satisfied patient speaks up.
Dr. J. Scott Roth demonstrates an inguinal hernia repair (MPEG or Windows Media) in a teleconference sponsored by UK Area Health Education Centers (AHECs) and Kentucky Telecare. Over 200 high school students from rural and urban Kentucky were part of the conference and were able to view the surgical procedure live.
DR. J. SCOTT ROTH SPECIAL TO THE HERALD-LEADER
posted with permission of the Lexington Herald-Leader
Published on January 1, 2009, Page C6, Lexington Herald-Leader (KY)
PREGNANCY HERNIAS COMMON
most don't need to be repaired, as surgery has some risks
Pregnancy is full of enough surprises, never mind the addition of a newly discovered bulge protruding from your belly button or groin. One of the most common reasons for an unexpected bulge during pregnancy is the development of a hernia. A hernia is simply a hole in the muscular layer of the abdominal wall, which causes intestinal or fatty tissue within the abdomen to stick out. This can cause pain and, occasionally, intestinal obstruction.
Hernias can occur as a result of any increase in abdominal pressure. While straining and lifting are most commonly associated with hernias, the pressure in your abdomen will undoubtedly increase from a growing fetus.
Hernias do not go away. Once a hernia has formed, it will remain until it has been repaired. However, not all hernias need to be repaired, particularly hernias that are not causing any symptoms. This is particularly true during pregnancy.
Most hernias diagnosed during pregnancy can be treated without surgery and if surgery is necessary in most cases it can be delayed until several months after the baby is born. In many cases, the hernia becomes less painful later in pregnancy due to the uterus blocking the hole in the muscles.
Surgeons should consider the risks of surgery in considering repair. During the first trimester, the likelihood of a miscarriage is increased with an elective operation. During the third trimester, the likelihood of pre-term labor is increased. Elective surgery should only be considered during the second trimester (months 4-6). However, the growing baby and uterus will place increased stretch and strain on the repair and could result in an early recurrence of the hernia. In general, when hernias return, they are larger than they were originally.
In general, hernias are repaired with a soft and pliable material called mesh. Mesh is sewn around the hernia to reinforce the defect in the musculature. While mesh is very strong and is designed to prevent hernias from returning, it will not stretch. If a mesh is placed during pregnancy, it may tear away from the muscles as a result of the growing uterus, resulting in a return of the hernia. This can cause significant discomfort during the remainder of pregnancy.
Minimally invasive surgical techniques can be used to repair most hernias. Three tiny incisions are made, and a small camera is placed inside of the abdomen. Patients undergoing a minimally invasive, or laparoscopic, hernia repair will have less postoperative discomfort and a quicker return to normal activities while avoiding the larger incision associated with a traditional open operation. The long-term outcomes following hernia repair are comparable between traditional open surgery and minimally invasive surgery.
Even with a hernia, a Caesarean section is not usually necessary. Almost all women can safely deliver a baby vaginally. Your obstetrician or midwife can help you throughout the delivery process to ensure that the hernia does not become a problem during delivery.
The development of a hernia during pregnancy is not uncommon. The joy of future motherhood need not be interrupted by the development of this new bulge. By working closely with your obstetrician and hernia surgeon, most hernias will not endanger your well-being or your baby’s.
Dr. J. Scott Roth is an associate professor of surgery and director of the Center for Advanced Training & Simulation (CATS) at the University of Kentucky College of Medicine.