New help for hernias: the latest surgical techniques will help you conquer the battle of the bulge

Men's Fitness, Sept, 1998 by Bill Bush

One of the universally shared experiences of being a male is going to the doctor for a checkup and having him (or her) place fingertips against your groin with the command "Turn your head and cough." What's going on, beyond your abject humiliation? Simply put, you're being checked for signs of a "rupture," otherwise known as a hernia. But despite your brief discomfort, this test's importance cannot be overstated.

The National Center for Health Statistics estimates that about five million Americans - mostly males - are living with a hernia, yet only 700,000 have theirs surgically repaired each year. Hundreds of thousands choose not to get help for their suffering, primarily because they fear painful surgery and being laid up for weeks. But those fears are unfounded, as new technology has greatly reduced both the agony of surgery and the length of the recuperation period. That's not to say that it's a pleasant experience, exactly, but it's sure as hell better than it used to be.

How hernias happen

A hernia develops when a small area of your abdominal wall weakens, allowing the inner lining to poke through. Picture a bike tire with a split along the sidewall - the inner tube bulges out through the break. The inner lining of your abdomen is covered with bands of muscle that are there to keep your intestines inside where they belong. But when a weakness develops, a portion of the intestines can push outward.

"The first symptom of a hernia is not pain, it's a bulge," says Ira M. Rutkow, MD, director of the Hernia Center in Freehold, New Jersey. "In most cases, it's only noticeable when you're standing up. If you lie down, it temporarily disappears."

While hernias occur in several spots throughout the body, the vast majority are in the groin area. In men, who get the lion's share of hernias, the affliction usually strikes in the region of the inguinal canal. That's the route your testicles took when they descended into your scrotal sac shortly before birth, and it's the same route they take in reverse after a blast of cold air or water. It's a naturally weak area, and the perfect place for a hernia to push through.

Not your father's surgery

OK, so you feel a queasy kind of pressure in your groin one day at the gym during a squat lift. A week later, you notice the same burning sensation as you bend down to tie your shoes. In the shower, you come upon a scary bulge that feels like half a TopFlite Magnum, right where your thigh and groin meet. These are the classic symptoms of a hernia. Now what do you do?

"You can just tolerate it - for a while," says Rutkow, "but it won't heal itself. It won't go away. The longer you wait, the worse it generally gets." The pouch will get bigger and a piece of your intestine may protrude into it. When that happens, your hernia takes on the ominous descriptive term incarceration. The intestine can protrude so far that it can't be pushed back into the abdomen without emergency surgery, Keep ignoring the problem and you're headed for strangulation, which is exactly what it sounds like: The blood supply to the bulging portion of intestine is cut off by the tight fit of the surrounding muscle. Now you've really got trouble.

Unfortunately, there's only one way to repair a hernia: surgery.

In 1896, you would have contacted a doctor by the name of Bassini, an Italian surgeon and the father of what's called herniorrhaphy. He would have put you out with ether; sliced through your skin, fat, muscle and inner-abdominal lining; pushed the bulging intestine back into place and sewn the muscle and skin back together.

That's the traditional hernia operation, and it has been performed for the past 100-plus years. But not without problems. One difficulty with the Bassini technique is that there's tension on the stitches, especially where the bulge creates pressure, and this results in moderate to severe pain for several weeks (or months) after the procedure. In addition, about 10 to 15 percent of the time, excess pressure that appears before the wound is thoroughly healed can cause a recurrent hernia. About 60 years ago, a doctor developed an ingenious multilayer closure technique that shrunk the recurrence rate to about 2 percent.

Until the past couple of decades, that was about the best you could do. Luckily for the modern man, medical progress since that time has produced an array of new surgical-repair techniques - called hernioplasty procedures - that have dramatically reduced all the problems caused by the older operation.

One advance is the "plug and patch" procedure, in which the bulge is pushed in and held back with special mesh material. This new technique produces recurrence rates of less than one-half of 1 percent - plus the whole procedure can be performed with local anesthesia and (usually) on an outpatient basis, with no overnight hospital stay. In certain cases, surgeons may opt to use a special plug device, resembling a badminton birdie, in addition to the mesh.

According to Rutkow, this method is vastly preferable to the older procedure. "It costs less, it's easy to do and, frankly, it works," he says. The plug seals the rupture opening like a cork in a bottle, and the surrounding tissue grows around and through the mesh, creating a strong and permanent repair. Because the mesh procedure is much less traumatic, requiring a smaller incision and creating no tension around the area of healing, most patients can be almost pain-free and back to work or (gentle) play in a few days to a week.