The moment we hear the word ‘surgery,’ we feel anxious and worried. This feeling intensifies with elderly patients, but sometimes surgery is necessary. Untreated hernias can cause severe issues like bowel obstruction or strangulation.
Hernias occur when internal tissue protrudes through weakened fascia, often due to age, injury, or strain. Activities like heavy lifting, coughing, and risk factors like obesity, poor nutrition, and smoking increase hernia risks.
Dr Amita Jain, Delhi’s top laparoscopic surgeon and hernia specialist doctor explains if hernia repair at an advanced age is dangerous or not.
What are the Types of Hernias found in the Elderly?
Hernias are common in older adults due to weakened muscles and tissues. Inguinal hernias, occurring in the groin, are prevalent among those aged 75 to 80, worsened by factors like constipation and respiratory conditions.
They require surgery to avoid complications like incarceration. Femoral hernias, though rare, appear lower in the groin.
Incisional hernias arise from previous surgeries on the abdominal wall. Early detection and surgical treatment are critical to prevent severe complications, which are riskier in elderly patients.
What are the Risk Factors?
Firstly, it may be risky for elderly patients to undergo hernia surgery. As we age, we face more medical issues, reducing our suitability for surgery.
The risks of surgery, including general anesthesia, may outweigh the benefits. Instead of surgery, careful monitoring of the hernia’s progression may be a better option.
Secondly, older patients have weaker abdominal muscles, making incarceration or strangulation of the hernia less likely.
However, hernias are progressive and will become larger and more difficult to repair over time. This decision requires careful consideration with your surgeon.
What about the Surgical Risks?
While hernia repair is usually safe, it can pose risks, especially for older adults. Here are some complications that may arise:
- Postoperative Delirium: Older brains are more prone to delirium after surgery, causing confusion and memory problems. Symptoms include trouble focusing, disorientation, and changes in alertness.
- Infection: Seniors have weaker immune systems, making them more likely to get infections at the surgical site or in the urinary tract.
- Seromas and Hematomas: Fluid-filled (seromas) or blood-filled (hematomas) pockets can form at the surgical site. They often resolve on their own but may need treatment.
- Hernia Recurrence: Hernias can return even after surgery, particularly if post-surgery care is not properly followed.
- Postoperative Pain: Persistent pain at the surgery site is common in older adults, often due to nerve damage or the surgical mesh.
- Anesthesia Complications: Older adults are more vulnerable to issues from anesthesia, such as confusion, pneumonia, stroke, or heart problems.
- Mesh Complications: If surgical mesh is used, it can lead to problems like migration, contraction, adhesions, or allergic reactions.
- Chronic Health Conditions: Conditions like heart disease, lung disease, or diabetes can make surgery and recovery more difficult for seniors.
- Decreased Mobility: Pain and long recovery times can reduce mobility, increasing the risk of blood clots in the legs.
- Other Risks: Seniors are also at higher risk for urinary tract infections, pneumonia, and blood clots, which can lead to more hospital visits.
What are the Symptoms in the Elderly?
With age, seniors often experience hernias, marked by the following symptoms:
- A noticeable bulge in the stomach, groin, or abdomen
- Pain
- bloody stools
- Constipation
- Heartburn
- Acid reflux, and
- Episodes of nausea and vomiting
These conditions are exacerbated by decreased immunity and heightened sensitivity to medication side effects. While lifestyle changes and initial treatments can alleviate symptoms, hernia repair surgery, performed by specialists, is typically the most effective long-term solution, ensuring minimal complications for elderly patients.
Patient Profile
Doctors carefully assess older patients for hernia repair, considering their unique health conditions such as high blood pressure, diabetes, and obesity.
Medication use is also reviewed for potential complications during surgery.
Due to increased anesthesia risks and slower drug metabolism, thorough medical evaluations are crucial to determine if surgery is safe, especially for those over 69 years old.
Surgical Methods
Hernia repairs can be done through traditional/open, robotic-assisted, or laparoscopic methods.
Laparoscopic surgery, using small incisions and a camera, is preferred for its safer, quicker recovery and lower complications like infections and hernia recurrence, especially beneficial for older patients.
It’s a minimally invasive option offering reduced postoperative challenges and faster healing times.
Now that you have a fair idea of the complexities surrounding hernia repair in elderly patients, it’s evident that while surgery presents risks, especially with advancing age, careful assessment and consideration of individual health factors are crucial.
Minimally invasive techniques like laparoscopy offer safer options, emphasizing tailored approaches for optimal outcomes in older adults.
Dr Amita Jain is a surgeon with highest degree of professional competence, precision and surgical craftsmanship. Performed all complicated general surgery procedures with in depth knowledge of invasive and few minimal invasive and onco surgical techniques. Underwent special training in trauma, executed various trauma-related complex life-saving neurosurgical procedures, reconstructed injured mangled limbs and performed vascular and reconstructive procedures with critical care.
Dr Amita Jain holds 28 plus years of rich experience in Trauma and General Laparoscopic Surgeries (including Gallbladder stone removal, appendix removal, hernia repair surgery, piles and fissure surgeries). She was the Professor Surgery of at the Army College of Medical Sciences and Base Hospital Delhi Cantt. In 1994 she was commissioned as Surgeon under the United Nations Mission in Congo. From 2020 to 2022, she worked with Bansals Hospital. Currently, Dr Amita Jain is the Senior Consultant, (Speciality: General and Laparoscopic Surgeon) at Artemis Lite Hospital, New Delhi