Help for Hernias

with Rudy Kluiber, M.D., Surgeon, Advanced Healthcare

Posted: April 1, 2005

When it comes to hernias, there is plenty of room for misunderstanding.

“People think that lifting, straining or significant physical activity is going to cause a hernia,” said Dr. Rudy Kluiber, a surgeon with Advanced Healthcare. “It won’t.”

What is probably happening in such a situation is that the hernia was already there, a small, innocuous defect, and the wear and tear has made it worse. A hernia is a protrusion of an organ through connective tissue or through a wall of the cavity in which it is normally enclosed.

Rudy Kluiber, M.D., Surgeon, Advanced Healthcare "Some people can have hernias their whole lives with minimal symptoms, other people develop symptoms early, and still others have hernias that are small and will develop symptoms as the hernia gets larger."

Some people develop hernias in areas of weakness in the abdominal wall. Lifting itself is rarely the problem. The increase in pressure inside the abdomen when people lift and hold their breath is the culprit. Breathing in or out while lifting can prevent the high pressures and minimize the risk of tearing the tissue.

“It’s like a small hole in a pair of blue jeans,” he said. “You never really notice it, and then one day you kneel down to pick something up and the stretch of kneeling down ripped it and made the hole bigger.”

A hernia can develop in different areas of the body.

Incisional or ventral hernias can occur in the abdominal wall as a result of surgery. Inguinal or femoral hernias are located in the groin; epigastric hernias occur in the middle of the abdomen; diaphragmatic hernias are between the abdomen and chest; hiatal hernias occur around the esophagus.

Bellybuttons can be a clue, Dr. Kluiber said. “The “inny” versus “outy” controversy is really ‘Do you have a hernia?’ or ‘Don’t you?’”

The outy is actually an umbilical hernia, which either gets bigger over time and by the time someone is age four, have either fixed themselves or not.

Most hernias don’t fix themselves. Many, said Dr. Kluiber, don’t cause problems.

Risks of hernias
“Some people can have hernias their whole lives with minimal symptoms, other people develop symptoms early, and still others have hernias that are small and will develop symptoms as the hernia gets larger,” he said

A fourth, and much smaller group, he said, develops complications of hernias, which include strangulation and incarceration.

Incarceration occurs when a loop of whatever happens to be in the area of the hernia gets caught in the hernia. That can lead to strangulation. In the case of an abdominal hernia, a loop of intestine gets caught, and continues to twist itself. The twisting can continue to the point where the blood supply gets cut off to that loop of intestine, causing an intestinal blockage. It can also cause a blockage of the blood supply to the intestine, which can turn into gangrene, necessitating emergency surgery.

Few hernias advance to that point. Still, Dr. Kluiber cited it as a reason surgeons advocate repairing any hernias once they’ve been detected.

“There are two reasons to repair hernias,” he said. “One is that they’re not going to fix themselves, and the second is that you don’t want to risk the extreme complications.”

Hernia repair surgery
Between 500,000 and 600,000 hernia surgeries are performed each year in the United States.

When Dr. Kluiber first began performing hernia repairs, in 1988, the procedure involved making an incision big enough for the surgeon to put his or her hands inside the patient at the point where the hernia was located. The repair was made by sewing it back together, or sewing a patch of synthetic material over the hernia.

The newest techniques for hernia repair involve laparoscopic surgery and large mesh patches placed inside the hernia. The surgeon makes very small incisions, between 5 and 10 millimeters (1/2 inch or less), then places a fairly large patch over the hernia.

“It solves the problem without making a large incision, and minimizes post-operative pain, swelling and complications,” he explained.

“It’s been a progression,” he said of the advances he’s seen in hernia repair, “and to have lived through the whole thing and seen the pros and cons discussed, along with patient results after each step of the way, I’m truly convinced that laparoscopy is the best way to go in most situations.”

Mostly, he said, because there are so many different types of hernias, and repairs can vary widely. In an emergency situation, where strangulation or incarceration has occurred, open surgery is the only option.

For more routine cases, however, Dr. Kluiber said there was no question that the laparoscope minimizes the amount of trauma created by the surgery.

“Instead of making a large incision and disrupting a larger amount of natural, undisturbed tissue, you create a very small defect and minimize the disturbance surrounding the normal tissue,” he said. “That minimizes the swelling, which minimizes the disfiguration in terms of scarring and maintains the integrity of the abdominal cavity.”

For each type of hernia surgery performed with the laparoscope, Dr. Kluiber, said, there is a different benefit. For groin and diaphragmatic hernias, pain, swelling and time away from normal activities is reduced by as much as half. For ventral or incisional hernias, the initial pain is similar to that of an open procedure, but wound breakdown or infection risks are significantly reduced.

Dr. Rudy Kluiber:
Good Hope Road Clinic
3003 West Good Hope Rd.
Milwaukee, WI 53209
414-352-3100

East Mequon Clinic
12203 N. Corporate Pkwy
Mequon, WI 53092
262-387-8200

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