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Medical Disability Advisor  >  Hernia Repair

Hernia Repair

Related Terms

  • Abdominal Hernia Repair
  • Herniorrhaphy
  • Laparoscopic Transabdominal Preperitoneal Herniorrhaphy
  • TAPP

Specialists

  • General Surgeon
  • Thoracic Surgeon
  • Urologist

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Factors Influencing Duration

The location of the hernia, the surgical approach, the presence of any complications such as an incarcerated or strangulated hernia, and the general health status of the individual may influence the length of disability.

Duration Trends from Reference Data

DURATION TRENDS
 ICD-9-CM: 53.0, 53.1, 53.4  
CasesMeanMinMaxNo Lost TimeOver 6 Months
9773301080.3%0%
 
  
 
Percentile:5th25thMedian75th95th
Days:819304468
 
  
 

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes

ICD-9-CM:
53 - Repair of Hernia
53.0 - Hernia Repair, Inguinal, Unilateral
53.00 - Unilateral Repair of Inguinal Hernia, Not Otherwise Specified; Inguinal Herniorrhaphy NOS
53.01 - Repair of Direct Inguinal Hernia
53.02 - Repair of Indirect Inguinal Hernia
53.03 - Repair of Direct Inguinal Hernia with Graft or Prosthesis
53.04 - Repair of Indirect Inguinal Hernia with Graft or Prosthesis
53.05 - Repair of Inguinal Hernia with Graft or Prosthesis, Not Otherwise Specified
53.1 - Hernia Repair, Inguinal, Bilateral
53.10 - Bilateral Repair of Inguinal Hernia, Not Otherwise Specified
53.11 - Bilateral Repair of Direct Inguinal Hernia
53.12 - Bilateral Repair of Indirect Inguinal Hernia
53.13 - Bilateral Repair of Inguinal Hernia, One Direct and One Indirect
53.14 - Bilateral Repair of Direct Inguinal Hernia with Graft or Prosthesis
53.15 - Bilateral Repair of Indirect Inguinal Hernia with Graft or Prosthesis
53.16 - Bilateral Repair of Inguinal Hernia, One Direct and One Indirect, with Graft or Prosthesis
53.17 - Bilateral Inguinal Hernia Repair with Graft or Prosthesis, Not Otherwise Specified
53.2 - Hernia Repair, Femoral, Unilateral
53.21 - Unilateral Repair of Femoral Hernia with Graft or Prosthesis
53.29 - Unilateral Femoral Herniorrhaphy, Other
53.3 - Hernia Repair, Femoral, Bilateral
53.31 - Bilateral Repair of Femoral Hernia with Graft or Prosthesis
53.39 - Bilateral Femoral Herniorrhaphy, Other
53.4 - Hernia Repair, Umbilical
53.41 - Repair of Umbilical Hernia with Graft or Prosthesis
53.49 - Umbilical Herniorrhaphy, Other
53.5 - Repair of Other Hernia of Anterior Abdominal Wall (without Graft or Prosthesis)
53.51 - Incisional Hernia Repair with Graft or Prosthesis
53.59 - Repair of other hernia of anterior abdominal Wall; Repair of Hernia: Epigastric Hypogastric, Spigelian, Ventral
53.6 - Repair of Other Hernia of Anterior Abdominal Wall with Graft or Prosthesis
53.61 - Incisional Hernia Repair with Graft of Prosthesis
53.69 - Repair of Other Hernia of Anterior Abdominal Wall with Graft or Prosthesis
53.7 - Repair of Diaphragmatic Hernia, Abdominal Approach
53.8 - Repair of Diaphragmatic Hernia, Thoracic Approach
53.80 - Repair of Diaphragmatic Hernia with Thoracic Approach, Not Otherwise Specified; Thoracoabdominal Repair of Diaphragmatic Hernia
53.81 - Plication of The Diaphragm
53.82 - Repair of Parasternal Hernia
53.9 - Other Hernia Repair; Repair of Hernia: Ischiatic, Ischiorectal, Lumbar, Obturator, Omental, Retroperitoneal, Sciatic

Definition

Hernia repair (herniorrhaphy) is a procedure performed to correct an abnormal protrusion of an organ or tissue through a defect in the abdominal wall. Abdominal hernias tend to occur where the muscle layer is interrupted such as at the navel, the inguinal area, or wherever the containing tissue (fascia) is weakened. Most commonly, hernias develop in the groin or inguinal area, the femoral and umbilical areas, at sites of surgical incisions, and at the based of the esophagus (hiatal hernia) where it passes through the diaphragm. Hernias develop following a weakening of the constraining muscle, which then allows contents of the abdominal cavity to bulge through the weakened tissue. Depending on the location, the hernial sac may contain fatty tissue or can include loops of intestine.

The basic cause of all hernias is pressure on an area of weakness. The potential for weakness may originate at a natural opening in the containing tissue or from surgical disruption of tissue. Pressure may come from such diverse causes as straining due to coughing, constipation, vomiting, lifting, pregnancy, or obesity. The vulnerable tissue may be further weakened by smoking or muscular laxity or may become compromised following surgery.

A hernia is described as reducible when the contents of the hernial sac can be placed back into the surrounding musculature; it is said to be incarcerated when it cannot be reduced. Some hernias are described as strangulated when blood supply to the area becomes compromised. A strangulated hernia may result in pain and tenderness. Symptoms of an abdominal hernia include a lump or swelling in the location of the hernia, pain upon standing, and/or colicky abdominal pain. To diagnose a hernia, the mass should be able to be pushed back into the body cavity with gentle pressure (reducible). If the mass is not reducible, then a hernia can be diagnosed by using diagnostic ultrasound imaging or performing a herniography (i.e., injecting dye into the peritoneal cavity to highlight the site in question on a scan or x-ray).

Hernia repair is one of the most frequent operations performed by general surgeons. With the exception of umbilical hernias seen at birth, which usually heal by age 4, once a hernia begins, it will not heal on its own. Surgical repair moves the protruding organ or tissue back into its normal position and then strengthens the weakened area using sutures and possibly mesh-like materials.

Source: Medical Disability Advisor



Reason for Procedure

Abdominal hernia repair is done to relieve symptoms of pain or tenderness and to prevent or resolve complications such as an incarcerated or strangulated hernia. In an incarcerated hernia, the intestine has become trapped in the opening in the muscle wall; in a strangulated hernia, the intestinal blood supply has been impaired by the presence of the hernia. Repairing incarcerated and strangulated hernia is considered urgent to prevent more serious systemic complications such as intestinal blockage, infection, or systemic infection (sepsis).

Source: Medical Disability Advisor



How Procedure is Performed

Small, uncomplicated hernias are repaired by herniorrhaphy, which involves returning the contents of the hernial sac to their normal place and then repairing the defect. The surgeon will use either the traditional open approach or, more frequently, use a less invasive laparoscopic approach (laparoscopic transabdominal preperitoneal herniorrhaphy or TAPP) performed through smaller laparoscopic incisions. TAPP is preferred, especially for inguinal hernia repair, because it provides more accurate evaluation of the hernia, avoids unnecessary exploration to confirm the presence of hernia, and allows less invasive, more timely repair.

When hernias are larger and more complicated, the surgeon will reinforce weakened areas with plastic or steel mesh to strengthen and relieve stresses put on the compromised tissue, thereby reducing the likelihood of recurrence. Tension-free tissue repair using synthetic mesh prosthesis to reinforce the defect is currently the standard procedure except when mesh is contraindicated (e.g., in strangulated hernias in which bowel resection is needed). The surgical use of mesh is called hernioplasty. The repair may be done using only local or regional anesthesia, or it may require general anesthesia; this decision will depend on the nature of the hernia.

The inguinal area is by far the most common location for herniation. Inguinal hernias occur in male fetuses where the testicles descend from the abdomen into the scrotum. The surgical principles for inguinal hernia repair follow those of hernias at other sites. They may be repaired using a traditional surgical approach (open) or, more frequently, through small laparoscopic incisions using a telescoping fiberoptic instrument (endoscope) to both visualize the operative procedure and make the repair. If bilateral inguinal hernias are present, one or both can be reduced at the same time. If both are done, general anesthesia is usually required. If only one at a time is done (staged procedure), local anesthesia may be used. The surgeon makes an incision over the area of the hernia, and the bulging tissue or organ is replaced inside the muscle wall or body cavity. The muscle tissue is then repaired with sutures or more often with synthetic mesh that bridges the defect and reinforces the muscle wall. The use of mesh depends on the size of the hernia. Lastly, the skin is closed with sutures or staples.

Several common approaches are used for laparoscopic inguinal hernia repair, including those in which the incision is placed through the abdominal muscle wall (transabdominal), through the inguinal area (anterior inguinal), outside the peritoneum (extraperitoneal, the peritoneum being the membrane that lines the abdominal and pelvic areas), or anterior to the peritoneum (preperitoneal). The approach used depends upon the surgeon's preference and the patient’s obesity, general health status, and comorbidity.

Femoral hernias refer to hernias in the groin area where a natural weakness in tissue is present due to large blood vessels that pass through the area. The surgeon will normally reinforce the site with mesh after reducing the hernia.

Umbilical hernias, as the name implies, occur around the navel. The herniated tissues are returned to the abdomen, and the adjacent muscle is pulled together over the incision for reinforcement.

Hiatal hernias are found at the hiatus of the diaphragm where the esophagus crosses from the chest into the stomach. Here the surgeon will choose either to approach from the chest or the abdomen, depending on the condition. The weakened area of the diaphragm is repaired, and then the positions of the stomach and esophagus are reinforced with sutures.

Incisional hernias occur where tissue has been weakened by prior surgery. After the herniated contents are returned to the abdomen, the surgeon will use a mesh to reinforce an already compromised area.

Source: Medical Disability Advisor



Prognosis

Surgical treatment of uncomplicated hernias usually results in complete recovery within a period of up to 6 weeks. Recurrence is less common since tension-free tissue repair has become a standard procedure following hernia reduction. Successful hernia repair is achieved by reducing factors that contribute pressure such as cough, constipation, prostatic obstruction, accumulation of fluid (ascites), or tumors, and repairing the defect so that the incision line remains free of tension. When a hernia recurs following surgery, it usually can be traced to inadequate repair, progressive weakening of the supporting structures, or continued intra-abdominal pressure.

Source: Medical Disability Advisor



Complications

Surgical complications may include allergic or abnormal reactions to anesthesia, excessive bleeding, urinary retention, infection of the incision, nerve injury, damage to the testicular blood supply or nerve supply, or recurrent hernia.

Source: Medical Disability Advisor



Return to Work (Restrictions / Accommodations)

Upon return to work, individuals should not lift anything heavy for 6 to 8 weeks after surgery. Standing and walking can be done to comfort level. Sanctions against heavy lifting usually include other types of strain such as pushing heavy items, since this also puts a strain on the healing muscle layers of the abdomen or inguinal area. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Source: Medical Disability Advisor



General References

"Laparoscopic Inguinal Hernia Repair." The Society of American Gastrointestinal Endoscopic Surgeons. 20 May 2005 <http://www.sages.org/pi_inguinal_hernia.html>.

Weinstein, Phillip R., and Julian T. Hoff. "Hernials and Other Abdominal Lesions of the Abdominal Wall." Current Surgical Diagnosis & Treatment. Eds. L. W. Way and Gerald M. Doherty. 11th ed. New York: McGraw-Hill, 2004. 783-796.

Source: Medical Disability Advisor






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