Treatment Options for Hernias
Treatment for a hernia involves two main considerations – patient comfort and safety. Beyond the discomfort that a symptomatic hernia can cause, it is incarceration or strangulation of the hernia contents that we want to avoid, first and foremost. When intestine or fat tissue pushes through the hernia, there’s always a chance that it becomes trapped within the defect. This is a greater risk for patients with smaller hernias. A hernia that cannot be reduced by gently pushing it back through the defect or by lying down is called an incarcerated hernia. This requires urgent medical care, although it is less dangerous than a strangulated hernia.
Strangulation occurs when the contents of the hernia become incarcerated/irreducible and blood supply is cut off to the affected organ or tissue. When blood supply is cut off, tissue necrosis begins very quickly. A strangulated loop of intestine, if left untreated, can lead to serious consequences and even death. When intestinal tissue dies as the result of strangulation, colon surgery is needed to remove part of the diseased intestine. This increases the risks of surgery dramatically.
Even in non-emergency situations, the only effective, curative form of treatment for a hernia is surgery. This is because the defect in the fascia has no way of repairing itself without surgical assistance. However, not all hernias need to be repaired immediately, and some may never need repair at all. This is often the case with older patients that have larger hernias because a) the patients themselves may not be suitable candidates for surgical intervention and/or b) the size of the hernia is large enough that the risk of incarceration or strangulation is low.
Younger patients that have symptomatic hernias are usually indicated for surgery because of their typical, good health. Further, since hernias tend to grow over time, it is ideal to address them sooner rather than later. With few exceptions, the larger the hernia, the more complex the repair.
Hernia Belts & Trusses
Hernia belts, or trusses, are sometimes touted as a viable option for the non-surgical treatment of hernias. These trusses are usually ineffective and can, in some cases, make matters worse. As a result, hernia trusses are never recommended by our practice.
Watchful waiting may be indicated when the hernia defect is extremely small and asymptomatic, or when the hernia is very large in older patients that have higher surgical risk.
The decision to have hernia surgery versus watchful waiting is one that can be made with a qualified general surgeon such as those that practice here at NYU Langone Long Island Surgical Associates.