hernias after wls 3

Hernias After WLS: Causes, Symptoms and Treatments

July 8, 2016

Bariatric surgery patients often have concerns about hernias. Basically, a hernia is a defect or a hole where there should not be one. The most common hernias I see in bariatric patients are hiatal hernias, ventral hernias, umbilical hernias, and internal hernias.

Causes of Hernias

Hernias are caused by a combination of muscle weakness and strain. A hernia can develop quickly or occur over a long period of time.

Muscle weakness
Constipation to the point that you strain when having a bowel movement
Heavy weight lifting
Weight gain
Chronic and persistent sneezing and/or coughing
Being pregnant, which puts pressure on your abdomen

Symptoms of Hernias

Bulge - Incisional hernias may cause a sac membrane to protrude outside of the surgical healing incision. The sac will contain fecal matter or other abdominal waste products. Due to increased pressure in your abdomen, activities such as lifting, straining or coughing may cause the bulge to enlarge. A bulge may be painful, achy or tender when touched. You may also feel a constant pressure or fullness. If left untreated, the hernia can increase in size.

Abdominal Pain - Pain is the most common complaint by someone with a hernia. The pain can be burning, tearing, sharp, dull and/or pulling pain. Stomach pain can be felt all over the abdominal cavity but is most commonly experienced in the middle portion. You may also experience middle back pain. An initial pain may be felt when the muscles first rupture creating the hernia. Initially, the pain may come and go, and present as a stomachache. If the symptoms of the abdominal pain are not treatment, the pain will increase in severity. As a hernia grows, localized pain and pain in other parts of your body may present.

Constipation - When the intestines become strangled by a hernia, bowel movements become very difficult. Constipation and bowel obstruction regularly will be present. You may have typical symptoms of constipation including hard stools, difficulty passing stools, straining, bloody stools, bloating and abdominal discomfort.

Nausea and Vomiting - An untreated hernia may cut off the blood flow to organs. In the case of a RNY Gastric Bypass, the small intestine is most at risk for hernia strangulation. If a small bowel obstruction occurs, you will not be able to produce a bowel movement. The backup of bowels through the gastrointestinal tract will cause nausea, vomiting and lack of appetite. If the intestines are only partially blocked, you may experience nausea without vomiting.

Abdominal Inflammation - Abdominal inflammation is typically one of the last symptoms to emerge. You will have an elevated white blood cell count and irritation of the lining of your abdomen. Abdominal inflammation is usually due to an intestinal infarction, which occurs when the blood supply to part of the intestines is cut off. This causes the body's tissue dying or perforation -- small tears, releasing contents into the abdominal cavity.

Types of Hernias and Treatments

Hiatal Hernias - These hernias occur when the opening in the diaphragm through which the esophagus passes (the hiatus) becomes enlarged and allows a portion of the stomach to pass into the chest. This condition is often (but not always) related to acid reflux. When I encounter a hiatal hernia while performing bariatric surgery, I generally repair it to help prevent acid reflux after surgery. It is impossible to know for sure that you have a hiatal hernia without performing a test such as an endoscopy or an upper GI X-ray. They are also readily identified during surgery.

Ventral and Umbilical Hernias - These hernias are types of  abdominal wall hernias. The abdominal wall is the muscular and connective tissue layer between the abdominal cavity and the skin. These hernias can be identified as a bulge or protrusion pushing out of the front of the abdomen. These hernias can be repaired at the time of surgery or especially if they are large, later on after the patient loses weight. Small hernias can simply be sewn closed, larger ones often require mesh reinforcement to make the repair more durable.

Internal Hernia - This hernia is a ring or opening formed by an adhesion, or sometimes created in certain types of surgery through which a portion of the small intestine can pass and get trapped. This type of hernia can be dangerous and require emergency surgery if the small intestine gets pinched off or obstructed within the hernia. No test is reliable to make a definite diagnosis prior to surgery. This condition is generally suspected by signs and symptoms of the patient and sometimes suggested by certain findings on a CT scan.

Not all bariatric surgery patients will suffer from hernias.  If you are concerned that you may have a hernia it is best to consult with your bariatric surgeon. He or she can then determine the best course of action.



Dr. Paul Macik performs advanced laparoscopic surgeries at Northside Bariatric Surgery Center and has been doing them since 1996. Dr. Macik performs 99% of his Bariatric cases laparoscopically. In addition to advanced laparoscopic surgeries, Dr. Macik has also performed abdominoplasties ("tummy tucks") on many of his Bariatric patients.