Hernia repair surgery

What is a hernia?

A hernia happens when an internal organ or tissue bulges through a weak or soft spot in the muscle or fascia that normally contains it. When left untreated, some hernias can lead to other complications—for example a hiatal hernia may cause severe acid reflux or gastroesophageal reflux disease (GERD). Not every hernia requires surgery; some may need only medication or other non-invasive care. Whether surgery is needed depends on the severity and should be determined after a proper examination.

Types of hernia

Some types are more common in men, others in women; hernias may be congenital (present from birth) or acquired later. Common types include:

• Inguinal hernias: occur in the lower abdomen near the pubic area, due to weakening of the internal inguinal ring; most common in men.
• Femoral hernias: also called groin hernias; more common in women. A weakness in the lower groin allows the intestinal sac to slip out of position. Once diagnosed, immediate repair is often recommended to prevent complications.
• Hiatal hernias: caused by weakness in the muscle that separates the chest from the abdomen; can lead to acid reflux into the oesophagus from the stomach.
• Umbilical hernias: a section of intestine passes through the abdominal wall near the navel; they mostly affect newborn children.

Hernia symptoms

Symptoms vary with the type and location of the hernia. With a hernia in the stomach area you may notice distension, tenderness, abdominal pain and discomfort, or in some cases ulcers, bleeding, or narrowing of the oesophagus. With an inguinal hernia you may feel pain and discomfort in the groin. In general, symptoms that should prompt a check include: unusual bulging or protrusion, abnormal swelling, tenderness in the area, and ongoing discomfort. We assess the size, location, and impact on your daily life before recommending treatment.

What causes a hernia?

Hernias are mainly caused by loosening, weakening, or opening of the muscle that houses a particular organ or tissue, so that the organ or tissue pushes through the weak spot. Some hernias are congenital; others develop later in life due to strain, ageing, or other factors.

Hernia treatment: open, laparoscopic, and robotic repair

Surgery repairs a hernia by putting the organ or tissue back in place and typically reconstructing or closing the hernia sac. The weak spot is often reinforced with a synthetic mesh to reduce the chance of recurrence. There are three main approaches, all done under general anaesthesia:

• Open surgery: an incision is made, the hernia sac is identified, the bulging tissue or organ is put back in place, and the soft spot is lined with mesh to strengthen the area and promote healing.
• Laparoscopic (keyhole) repair: very thin instruments are passed through small cuts (often near the umbilicus); a laparoscope sends images to a monitor so the surgeon can locate and repair the hernia. It is usually less invasive and painful, with faster recovery.
• Robotic repair: similar to laparoscopic surgery but with very small or minimal incisions and advanced three-dimensional (3D) imaging instead of 2D, giving the surgeon greater precision.

Prevention and recovery

Some hernias are congenital and cannot be prevented, but healthy lifestyle changes can reduce the risk of developing or worsening a hernia: eat a balanced diet with plenty of fruits and vegetables, avoid smoking and persistent heavy coughing (see a doctor for ongoing coughs or sneezing), maintain an ideal body weight through exercise and diet, and avoid extremely strenuous activity and lifting weights beyond your capacity. Recovery depends on the type of repair; we give you clear instructions on activity, driving, and follow-up.