In my practice, I have performed over 2000 laparoscopic and open preperitoneal inguinal hernia repairs. When I began performing hernia surgery, I performed laparoscopic operations exclusively.

In 2003, I learned a more advanced technique than laparoscopic hernia surgery and observed that my patients had a much better experience with this new open preperitoneal inguinal hernia repair. Over time It was obvious to me that patients had less pain with this technique and I switched to this more advanced method in 2007.

I have personally found this repair to allow almost every patient to return to work in 1-3 days. Additionally, about 50% of patients only take Tylenol or Ibuprofen after surgery instead of narcotics. After two weeks, almost all patients are fully active, including working out at the gym and playing contact sports. The postoperative nerve pain has been almost completely eliminated in my practice.

Below, I’ve answered the most common questions I receive from my patients and their families.

What insurances does Dr. Reinhorn accept?

Below is a list of the insurances that are accepted by Dr. Reinhorn’s office. Please call the office for questions or clarification on specifics about insurance.

  • AARP
  • Advantra Freedom
  • Aetna
  • BCBS MA
  • BCBS Out of state
  • BCBS Blue Access
  • Cigna
  • Tufts
  • Tufts Silver Advantage HMO
  • Carelink
  • Comm Indemnity/GIC
  • Unicare
  • GEHA
  • Health Plans Inc
  • HPHC
  • Humana
  • Liberty Mutual
  • Mass Health
  • Medicare
  • NHP
  • Oxford
  • RR Medicare
  • Senior Whole Health
  • Tricare
  • United Healthcare

What is a hernia?

A hernia occurs when tissue such as intestine or abdominal fat slides through a hole in the abdominal wall, just under the skin.

What causes a hernia?

Some people are actually born with a hernia. This is called a congenital hernia and can occur in the belly button (umbilical hernia) or in the groin (inguinal hernia). Others develop a hernia, such as an inguinal hernia, as some of their abdominal tissues stretch enough to allow internal abdominal organs or fat to pop through the abdominal wall. Typically all of our tissues stretch as we get older and the abdominal wall is no different. Heavy lifting, coughing or straining may lead to an increased risk for hernias.

Where do hernias occur?

Hernias occurring in the lower abdomen, near the groin are called inguinal or femoral hernias. Hernias occurring in the front of the abdomen are called ventral or umbilical (if at the belly button).

Who can get a hernia?

While some children are born with hernias, most hernias occur in adults of any age. Men are much more likely to get hernias than women by a factor of 10 to 1.

What are symptoms of a hernia?

  • Pain or discomfort when sitting, standing, lifting, sneezing, coughing or just at the end of the day.
  • Pain during activity that restricts that activity.
  • Pressure or weakness in the inguinal region (groin).
  • New constipation or difficulty in urination when combined with a new bulge.

Many hernias only cause a bulge that is painless. Symptoms of a hernia include pressure in the lower abdomen and pain in the groin that goes to the testicles. Some people feel these symptoms after sitting for long periods of time or after exercise. Severe pain, associated with a tender mass in the groin or abdominal wall, could signify an incarcerated hernia and is a surgical emergency.

How can I tell if I have a hernia?

The hernia is an abnormal opening in the abdominal wall that allows internal abdominal contents to bulge through the hole and just under the skin, so it can generally be felt as a noticeable bump. A hernia is similar to a hole in a tire, where the inner tube bulges through the tire (see figure). While many hernias cause little or no discomfort, many can be uncomfortable. Most people know they have a hernia because they notice a bulge that is bigger when standing, sitting or coughing and often disappears when they lay down in bed.

I have pain in my groin, is it a hernia?

We see many people in the office each year with complaints of pain in the groin. In fact, almost one in four patients referred for a hernia has a groin strain. In order to figure out if the pain is coming from a hernia or groin strain, it is important to see your doctor or hernia specialist.

Many patients will sustain an injury to their lower abdomen or upper thigh as a result of a new exercise routine, or just doing something around the house. In winter, shoveling is a common way to injure the core. During the rest of the year, moving boxes or starting a new gym routine may cause problems. Patients with a groin strain will often have pain at night, something patients with a hernia rarely experience. Most injuries are due to an imbalance in the core musculature and require some form of physical therapy to correct. Some people are able to work on their core at home, while others utilize a personal trainer or physical therapist.

What is a recurrent hernia?

A recurrent hernia is a hernia that comes back sometime after surgery. This occurs in about 1 in 100 patients. A recurrence occurs as a result of poor wound healing, continued stretching or stress on the abdominal wall, or a technical error on the part of the surgeon. Given the 99% success rate of most hernia repairs, hernia surgery has better outcomes than and some of the lowest risk among most elective operations.

Is a hernia dangerous?

Typically, hernias are not dangerous. Most hernias cause minor discomfort or mild pain. Emergency situations, such as the intestine getting stuck occur infrequently, but can be life-threatening. Still, because of potential problems and complications associated with hernias, anyone suspected of having a hernia should be evaluated by a primary care physician or surgeon.

What is a sports hernia?

Most hernia surgeons refer to sports hernias as Inguinal Pubalgia or Athletic Pubalgia. While there is a lot written online about this subject, the consensus of most hernia surgeons is that a musculoskeletal injury occurs as a result of a sport. Most patient present with Inguinal or lower abdominal pain which is made worse with exercise. Patients often feel discomfort at night and do not have a hernia on physical examination.

Current treatment recommendation is for aggressive physical therapy to treat the injury and core muscle imbalance that caused the injury. If unsuccessful after 6 months, surgery is recommended, though no single approach as been shown to be better than any other approach.

Do I have to have surgery if I have a hernia?

Whether or not you need surgery if you have a hernia depends on your 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.

Read more about your treatment options here.

When should I consider hernia repair surgery?

If your hernia causes pain, interferes with your daily activities, or prevents you from exercise, it’s time to talk to a surgeon about repair options.

I don't have any symptoms now, but I'm not getting any younger. Should I get hernia repair surgery now?

Whether or not you get hernia repair surgery without symptoms is a decision between you and your surgeon.

I have an inguinal hernia that's causing me symptoms. What are my treatment options?

With an inguinal hernia, you have two broad treatment options, which each have two methods:

A) Repair the abdominal wall from the outside in

  • Old-fashioned open surgery
  • Newer open mesh repair

B) Repair the hole in the abdominal wall with a patch on the inside

  • Laproscopic
  • Open preperitoneal

I typically recommend the last repair because it offers the best of all worlds. It offers the safety of open surgery while allowing for faster recovery and less of the long-term pain for which laproscopic hernia surgery is known.

How do I choose a surgeon?

Your primary care doctor is one of the best sources of information about how to choose a hernia repair surgeon. The most important question to ask a prospective surgeon is how many hernia repair surgeries they have done or do per year. While there is no minimum number per year, you should feel comfortable with the answer you get.

How many hernias has Dr. Reinhorn repaired?

While the average general surgeon repairs about 30 hernias per year, Dr. Reinhorn now repairs more than 200 hernias each year. He specializes in the unique, posterior, open pre-peritoneal repair.

I'm worried about chronic pain. Is one repair better than another?

Yes, the posterior repairs – Laparoscopic or Open Pre-peritoneal repairs – are associated with a lower risk of chronic pain.

What is hernia mesh?

The most common material used to make a hernia mesh patch is polypropylene. It is safe, resistant to infection and has been used for more than 50 years. Every several years technology improves the material characteristics in order to provide stronger, lighter products that are better tolerated by patients.

I use the Ventrio™ ST patch for most inguinal hernias and the Ventralex™ patch for umbilical hernias.

Is mesh dangerous?

Not Often. The standard of care in the US for more than 30 years has been to repair hernias with mesh. If mesh was dangerous, it would not be used in almost 99% of hernia repairs. Every year, many patients have complications of any surgery, including hernia surgery. Some of these complications can be related to the use of mesh. Because there are many ways to fix hernias, the complication rate is quite variable, depending on the technique used. The biggest problem after hernia surgery is chronic pain. While mesh can contribute to this, hernia repair options that do not include the use of mesh, often are associated with chronic pain as well. As more and more outcome data becomes available, we are learning that not all hernia repairs are created equal. The open preperitoneal repair is associated with a lower risk of chronic pain, and very few mesh complications. For thin patients, a non mesh repair may be a good alternative.

Why does Dr. Reinhorn recommend a POSTERIOR mesh repair?

I studied engineering before medical school. I constantly look at any medical problem in an analytical way. 120 years ago, when mesh was not around, primary tissue (non-mesh) repairs were the only way to go. Today, patients and surgeons have many more options than were available in 1889, when Edoardo Bassini first described his tissue only repair. I learned non mesh repairs in residency, along side the mesh repairs. While most surgeons and patients believe that recurrence rates are lower with non mesh repairs, the chronic pain associated with anterior mesh repairs is close to 17%. To me this is an unacceptable number, which is why I do not recommend an anterior mesh repair, unless a posterior mesh repair is not possible. Posterior mesh repairs, Lap or Open, are associated with less chronic pain than anterior repairs, and in my experience, the open repair leads to much less pain than the Laparoscopic method, which is the main reason I no longer offer that approach.

Will I need general anesthesia during hernia repair surgery?

For the open preperitoneal repair, we can often do the operation under a sedative and local anesthetic, allowing most patients to spend less than 5 hours total in the hospital. There are exceptions, of course, and the following people often require a general anesthetic: Patients who are overweight and have a Body Mass Index (BMI) greater than 28, patients who have had their prostate removed and patients with recurrent hernias.

How long will I be in the hospital?

About 3-5 hours. All patients come in one hour before surgery to allow time to meet with the OR staff, the anesthesiologist and to ask Dr. Reinhorn any last minute questions. Surgery typically takes less than an hour, and patients spend about 1 hour after surgery recovering. Patients requiring general anesthesia (those with a BMI > 28 or those with recurrent hernia), will require an additional 2 hours, including anesthesia, surgery and recovery.

What to expect on the day of surgery and after?

On the day of surgery, you are required to come to the hospital approximately 60 minutes before your scheduled operation. This is necessary to allow time for you to change, have an intravenous started, speak with the nurses, anesthesiologist and me. I suggest you wear loose comfortable clothing.

Surgery can take approximately 1 hour for a single hernia. Depending on the complexity of the hernia and its size, surgery may take more or less time.

Most people spend 1- 2 hours recovering from surgery in the hospital.

Once home, it is important to stay ahead of any pain or discomfort. While half of my patients take Tylenol only, I provide everyone with a prescription for pain medication. Most people will feel the most discomfort over the first 48 hours after surgery. This is typically the time when there is the most swelling and black and blue discoloration.

By 2 weeks, almost everyone is back doing everything they did before surgery.

Is any muscle cut during surgery?

No. Only fibrous tissue is cut and the muscle is split and retracted out of the way. This way no muscle is cut and patients have little pain and no disability after surgery.

Is a hernia repair the same in women and men?

Yes and No. For umbilical and ventral hernias, the repairs are identical.

For inguinal hernias the mesh is placed in the same location and the incision and anesthesia are the same. Women sometime experience a slight increase in discomfort after inguinal hernia surgery because a small tube (round ligament) is often cut in order to place the mesh properly. This does not lead to any long term issues, but only to a slight increase in short term pain.

What are my options if I had prostate surgery?

Many men will develop an inguinal hernia after a prostatectomy, or removal of the prostate. This operation can be done open, laparoscopically or with the help of a robot. All of these techniques lead to scarring in the pelvis. Because of this scarring, laparoscopic surgery for inguinal hernia after a prostatectomy is nearly impossible.

The only options available are the traditional open or the advanced open preperitoneal repair I perform. Typically I am able to do a preperitoneal repair in 80% of patients who have had a radical prostatectomy. When I cannot place a patch in the preperitoneal space, I convert to a traditional repair.

When can I return to work after hernia repair surgery?

After an open, preperitoneal repair, you can return to most jobs 1-3 days after hernia repair surgery. If your job requires heavy lifting, you may need up to 2 weeks of time off for recovery from the operation.

Most of our patients that have hernia surgery on Thursday or Friday, return to work by Monday.

Are you traveling a long distance for you hernia surgery?

If you are traveling from out of town, check out the Hotel Indigo, located less than 1 mile from Newton-Wellesley Hospital. They offer discounted rates for patients of the hospital, as well as provide shuttle transportation in the mornings and evenings on Monday-Friday.

For reservations, call 877-834-3613, or click here to visit their website.

Will I have a lot of pain after hernia repair surgery?

While everyone recovers from surgery differently, most people come off of prescription pain medications by the third day after surgery and almost half of all patients do not take prescription pain medications at all!

Most patients can take Acetaminophen (Tylenol) instead of the prescription medicine. Ibuprofen(Advil) or Naproxen (Aleve) can often be taken in addition to the Tylenol or your prescription. Since most pain medicine can be taken every 8 hours, some people find it helpful to take Acetaminophen every 8 hours and Ibuprofen every 8 hours, but staggered by 4 hours, thus taking something for pain every 4 hours and avoiding narcotics all together. For example, a patient might take Ibuprofen at 1:00 pm, 9:00pm and 5:00 am and Tylenol at 9:00 am, 5pm, and 1 am if needed.

Patients should consult their surgeon or primary care physician prior to taking over the counter medicine after surgery.

How likely is it that a hernia will come back after repair?

Recurrence rates vary. Reports of 90 – 99% success rates are common. Mesh repairs offer a smaller recurrence rate than non mesh repairs.

The key is to find a surgeon that performs a lot of hernia surgery. Typically, a high volume surgeon will have better results.

How long is recovery time after hernia repair surgery?

There is no hard number that is consistently used to determine when patients can resume physical activity after hernia repair surgery. Once the surgery is done, your body is in better shape than before the surgery, but in the first 2 weeks afterward, you may experience quite a bit of swelling and scarring that could prevent you from some of the activities you’re accustomed to. For this reason, I typically recommend a lot of walking or non-weight-bearing exercise for the first 2 weeks before return to full activity.

When can I exercise after hernia surgery?

After a preperitoneal repair Lap or Open) most surgeons allow their patients to resume full physical activity, without restriction, at 2 weeks. With other types of repairs, some surgeons restrict activity for 4-6 weeks to allow time for tissues to fully heal. The advantage of the preperitoneal repair is that the abdominal pressure is always helping to keep the mesh in place.

I typically suggest that patients use walking as exercise the first 2 weeks after surgery and avoid lifting more than 25 lbs.

Do you have a video of the surgery where I can learn more about what you do?

In Sept 2014, I published an article in JOMI, a new and innovative online journal. Check out the link to the article here.

Can hernia surgery lead to sexual dysfunction?

No. Since hernia surgery does not interfere with the blood vessels or nerves that are used for sexual function, there is little to no risk.

Will I feel my hernia mesh after surgery?

Not if you have pre-peritoneal repair. Many patients complain of feeling their mesh after traditional hernia surgery. This is because the body is constantly trying to push the mesh out. With the posterior repair the mesh is held in place by the body’s natural pressure, avoiding any feeling of the mesh being there.

What happens if I get a cold or the flu after hernia surgery?

The winter months bring lots of colds and sometimes the flu. If you find yourself needing to cough or sneeze, it’s often helpful to place a pillow over your incision. This provides some support and comfort, and will hopefully decrease your pain when you cough or sneeze. Sharp pain is not uncommon after a cough or sneeze, and lingering effects should resolve in a day or two. It’s very unlikely that the hernia will return as a result of this. If you develop a fever and/or redness around your incision, it’s best to call your surgeon.

What are the costs of hernia surgery?

This question often comes up during a consultation. Currently the cost of surgery is composed of the surgeon’s fee, the anesthesiologist’s fee, and the hospital’s fee. Since these costs vary by insurance plan, Dr. Reinhorn or his staff will be happy to explain these fee in greater details in person, allowing for a fully informed decision prior to scheduling surgery.

I want a non-mesh repair? Where should I go?

Over the last few years we started offering non mesh repair for elective patients. In years past, these repairs were reserved for emergency situations only. Given some people’s concerns about mesh, we now offer non mesh options for umbilical and inguinal hernia. Dr Reinhorn has observed the non mesh Shouldice technique by visiting the famous Shouldice hospital in Toronto. While he understands and performs this technique here in Boston, the surgeons at the Shouldice hospital perform aver 500 Shouldice surgeries every year and are best qualified to perform that operation.

Is it safe to use a hernia belt or hernia truss?

A hernia belt or truss is designed to keep the contents of your hernia inside the abdominal wall. This is accomplished by the application of pressure over the hernia, much like you can do with your hand, if the hernia is uncomfortable. Many patients have used hernia belts safely as a bridge to hernia surgery. Some patients may have travel or business plans when their hernia is first diagnosed. When supervised by a physician, the hernia belt can be used to minimize symptoms and the need for immediate surgery. These belts are safe and effective; however, surgery is still the best way to avoid an emergency situation.

Careway Wellness is a shop just north of Boston where you can find a Hernia Truss 

What are the costs of hernia surgery?

This question often comes up during a consultation. Currently the cost of surgery is composed of the surgeon’s fee, the anesthesiologist’s fee, and the hospital’s fee. Since these costs vary by insurance plan, Dr. Reinhorn or his staff will be happy to explain these fee in greater details in person, allowing for a fully informed decision prior to scheduling surgery.

The above information is provided for educational purposes only. This information is not intended as a substitute for professional evaluation by an experienced surgeon.

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