Complex hernias happen for a variety of reasons, but there are two important and somewhat unexpected factors that greatly affect a patient’s level of risk: smoking and weight gain.
Dr. Joel “Trey” Bradley, General Surgeon
“A hernia is simply a hole where we’re not supposed to have one,” says Premier Surgical general surgeon Joel “Trey” Bradley III, MD. “The more complex hernias are usually the ones that are larger and require more significant operations, and the majority of complex hernias are incisional hernias from previous surgeries.”
With hernias occurring in areas of the body that have already been affected by incisions, the ability to heal is critical. That’s why smoking is now considered a major risk factor for development of a hernia.
Dr. Bradley explains that smoking impairs the healing of wounds old and new. If a wound doesn’t heal from an initial operation, muscle can separate, creating a hernia. If a hernia is repaired but the body lacks the ability to heal properly, complications may follow.
“The ability to get blood flow to the muscle is critical to hernia repair, so muscle can regrow together,” Dr. Bradley says. “Nicotine and the products in tobacco prevent good blood flow to wounds.”
He says it’s ironic that the risk factors that help hernias develop are also the ones that can cause complications after the hernia repair itself. “That’s something that we didn’t realize many years ago, and it’s more recently that we’ve discovered the detrimental effects of smoking on hernias and hernia surgery,” Dr. Bradley says.
Getting a patient’s weight down to a healthy level is important, too.
“It comes down to the physics of just trying to get the abdominal wall closed,” Dr. Bradley says. “Especially with morbid obesity, the pressures on the abdominal wall are so great that they pull the hernia back apart.”
Dr. Bradley says a patient’s weight can reach a point where it becomes “almost impossible” to perform hernia repairs that will last. He tries to impress upon patients the importance of reaching a healthy weight and kicking the habit of smoking before undergoing a hernia repair procedure.
“The best hernia repair is usually the first one you do, and if you’re having to do a revision of a hernia repair, or a revision of a revision of a revision, that can get very complicated,” Dr. Bradley says.
For more information about preparing for a successful, lasting hernia repair, visit Premier Surgical’s ComplexHernia webpage.