Hernia Repair (Inguinal and Umbilical Hernia Operations)

A hernia is the protrusion of tissue from inside the abdomen (usually bowel or fatty tissue) through a weakness or opening in the muscle and connective tissue of the abdominal wall. It occurs most often in the groin (inguinal hernia) and around the navel (umbilical hernia); it can also develop at the site of a previous surgical incision (incisional hernia, scar hernia).

Hernia repair (herniorrhaphy) is the surgical closure of this opening. Hernias do not heal on their own; they are not permanently corrected by medication or a support belt. They may grow over time and, although rarely, may lead to situations requiring emergency treatment, such as trapping of the bowel (strangulated hernia). For this reason, the treatment is surgical.

Hernia repair is generally recommended in the following situations:

• A swelling in the groin or at the navel, which becomes more noticeable especially when standing or straining,
• The swelling affecting daily life together with pain, burning or a feeling of fullness,
• The hernia growing over time,
• The hernia contents being at risk of becoming trapped, or having become trapped (in this case the operation is performed as an emergency).

For some small hernias that cause no symptoms, the doctor may also recommend monitoring with regular check-ups. Which approach is suitable is determined by assessing the location, size and symptoms of the hernia together with the person’s general health.

The basic aim of hernia repair is to return the protruding tissue into the abdomen and to strengthen the weak point in the abdominal wall. In most adult patients this strengthening is done with a body-compatible synthetic net material called mesh. The mesh reinforces the weak area like a supporting layer and helps reduce the likelihood of the hernia coming back (recurrence). The mesh is permanent; over time it becomes integrated with the body’s tissue.

There are two main methods:

• Open surgery: The hernia is repaired through an incision made over the hernia site and, if necessary, mesh is placed. It is an established and reliable method; for some types of hernia and some patients it may be the preferred choice.
• Laparoscopic (keyhole) surgery: A camera and special instruments are introduced through a few small openings in the abdomen, the hernia is repaired from the inside and the mesh is placed from the inside. This generally involves smaller incisions and, in most patients, a quicker return to daily life.

Each method has its own advantages; which one is used is decided together with your doctor according to the features of the hernia, previous operations and the patient’s general condition. The operation is mostly performed under general anaesthesia; some open inguinal hernia repairs can also be carried out under regional anaesthesia (numbing from the waist down).

Hernia repair is a frequently performed operation that is generally considered safe. Nevertheless, as with any surgical procedure, it carries some risks:

• Bleeding, bruising or fluid collection (seroma) at the operation site,
• Wound infection,
• Temporary or, rarely, long-lasting pain or numbness at the operation site,
• The hernia coming back in the future (recurrence),
• Risks related to anaesthesia,
• With inguinal hernia, rarely, problems involving nearby blood vessels, nerves or, in men, the sperm duct.

How often these risks occur and what they mean for you vary according to the type of hernia, the chosen method and your general health. At the pre-operative consultation, your doctor will explain the risks specific to you in detail.

After hernia repair, a large proportion of patients are discharged on the same day or the following day. It is normal to have pain and tenderness at the operation site in the first days; this is generally well controlled with the painkillers your doctor recommends.

General recommendations during the recovery period are:

• Starting short walks early supports recovery; avoid staying inactive for long periods.
• Unless your doctor says otherwise, avoid heavy lifting and strain that increases pressure inside the abdomen in the first weeks.
• To prevent constipation, take care to drink plenty of fluids and eat a high-fibre diet; straining can put stress on the repair site.
• If increasing redness, discharge, worsening pain or fever occurs at the wound site, contact your doctor.

People with desk jobs can generally return to work within 1-2 weeks, while those in physically demanding jobs may return after a longer period, depending on the doctor’s assessment. Attending follow-up examinations regularly is important for monitoring your recovery.