Hernia Repair

What are hernias?

A hernia is a weakness in the muscular wall of the abdomen that allows the internal organs to sit directly beneath the skin.  Hernias usually occur a site of natural weakness such as the navel (umbilicus) or the groin, although they can also occur through scars from previous surgery.

A hiatal hernia is a special type of hernia that occurs where the oesophagus passes through the diaphragm muscle between the chest and abdomen and is discussed further on the gastro-oesophageal reflux page.

What symptoms do hernias cause?

Hernias typically cause a bulge in the groin or abdominal wall.  This bulge usually comes and goes at first, getting larger with coughing or straining and getting smaller on lying down.  At this stage hernias can cause pain but few other symptoms.  If left they usually grow larger, but there is a small chance of more serious complications such a blockage to the bowel or its blood supply.  For this reason, repair of even small hernias with few symptoms is usually recommended.

How are hernias treated?

As hernias are caused by a weakness in the abdominal wall, treatment usually involves surgery to strengthen the area of weakness.  This is achieved by placing a piece of polypropylene mesh in to the abdominal wall, like patching a bicycle tyre.  Most hernias can be repaired using either an open incision or a laparoscopic (keyhole surgery) approach.

What are the advantages of laparoscopic hernia repair?

Laparoscopic or keyhole surgery techniques can be used to repair most types of hernias, but the advantages of this approach are most marked for groin hernias.  For groin hernias there is good evidence that compared to open surgery, a laproscopic repair offers:

  • Less pain immediately after surgery
  • Faster return to work
  • Faster return to normal activities
  • A lower risk of chronic groin pain (pain that may last months or years after surgery)
  • The same risk of the hernia recurring (coming back)

Laparoscopic surgery can also repair hernias in both groins at the same time with the same three small cuts, and offers specific advantages for repairing hernias that have come back after an open repair.

What about other types of hernia?

As well as hernias in the groin, hernias can occur at the navel (umbilicus) or through scars from previous surgery (incisional).  Together these types of hernias are often called ‘ventral’ hernias.  Ventral hernias vary a lot in their size, cause and location, and there is no ‘one size fits all’ approach to repairing them.  For very small hernias at low risk of recurring, often one or two stitches through a small incision is all that is needed.  For larger ventral hernias, mesh reinforcement of the abdominal wall usually helps prevent the hernias recurring.  A laparoscopic approach to mesh placement reduces the risk of problems with wound healing and infection at the hernia site.  For very large hernias, particularly those caused by previous open surgery, an open operation that separates the different muscular layers of the abdominal wall while maintaining a healthy blood supply to heal the surgical wound is often the best option.  Dr Smith is experienced in multiple different options for repairing these ‘complex’ ventral hernias, and would be happy to discuss the surgical options with you.

Further information about hernias and surgery to repair them click here.

At ABLE we are pleased to offer laparscopic or open repair of all types of abdominal wall hernias.  For more information please contact us or ask your GP for a referral for consultation.