Updated September, 2024
1. Are my symptoms really hernia symptoms or something else?
In our practice, one out of every six patients who has previously been diagnosed with a hernia is actually found to have a muscle injury instead. Those patients should NOT have surgery. Musculoskeletal injury is caused by over use of certain core muscles in daily life as well as in more strenuous activity. This problem cannot be fixed surgically but instead requires strengthening and learning to use other core muscles to offload the ones that are being overused. These injuries require treatment with PHYSICAL THERAPY and surgery is unnecessary, unhelpful, and should be avoided.
It’s important to ask your hernia surgeon if they are sure that your symptoms are from a hernia and not a muscle injury/strain. Muscle injuries often mimic hernia symptoms but there are some nuanced differences (such as muscle injuries often causing pain at night, in bed while rolling over, or while getting in and out of the car). An experienced hernia doctor will help tease out these differences in your symptoms and can tell on physical exam if this is a muscle injury versus a hernia.
It is so important to get this step right and the treatment is drastically different! Unnecessary surgery risks complications without any benefit or improvement of symptoms!
2. Do I need to have hernia surgery now?
Not necessarily! Whether or not you need hernia surgery depends on your hernia symptoms. Recent medical research indicates that patients who have either little or no discomfort from their hernias have such a low rate of complications that surgery is not immediately necessary. In our practice, we advise about 1 in 3 patients that they can delay surgery because their hernia symptoms do not yet interfere with their lifestyle.
Seeing an experienced hernia surgeon allows for your questions to be answered and your care to be guided towards your best interest. Assessment of your symptoms, their impact on your life, your outside obligations, and goals should all be considered in the decision to proceed with surgery and when. Patients can be spooked by what they read on the internet and scary stories can result in a lot of anxiety during this process. Getting an expert opinion can really change how you manage what your going through with your hernia and your health overall.
3. Are there non-surgical treatments for my hernia?
Maybe. You and your hernia are unique. Your care should be individualized to you. Patients who have a groin strain and not a hernia need physical therapy to improve their core imbalance. Patients who have a hernia with minimal symptoms can often safely wait to have surgery. Some patients with a diagnosed hernia can use a hernia belt or truss to delay hernia surgery, while other patients need hernia surgery soon to relieve symptoms and reduce the risk of an incarcerated hernia.
At Boston Hernia, we are committed to guiding our patients toward the best outcomes with attention to achieving their own goals for their health. We work with patients to tailor care for their unique needs.
4. What are the treatment options for my inguinal hernia surgery?
There are dozens of surgical techniques for repairing hernias. There are dozens of medical device companies producing hundreds of types of meshes to use in inguinal hernia surgery.
An experienced, specialized hernia surgeon should be able to offer different approaches based on the type of hernia and your particular medical history. Almost all techniques for inguinal hernia repair fall into four basic categories:
- Suture (no-mesh) repair. Example: Shouldice Repair
- Mesh repair between the layers of the muscle. Example: Lichtenstein Repair
- Mesh repair under all the muscle layers using general anesthesia. Example: Laparoscopic and robotic hernia repair
- Mesh repair under all the muscle layers using local anesthesia with sedation (open preperitoneal repair). This is the most commonly used treatment approach at Boston Hernia
Recent international guidelines suggest that placing the mesh under the muscles is better than placing it between the muscle layers, and that using local anesthesia is better than general anesthesia for hernia surgery.
For most patients, Dr. Reinhorn and Dr. Fullington recommend placing mesh under the muscles using local anesthesia. This is a revolutionary approach that has moved beyond many of the common complications of other approaches, constituting the LEAST INVASIVE APPROACH to inguinal hernia repair. Patients have less overall risks, the lowest possible risk of recurrence of their hernia, less pain, quicker recovery, and better quality of life in recovery.
In some situations, they recommend a no mesh repair – which has been studied and shown to produce excellent outcomes in certain patients and can be a great alternative to a mesh repair.
We have created a video demonstrating the differences, as well as a full page explanation of techniques.
5. What should I expect my hernia surgery recovery to be like?
It’s really clear from our patients that certain surgeries result in more pain and longer recovery. We’ve had many patients come to see us after they’ve already had an inguinal repair on the other side via the traditional mesh over the top/between muscle layers (lichtenstein) repair. Almost every patient is shocked by how much easier the recovery was after the mesh repair we do for most patients – the open preperitoneal repair where the mesh is placed on the inside of all the muscle layers. Patients undergoing this type of surgery typically don’t require opioid pain medications in recovery, and are returning to work and driving within a few days after surgery.
Hernia surgery recovery depends on the type of hernia repair you undergo. It’s important to ask your hernia doctor about what they expect for the best and worst case scenarios for recovery. Some patients and some repairs allow people to work the next day, while others require more time off. In our practice, 75% of working patients missed 3 or less days of work.
6. What are the risks of inguinal hernia surgery?
This is probably the most critical question to ask. Over 30,000 patients are harmed every year by inguinal hernia surgery in the United States. The most commonly performed repair in this country involves placing mesh over the hernia defect within muscle layers of the abdominal wall. This repair is performed in the area where three nerves are exposed and at risk of being caught in stitches or irritated by mesh.
A highly specialized expert in hernia anatomy can protect patients from these kinds of complications through good surgical technique and decision making. If mesh can be placed in another area, the risk is significantly reduced. If nerves are identified and attention is paid to protecting the patient from these types of injuries, the risk is significantly reduced. Who you choose to do your surgery can have a major impact on your outcomes – studies show that in many cases surgeons who do higher volumes of a particular surgery have better patient outcomes.
Other risks include the risk of recurrence, infection, and bleeding and your surgeon should discuss each of these possibilities with you. Again, high volume surgeons, performing a large number of repairs each year are commonly found to have reduced rates of each of these complications.
7. How many hernia surgery operations do you do each year?
Medical literature has shown that high-volume surgeons in high-volume facilities have better outcomes than their counterparts with lower volumes. Dr. Reinhorn, Dr. Fullington, and their physician assistant team perform approximately 1000 hernia surgeries every year. Most general surgeons in the US perform less than 50 hernia repairs per year, about one per week on average.
Update 2/13/2024: The National Health Council recently published a similar article about considerations for hernia patients when selecting a surgeon. Take a look below!
Dr. Michael Reinhorn is a specialist in inguinal hernia and umbilical hernia. He started his practice as a general surgeon in 2001, and in 2012 he transitioned to focus on the care of hernia patients. In 2018, he co-founded Boston Hernia, an ambulatory surgery practice focused exclusively on hernia surgery. In 2020, Dr. Nora Fullington was recruited from her work as a general surgeon, where she performed hundreds of laparoscopic hernia repairs, to Boston Hernia where she was intensively trained by Dr. Reinhorn in the open preperitoneal and Shouldice techniques. Together with their physician assistant team, they perform approximately 1,000 hernia surgeries every year. Both surgeons offer a tailored approach for each patient, taking into account individual patient factors to decide if surgery is recommended or not, what type of repair (open, laparoscopic, mesh, non-mesh) is best, and what type of anesthesia is safest. At Boston Hernia, our focus is on each individual patient and continuously improving our own surgical techniques and outcomes. We do this by participating in various hernia societies, studying our own outcomes through a national database, and publishing our data to influence the care of hernia patients nationally and internationally. Boston Hernia is an affiliate practice of the Mass General Brigham system. In addition to operating at Mass General Brigham Newton-Wellesley Hospital, we offer care at ambulatory surgery centers in Waltham, MA and Derry, NH.