Don’t Let Hernias Put a Strain on Your Life


One day you’re lifting something, golfing, or doing something routine when you feel a telltale pop in your lower belly or groin. After the pop, a bulge appears. That bulge may happen gradually and then disappear… only to return again the next time you cough or sneeze. These are some of the classic symptoms of an abdominal hernia.

What is a hernia exactly?

The abdomen is surrounded by numerous muscles to keep your internal organs where they belong. When these organs start to slip through a weakness or a hole in those muscles, it’s called a hernia. Hernias are believed to be caused by a congenital defect in the abdominal wall. Activities that put pressure on the abdominal wall such as weight lifting, chronic cough, or straining when constipated can cause this weak area to give way and allow a hernia to develop.

Abdominal (inguinal) hernias can happen anytime, even to people who are healthy and fit, says Dr. Christopher Moheimani, chief of general surgery at Cortland Regional Medical Center. “Sometimes it’s just how you’re put together,” he says. “Usually the abdominal muscles are intact, but in some people there can be a little gap at the navel, or in the natural space in the groin where a testicle exists. And whenever there’s an incision made in your abdominal wall, you can develop a weakness in that area. Whether a hernia happens naturally or not, you wind up with a bulge that can be unsightly, uncomfortable, and can lead to potential bowel obstruction.”

Abdominal hernias occur in both men and women and appear as a swelling with some discomfort that tends to get worse when a person stands, strains, or lifts heavy items. If part of your bowel becomes trapped, causing an obstruction or strangulation, emergency surgery may be necessary.

“When the bowel gets involved that’s when we become concerned,” says Dr. Moheimani. “Patients will often report feeling bloated or distended, or they notice other issues with digestion,” he says. Other symptoms of a hernia may include a heavy sensation or pressure in the groin, a feeling of weakness, or pain and swelling in the scrotum if the intestine descends into it.

Once a hernia appears, surgery is the only way to fix it. Open hernia repair often involves making an incision in the abdomen so the surgeon can push the tissue back into place and repair the muscle around it.

Dr. Jabbar Saliba, general surgeon at Cortland Regional, also uses a minimally invasive, laparoscopic procedure that involves “inserting a small camera through an incision, then making a bunch of smaller incisions. This allows you to insert a piece of surgical mesh to span the gap and repair the muscle,” he says.

Recovery times vary depending on the person, the type of hernia, and the type of repair done, but in general, “patients should avoid any heavy lifting and extremes in body posture for about six weeks after surgery,” says Dr. Saliba. “With a mesh repair behind the muscle, people can usually resume normal activities as tolerated,” Dr. Moheimani adds.

“Hiatal hernias are another common issue that occurs due to a congenital weakness in the diaphragm, or increased pressure in the abdomen due to obesity, for example,” says Dr. Saliba. “The stomach herniates through an opening, stomach acid regurgitates into the esophagus, and people experience heartburn as the most common symptom.”

Hiatal hernias are diagnosed by endoscopy, and the symptoms are controlled with medicine or antacids. The classic surgical repair involves wrapping the upper portion of the stomach around the esophagus, either partially or totally, to eliminate reflux. “Larger hernias would require this more invasive, gold-standard approach called Nissen fundoplication surgery,” says Dr. Saliba.

Dr. Saliba and his colleague, gastroenterologist Dr. Adam Moskowitz, are the only specialists within nearly 150 miles to offer a less invasive TIF (Transoral Incisionless Fundoplication) repair. “This procedure rebuilds the anti-reflux valve from inside the patient’s stomach without incisions. In patients who qualify for it, we can achieve 70 to 75 percent relief from chronic heartburn symptoms and eliminate the need for heartburn medicine,” Dr. Saliba says.

“In general, we see more abdominal hernias than hiatal hernias since many patients will simply seek heartburn medicine from their primary care provider. Recent studies have shown that there can be some worrisome complications from taking heartburn medicine long-term. If this describes you, ask your doctor to refer you to a specialist,” Dr. Saliba says.

For more information about Dr. Moheimani and Dr. Saliba, please call 607-753-0700. For more information about Dr. Moskowitz, call 607-428-5701. All providers are accepting new patients.

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