The Oregon Clinic - Pacific Northwest Hernia Center
ARE YOU CONCERNED ABOUT A HERNIA?
Nearly 5 million people in the U.S. are living with an abdominal wall hernia. Many people still believe that hernia repair involves difficult and invasive surgery that requires an overnight hospital stay and a painful recovery that can last for weeks or even months. However, new treatment options exist today that can make hernia repair faster and more effective. With today's advanced treatment options, many hernias can often be repaired in less than an hour. Patients typically go home the same day!
The Pacific Northwest Hernia Center is conveniently located in the Portland, and Tualatin areas. Our Surgeons have over 50 years combined experience performing hernia repairs. During your consultation, our surgeons will discuss what treatment options and possible repair techniques are best suited for your specific needs. We use the most advanced procedures available and believe in an active pain management plan to reduce the amount of discomfort involved in your hernia repair.
Call today for an appointment to meet with one of our specialists and begin the road to recovery.
Pacific Northwest Hernia Center Surgeons
The Pacific Northwest Hernia Center is committed to being a center of excellence. We provide advanced hernia care solutions with emphasis on quick recovery and aggressive pain control.
At The Pacific Northwest Hernia Center, we have a team of expert surgeons who are dedicated to providing you and your family with the best surgical options for your hernia repair. Our surgeons have over 50 years of combined surgical experience diagnosing, treating and maintaining many different types of hernias.
All of our surgeons are board certified and were trained in major university surgical departments that demanded high academic and clinical standards.
Surgical Treatment Options
There are several different techniques used in hernia repair. The surgeons of the Pacific Northwest Hernia Center have expertise in all of these techniques. Your surgeon will discuss these techniques with you and use the technique best suited for your situation.
Inguinal Hernia (Groin)
Open Repairs- a small incision is made in the groin and the repair is performed from the “front”. This is typically outpatient surgery.
Laparoscopic Repairs- small incisions are made in the lower abdomen and the repair is made from the “inside”. This is typically outpatient surgery.
Play the video below to see an example of open hernia repair versus laparoscopic.
Ventral Hernia (Abdominal)
Open Repairs- a small incision is made above the hernia and the repair is performed from the “front”. This is usually outpatient surgery for smaller hernias and inpatient for larger hernias.
Laparoscopic Repairs - small incisions are made in the abdomen and the repair is made from the “inside”. This is usually outpatient surgery for smaller hernias and inpatient for larger hernias.
Complex Ventral Hernia Repairs (Abdominal Wall Reconstruction)
Some patients will have hernias which require advanced techniques to repair. Very large or multiple hernias are often challenging to repair. Hernias associated with infection risk (obesity, diabetes, smoking, prior wound infection, etc.) are also complex.
A technique referred to as "component separation" is used for larger and more complex hernias. The hernia is repaired by moving the patient's own muscle and abdominal tissue together to repair the hernia. The hernia is repaired by closing the defect with the patient's own tissue and a mesh is used to reinforce the repair. This leads to a more functional long term repair. This technique requires inpatient surgery.
Hernia repairs were traditionally performed using a series of sutures to close the hernia opening. This type of repair has a very high failure rate and has been abandoned by most hernia repair experts. Modern hernia repairs use a reinforcing “mesh” to give the repair strength and durability. Mesh comes in two broad categories: synthetic and biologic.
Synthetic mesh is made from a variety of products including sterile plastics, gortex and polyester. These are permanent implants that the body incorporates into the repair. Biologic mesh is derived from animal and human collagen tissue. These products are incorporated into the repair and are slowly remodeled into the patients own tissue.
Pain management is very important after hernia surgery. The surgeons of the Pacific Northwest Hernia Center will work hard to manage your pain effectively. There are generally two types of pain, Acute Pain and Chronic Pain. Understanding the type of pain you have will help in your recovery process. Pain after a surgical procedure is also acute pain. Acute pain is temporary and may last from a few seconds to several months. It usually goes away as part of the normal healing process. This type of pain is called post-operative pain. Pain after surgery is not something you have to just “put up with.” We want you to be comfortable after surgery. Controlling your pain after surgery is important to your recovery. With less pain you can start walking sooner, do your breathing exercises easier, and may even leave the hospital earlier. Patients whose pain is well controlled after surgery may avoid some complications, such as pneumonia and blood clots.
Local anesthetic is injected at the time of surgery to "numb" the area during and after surgery.
Pain pumps are implanted at the time of surgery to provide continuous surgical site pain relief for the first 2-3 days. Continuous surgical-site pain relief involves giving a constant infusion of a local anesthetic medicine directly into the surgical site. You experience pain relief directly at the incision site without the side effects of narcotics. Because the medicine is given continuously at a safe and slow rate, you do not have to worry about the medicine wearing off. As a big plus, being comfortable after surgery may actively speed your recovery.
The system works by providing a small balloon-like pump that is filled with local anesthetic medicine. The pump is attached to a catheter (tiny tube) that the doctor places near your incision site. The system is very easy to use. The pump automatically delivers the medicine at a slow rate. The pump may last anywhere from two to five days. The pump is completely portable, lightweight and can be attached to your own clothing or placed in a carrying pouch. When the infusion is complete, the catheter is removed and the pump thrown away. Depending on your surgery, you may go home with one of these pain relief systems. You will be shown how to remove the pump at home. We will also provide you with a 24/7 resource regarding the pump.
Narcotics are taken by mouth to ease the pain after surgery. They are taken every 3-4 hours as needed. Follow the directions on your individual prescription.
These medicines include ibuprofen and Alleve. They will help as a pain reliever and reduce inflammation after surgery. It may be taken with narcotics and may help to increase the effect of the narcotics. Follow the directions on your individual prescription
Tylenol will help as a pain reliever after surgery. It may be taken with narcotics and may help to increase the effect of the narcotics. Follow the directions on your individual prescription.
Post Surgery Information
Day 1. When you leave the hospital you will have a wound closure type and wound covering type. Staples, sutures, steri-strips or medical glue may be used. Whatever closure type is used it is important to keep the wound clean and dry. Spend the day relaxing and take your medications as prescribed.
Day 2. Return to a normal diet and resume any medications you normally take unless specifically told otherwise by your surgeon. Normal swelling and bruising may start to occur on this day. You may remove plastic covering and replace gauze bandage. Try to keep wound covered with clean dressings.
Day 3. You may shower but not bathe. Try to keep the wound from being soaked and pat dry as necessary. If you have not had a bowel movement by this day you may want to try a mild laxative such as milk of magnesia. Continued swelling and bruising is normal. Some people may feel well enough to return to work on this day. Activity should be based on your body. If an activity is causing pain discontinue. Continue pain medications as prescribed.
Day 4-14. Continue to let your body heal and follow prescribed medication courses. Changing your coverings and allowing air to your wound will help with the healing process. When the steri-strips start to curl at the ends this will indicate they are ready to be removed. They should be easy to remove and not require much manipulation. Your stitches will most likely be self dissolving and will not require assistance to be removed. Try new activities and gauge how your body responds.
Day 15-30. You should have a post-op appointment in this time to make sure that the incision is healing well and that your return to normal activity is in progress. Swelling, bruising and pain management should be minimal at this time.
Instruction for post operative care:
- Resume a regular diet after release from the hospital.
- Resume normal medication after release from the hospital unless specifically instructed by the surgeon.
- You may shower the day after surgery. Avoid soaking bandage or taking baths for the first 2 weeks.
- Driving should be restricted if you are taking narcotic pain medications.
- Activity as tolerated. Let your body be your guide and refrain from activites that cause pain.
- Return to work when you feel able. This will be typically 3-5 days and depending on the work you do.
- Avoid constipation (Milk of magnesia works well)
- It is common to have swelling and bruising around operative sites.
- Take prescriptions as prescribed.
- Use tylenol and Ibuprofen if you can tolerate these medications.
- Sexual relations as tolerated.
- Call the office if your incisions are red or draining fluid. (Clear or straw colored fluid is typically not concerning)
- Call the office if you have extreme pain or nausea.
UP TO 1
|Hiking, strenuous exercise||B||C||D||D|
|Lifting, < 25 lbs||B||C||D||D|
|Lifting, > 25 lbs||B||C||D||D|
|A. Do not engage in this activity|
|B. Proceed cautiously, stop immediately if discomfort occurs|
|C.Essentially no restriction, but don't really push it|
|D. No restrictions, resume normal activity in this area|
The Pacific Northwest Hernia Center is a surgical practice that specializes in hernia repairs. We use the most advanced repair options and couple this with aggressive pain management. The Pacific Northwest Hernia Center is a service of The Oregon Clinic.
Hernias are often repaired by surgeons who perform hernia surgery infrequently. The doctors at the Pacific Northwest Hernia Center perform hundreds of hernia repairs a year. We have become a center of excellence through our devotion to advanced hernia repair.
A hernia is a small sac containing abdominal tissue which protrudes through an opening in the muscles of the abdominal wall. This opening can be a result of congenital defect (an opening which you were born with) or may be an acquired flaw due to stress on the abdominal muscles.
An abdominal wall hernia is a weakness or tear in the abdominal muscles that allows fatty tissue or an organ (such as the intestines) to protrude through the weak area. Although more common in men a hernia can develop in anyone - from a newborn baby to older adults.
An inguinal hernia is the most common type of hernia, affecting about 2% of men in the U.S. Men are more susceptible to this type of hernia because of a potentially weak spot in the groin (known as the "internal ring").
A ventral hernia occurs in a weakened area of the abdominal wall.
An epigastric hernia occurs as a result of a weakness in the muscles of the upper-middle abdomen (above the navel). Three times more men than women develop epigastric hernias with the majority occurring in people between the ages of 20 and 50.
A femoral hernia, which occurs in the area between the abdomen and the thigh, is usually the result of pregnancy and childbirth and is more common among women.
An incisional hernia can occur at the site of an incision from a previous surgery when fat or tissue pushes through a weakness created by a surgical scar. These can develop weeks, months or years after the initial surgery.
An umbilical hernia can occur in the naturally weakened area of the navel where the umbilical cord was attached and the tissue is thinner than the rest of the abdomen. Umbilical hernias can occur in babies, children and adults.
Hernias most often occur in or near the groin, abdomen, navel or previous sites of abdominal surgery. Left untreated, a hernia will generally increase in size and become more painful. It can lead to more serious, life-threatening complications.
Any part of the abdominal wall can develop a hernia, however, the most common site is in the groin area (inguinal hernia). With an inguinal hernia, the sac protrudes into the groin and sometimes the scrotum. Ventral hernias occur in the abdominal wall and some types include umbilical, epigastric and incisional hernias. Umbilical hernias occur through the naval area, femoral hernias occur in the lower groin area and incisional hernias occur through old surgical scars.
- Lifting heavy objects
- Sudden twists, pulls or muscle strain
- Chronic straining with urination
- Chronic constipation
- Repeated coughing attacks
A hernia occurs when the layers of the abdominal wall weaken. The inner lining of the abdomen pushes through the weakened area to form a balloon like sac. A loop of intestine or abdominal tissue can then slip into the sac. This causes a bulge which can be seen or felt on exam.
You may experience any of the following symptoms:
- A noticeable protrusion in the groin or abdominal area
- Feeling pain while lifting
- A dull aching sensation
- A vague feeling of fullness
Risk factors for developing a hernia include: a chronic cough, obesity, straining during bowel movements or while urinating, pregnancy, straining to lift heavy objects and persistent sneezing.
- One million hernia repairs are done each year.
- 700,000 of those are inguinal hernia repairs.
- 300,000 of those are ventral hernia repairs.
- 20 million hernia repairs are done worldwide each year.
- Approximately 27% of men will develop an inguinal hernia in their lifetime compared to only 3% of women.
- 10-20% of Laparotomies will develop into incisional hernias each year.
- Two million laparotomies are done annually
No. Although a hernia may not worsen for months or even years, an untreated hernia Will Not get better on its own. Hernias which are reducible, (can be pushed in) are not generally an urgent danger to your health, though they can be painful. A non-reducible hernia (can't be pushed in) can become life-threatening if any part of the intestine becomes trapped in the hernia opening. This might require emergency surgery.
As you may know postponing any type of treatement can have its drawbacks. Untreated hernias will often get larger and more difficult to treat over time. Your physician will recommend the urgency of surgery. If the bowel becomes trapped in the hernia, Emergency surgery may be necessary. Hernias have a continued risk of bowel entrapment until they are repaired.
The majority of patients go home the same day. Larger hernia repairs may require hospitalization for recovery. Your surgeon will discuss this with you in detail in your consultation.
Pain after a hernia operation is common. Pain is a subjective sensation and every patient will experience a different level of pain. Your surgeon will discuss post-operative pain control with you in detail at your consultation. The Pacific Northwest Hernia Center is committed to aggressive pain control and will work with you closely.
Normal activity can be resumed as soon as you feel well - usually in a few days. Heavy lifting or strenuous activities may require 2-4 weeks of recovery.
Pacific Northwest Hernia Center Research
Pacific Northwest Hernia Center is committed to long term patient care. We are interested in successful long term results.
Research interests include our Pacific Northwest Registry, long term outcome results and long term pain and functional status. Active research projects are underway to achieve our center of excellence