Hernia Repair

What are Hernias?

A hernia is a condition where an organ, or a part of an organ, passes through a gap it isn’t supposed to. You might develop a hernia in a range of sites in the abdomen. Depending on the site and what is passing through the hernia defect, your surgeon will advise you on your options. The most common sites for hernias are in the groyne, near the navel (belly button) and through previous incisions or wounds. A hiatus hernia is a hernia through the diaphragm inside your abdomen. It is different in many ways and is discussed elsewhere on our website.


What is Hernia Repair?

Hernia repair is a surgical procedure to correct hernias and eliminate the symptoms they cause. The primary goal of this surgery is to push the displaced organ or tissue back into its proper position and then strengthen the weakened or torn muscle or tissue to prevent the hernia from recurring. Depending on several factors, this may involve stitches or sometimes mesh to reinforce the repair.


Who is Suitable for Hernia Repair?

Hernia repair is recommended for individuals who experience symptoms or complications from a hernia or those in whom the hernia poses a significant risk of complications. The decision on whether to undergo hernia repair often depends on several factors:

  • Symptoms and Discomfort: Suitable candidates are individuals experiencing pain, discomfort, or other symptoms, such as a noticeable bulge that affects their daily activities or quality of life. Symptoms may include pain during physical activities, a visible lump, or feelings of pressure or weakness in the hernia area.
  • Type and Size of Hernia: The type of hernia can influence the need for surgery. For example, hiatal hernias, which can lead to gastroesophageal reflux disease (GERD), often require surgical intervention. Large hernias are more likely to need repair than smaller ones, which might be managed conservatively initially.
  • Risk of Complications: Some hernias, such as strangulated or incarcerated hernias, pose immediate risks and require urgent surgical repair to prevent serious health complications.
  • Age and Overall Health: While there is no absolute age limit for hernia repair, the patient's overall health and ability to undergo surgery safely are crucial considerations. Surgeons and patients must weigh the benefits of surgery against potential risks, especially in elderly patients or those with significant comorbid conditions.
  • Lifestyle and Occupational Factors: People whose occupation or lifestyle involves heavy lifting or strenuous physical activity may be advised to undergo repair to prevent hernia from worsening or recurrence.
  • Previous Hernia Repair: Individuals with a previous hernia repair but experienced a recurrence may need another surgery. The approach to re-repair can be more complex and might require different techniques or materials.


Benefits of Hernia Repair

Hernia repair is very effective and has very low rates of complications. It can help with the following:

  • Relief from Symptoms: One of the primary benefits of hernia surgery is the relief from symptoms associated with the hernia. This includes reducing or eliminating pain, discomfort, and the visible bulge caused by the hernia.
  • Preventing Complications: Hernias can lead to serious complications, such as bowel strangulation, which is a medical emergency. Surgery can prevent these life-threatening complications by repairing the hernia and preventing bits of the bowel from getting trapped.
  • Improved Quality of Life: After successful hernia surgery, patients generally experience an improved quality of life. They can return to their normal activities, including work and exercise, without the limitations imposed by the hernia.
  • Minimally Invasive Options: The HWL surgeons will always discuss how your hernia could be fixed. We generally perform most hernia repairs laparoscopically (keyhole) where appropriate to reduce discomfort and allow quicker recovery.


Types of Hernia Repair

Hernia repair techniques vary depending on the type and location of the hernia. 


Inguinal Hernia and Mesh Repair

Inguinal hernias are among the most common and occur in the groyne area. Mesh repair is frequently used due to its effectiveness in reducing the risk of recurrence.

  • Open Mesh Repair (Lichtenstein Technique): This is a tension-free repair method where a synthetic mesh is placed over the hernia defect to reinforce the abdominal wall. The procedure is performed under local or general anaesthesia, typically allowing for quick recovery.
  • Laparoscopic Mesh Repair: This minimally invasive approach uses small incisions and a laparoscope to place the mesh. It's associated with less post-operative pain and a faster return to daily activities compared to open surgery. There are two main techniques:
  • Transabdominal Preperitoneal (TAPP) Repair: The mesh is placed through an abdominal approach, covering the hernia inside the abdominal cavity.
  • Totally Extraperitoneal (TEP) Repair: This technique avoids entering the abdominal cavity by only placing the mesh within the preperitoneal space.


Laparoscopic TEP Hernia Repair

The Totally Extraperitoneal (TEP) approach for inguinal hernia repair is advantageous because of its reduced recovery time and minimal disruption of the abdominal wall:

  • Procedure: The surgeon makes several small incisions near the hernia site. Special instruments and a camera are inserted to guide the mesh placement without opening the peritoneum (the abdominal cavity lining).
  • Benefits: Less postoperative pain and scarring, lower risk of internal organ injury, and quicker return to normal activities.


Open Incisional Hernia Repair

Incisional hernias occur at the site of a previous surgical incision. They are often larger and more complex, requiring a robust surgical approach.

  • Procedure: A larger incision is made directly over the hernia site. The herniated tissue is repositioned, and the defect is typically closed with both sutures and mesh to reinforce the area and prevent recurrence.
  • Considerations: Due to the complexity and size of incisional hernias, open repair is often preferred to effectively manage the broader weakened area.


Abdominal Wall Hernia Repair

This type of hernia repair is for Epigastric, Umbilical, Ventral, and Incisional Hernia. These hernias occur in various parts of the abdominal wall and are often treated similarly, though the approach may differ based on specific circumstances:

  • Open Repair: This traditional method involves a direct incision over the hernia, through which the defect is repaired using sutures, mesh, or a combination of both. It is often used for larger or more complicated hernias.
  • Laparoscopic Repair: A minimally invasive technique that uses small incisions, a camera, and special instruments to repair the hernia with mesh. This method is suitable for smaller hernias and offers the benefits of reduced postoperative pain and quicker recovery.


Preparation Before Hernia Repair

  • You can schedule a consultation with one of our surgeons to assess the hernia's size and type and determine the most appropriate surgical approach.
  • Undergo a thorough medical evaluation, occasionally including blood work and imaging tests, to ensure you are healthy for surgery. If you’ve already had blood tests or scans, bring the results if possible.
  • Inform your surgeon about any medications or allergies. Some medications may need to be adjusted before surgery.
  • Follow the fasting instructions provided by your surgeon, anaesthetist or the hospital. Typically, patients are required to refrain from eating or drinking for a specified period before surgery. Following most hernia repairs, you can eat normally immediately afterwards.
  • Arrange for transportation to and from the hospital and for someone to be around to give you a hand for a couple of days following your discharge.


Hernia Repair Procedure

  • Anaesthesia: You will receive anaesthesia to ensure you are comfortable and pain-free during the procedure. Depending on the surgery type, this may be local, regional, or general anaesthesia.
  • Incision: The surgeon makes the necessary incisions to access the hernia site.
  • Hernia Reduction: The protruding organ or tissue is gently pushed back into its proper position.
  • Repair: The weakened or torn muscle or tissue is repaired. This may involve sutures, mesh placement, or both.
  • Closure: The incisions are closed with sutures, and dressings are applied. Your sutures will be dissolvable underneath the skin, so you don’t need any stitches removed.


What to Expect After Hernia Repair?

  • You will be monitored in the recovery room until you wake up from anaesthesia and your vital signs are stable.
  • A mild degree of discomfort is common after this type of surgery. Your surgeon will provide pain management strategies, which may include medication. Often, patients have little to no pain.
  • Early mobilisation is encouraged to aid your recovery. You will also be able to eat whatever you please.
  • Your surgeon will provide guidelines regarding physical activity and lifting restrictions during recovery.
  • The timeline for returning to work and normal activities varies depending on the type of surgery and individual recovery. You will be informed of this before surgery to plan work and activities.
  • You will be given instructions about wound care. Generally, you won't be required to do anything other than remove your dressings.
  • You will be booked a post-op appointment with your surgeon. Depending on your preference, this can be done in person, via telehealth or over the phone.


Hernia Repair Prognosis

The prognosis for hernia repair is generally very good, with most patients experiencing relief from symptoms and significantly reducing the risk of hernia-related complications. The success rates for hernia surgery are high, particularly with modern surgical techniques and materials such as synthetic mesh, which reduces the chances of recurrence. Most patients can return to their normal activities within a few weeks, although complete healing and the ability to engage in strenuous activities might take longer.


Hernia Repair Risks

Common risks and complications can include:

  • Infection
  • Pain/Nerve irritation
  • Hematoma (bruising)
  • Recurrence (the hernia coming back)
  • Adverse Reactions to Anaesthesia


What if Hernia Repair is Delayed?

Delaying hernia repair can lead to several complications, particularly if the hernia is at risk of becoming incarcerated or strangulated:

  • Incarceration: An incarcerated hernia occurs when herniated tissue becomes trapped and cannot be pushed back into the abdomen. This can cause severe pain and lead to complications, including obstruction of the bowel.
  • Strangulation: If the blood supply to the incarcerated tissue is cut off, this can lead to strangulation, a life-threatening condition that requires immediate surgery. Strangulation can result in the death of the affected bowel tissue, leading to serious infection and septic complications.
  • Increased Pain and Discomfort: As a hernia enlarges, it can cause increased pain and limit physical activity. Over time, this can significantly impact quality of life and increase the complexity of the eventual surgical repair.
  • Complexity of Surgery: Larger or more complicated hernias that have been left untreated for a long time may require more complex surgical interventions, potentially increasing the risk of complications and the time needed for recovery.
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