Advanced Surgical Health Associates

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All Posts in Category: Symptoms

Do You Need Hernia Repair Surgery?

If you’ve noticed a bulge under your skin near your belly button or abdomen, or perhaps felt a pop in your groin area after lifting something heavy, don’t be surprised if your doctor says you have a hernia. A hernia is when an internal organ, fat, or tissue breaks through a weak spot in a muscle; a condition that never goes away on its own and requires surgery to fix.

Hernias are more common in certain parts of the body like the abdominal wall (ventral hernia), belly button area (umbilical hernia), groin (inguinal hernia), and diaphragm (hiatal hernia).  Some hernias don’t cause physical discomfort and are only visually detected when you notice a bulge under the skin.

Other hernias are extremely painful and tender to the touch. In some cases, the lump may disappear when you lie down, and then reappear or enlarge when you put pressure on your abdomen or groin area, such as when you stand, or lift or push something heavy. Hiatal hernias, when a piece of your stomach pokes through the small opening connecting your esophagus to your diaphragm, do not have symptoms you can see. They do, however, cause heartburn, and gastroesophageal reflux disease (GERD), because they can cause food and acid to back up into the esophagus.

So how can you tell if you can leave your hernia alone, or if you need to make an appointment with a surgeon who can repair it before it gets worse and requires emergency surgery?


“One way to judge if ventral, umbilical or inguinal hernia surgery is necessary is the push test”, says Amit S. Kharod, M.D., a general surgeon, board-certified in general and laparoscopic surgery, who specializes in laparoscopic hernia repair. “When a painful hernia cannot be pushed back into the body using gentle pressure, it’s time for surgery.” This is a sign that the hernia has become incarcerated – when the hernia contents get stuck in the surrounding weak spot of tissue or muscle.  An incarcerated hernia can lead to strangulation, where blood flow is cut off to tissue in the hernia, and requires immediate surgical treatment.

Experiencing severe pain, nausea, vomiting, skin discoloration around the bulge, as well as the inability to pass gas or empty your bowels are other signs that it is time to have a ventral, umbilical, or inguinal hernia fixed. Some people choose to fix their hernia before it expands, while it’s still small and not painful. “It can be advantageous to repair a hernia when a patient is healthy, before the hernia becomes bigger or requires emergency surgery due to strangulation,” explains Dr. Kharod.  However, some people may be able to ward off surgery for a time, and some even altogether with help of a hernia aid.

There are several over-the-counter hernia support aids that do not require a doctor’s prescription. However, it’s recommended that you talk to your doctor before purchasing any form of an aid.  Those suffering from inguinal hernias might find temporary relief of discomfort using a hernia truss, a compression undergarment designed for men, which forces the bump back into place.  Abdominal hernia belts are designed for both men and women. The padded flexible belt wraps around the abdomen and presses on the hernia to stop the lump from popping out.


When it comes to hiatal hernias, the signs you need it surgically fixed are different than with the other types of hernias, because the symptoms are not seen but felt. When self-care techniques like change in diet, over-the-counter drugs, or prescription medications don’t control your heartburn, or when asthma and laryngitis develop, surgery can be effective in eliminating the discomfort.

Surgical Options:

A hiatal hernia can be fixed through a minimally invasive procedure called Transoral Incisionless Fundoplication (TIF), which corrects GERD by creating a valve mechanism at the bottom of the lower esophageal sphincter. In the past, this was accomplished either through open abdominal surgery or through tiny laparoscopic incisions in the abdomen. “TIF is performed under general anesthesia and most patients can return to work within a few days,” says Dr. Kharod.

Minimally invasive laparoscopic surgery is the most common surgery method used to fix ventral, umbilical and inguinal hernias. Surgeons make a few small incisions in the abdomen, navel, or groin area. Then, by using long, thin surgical instruments and a small camera that guides the doctor, he/she can close the weak spot in the muscle wall. Robotic surgery offers an innovative approach to hernia repair. The surgeon uses small tools attached to a robotic arm that is controlled by a computer. The treatment is similar to laparoscopic repair but allows for more precision to service hard-to-reach spaces in the body.  For a very large hernia, traditional open hernia repair may be the best option.  A patch is placed over the whole hernia to reinforce the fragile area.


After surgery, it is rare for a hernia to come back. Dr. Kharod suggests following these hernia aftercare strategies in order to ensure it doesn’t.

·  Maintain a healthy weight

·  Avoid straining when moving your bowels

· Use proper technique when lifting something heavy

· Stop smoking to reduce coughing

· Treat coughs before they become chronic or hacking coughs

Even straightforward surgeries can result in complications; so make sure you choose your surgeon carefully. Research providers by asking your social network, as well as medical office and hospital based nurses for recommendations, and make sure you choose a quality surgeon with whom you feel comfortable entrusting your life.  Don’t hesitate to ask a surgeon for patient references. You want to make sure that the surgeon you choose is regularly performing the operation you need with consistently successful outcomes.

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Minimally-Invasive Transoral Incisionless Fundoplication (TIF) Procedure Helps Relieve GERD Symptoms Quickly

Do you suffer from chronic heartburn? Unexplained coughing fits? Hoarseness or a sore throat? These could all be signs that you’re one of the more than seven million Americans who suffer from Gastroesophageal Reflux Disease (GERD).

GERD, the more severe form of acid reflux, occurs when your lower esophageal sphincter — the band of muscle between your esophagus and stomach — does not squeeze itself closed. This forces your food and stomach acids up instead of down your digestive tract, causing that sour taste you may have experienced after eating foods like tomato-based sauces, spicy or fried foods, high-fat meat/dairy products, or drinking caffeinated products, such as coffee, tea or soda.

If GERD is at its primary stage, dietary and lifestyle modifications, such as eliminating foods known to aggravate the condition is an effective way of controlling it. For others, an over-the counter antacid can usually relieve the discomfort. If you suffer from frequent heartburn that occurs more than twice a week, you may be prescribed daily medications, such as H2 blockers, that can generally relieve heartburn and treat reflux, especially if you’ve never had treatment before.

But when prescription drugs aren’t enough to control the condition, and symptoms that may include asthma and laryngitis begin to reduce your quality of life, it’s time to talk to your doctor about surgical treatments.

There are several invasive and non-invasive techniques through which GERD can be treated, but a very successful and minimally-invasive procedure that’s often performed is called Transoral Incisionless Fundoplication (TIF), says ASHA’s Dr. Michael J. Menack, a board-certified, fellowship-trained surgeon practicing in the area of general surgery and minimally-invasive and incisionless surgery that corrects GERD.

The TIF procedure corrects GERD by creating a valve mechanism at the bottom of the lower esophageal sphincter. “In the past, this was accomplished either through open abdominal surgery or through tiny laparoscopic incisions in the abdomen,” explains Dr. Menack. The innovative TIF uses a EsophyX device and endoscope that is gently inserted through the mouth restoring the natural flow of food and acid down the digestive tract.

TIF is performed under general anesthesia and most patients return to work within a few days. “There are many benefits of an incisionless approach to GERD surgery, but most patients really appreciate the quick recovery time,” says Dr. Menack.  Surgeons do not cut into the abdomen, which means faster recovery and fewer post-surgical complications. “Patients also need be aware that prescription drugs, including proton pump inhibitors (PPIs) used to treat heartburn, GERD and gastric ulcers, can have severe side effects from prolonged use, so a procedure like this offers a safe and effective solution.”

For more info about GERD and the TIF procedure, please call our office at 732.308.4202 to schedule a consultation with Dr. Menack and/or visit

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