How are hernias treated? 

Hernias can only be treated with surgery. There are different types of operations you can have, and what you are offered will depend on the type of hernia you have, as well as your medical fitness. The surgeon performing the operation will talk you through the type of operation they offer you, and why. 

Essentially there are two different types of surgery for hernia repair: 

  1. Open Surgery: This involves making a cut over the site of your hernia and repairing the hole in the muscles to prevent the contents of your abdomen from pushing through. Sometimes, a mesh is placed over the muscles to reduce the risk of them splitting again in future. 
  2. Laparoscopic Hernia Repair: This is also known as ‘keyhole surgery’. The surgeon will make three small cuts in your abdomen to allow a small telescopic camera to enter the abdomen and inspect the hernia; the other two cuts are for the instruments used to perform the repair. 

There are then two different approaches your surgeon might take. 

One is called a TAPP repair (trans-abdominal preperitoneal) and involves going directly into the abdominal cavity. The muscle is then repaired from the inside. 

The other is called a TEP repair (totally extraperitoneal) where the whole operation is done between the layers of the muscles and the lining of the abdominal cavity. The muscle is then repaired from the outside. 


What type of surgery should I have? 

It is important that you are aware of the different types of surgery available. In general, there is little difference between them so long as they are performed well. Your surgeon’s ability in a particular technique is just as important to be aware of. 

In some circumstances, the laparoscopic (‘keyhole’) repair may be better. These are: 

  1. Recurrent hernias (where the hernia has returned after an open surgery repair). 
  2. Bilateral hernias (a hernia on both sides of the groin). 
  3. In very active patients whose main symptom is pain. 

It is important for your surgeon to explain why a certain type of repair is more suitable, and you should not be afraid of asking questions until you understand it well. You might also wish to ask how many procedures they have done, and their experience treating patients with this condition. 


What anaesthetic would I need to have my hernia repaired? 

You should discuss the type of anaesthesia that you will be given to undertake this repair with your surgeon. 

You may be given local anaesthetic (where you are kept awake and only the area to be treated is numbed) or general anaesthetic (where you are put to sleep for the duration of the operation). Laparoscopic hernia repairs are normally done using general anaesthetic. 


What complications can arise after a hernia repair? 

Like any surgery, there are potential risks (complications). Hernia repairs are normally done with minimal problems, but you could potentially experience the following complications: 

  • Bleeding from the cut 
  • Infection, which is usually treated with antibiotics 
  • Seroma – this is a collection of clear fluid that can occur because the surrounding lymphatic channels are damaged during the surgery. This usually settles without any intervention.
  • Damage to surrounding structures, such as the blood supply to the testicles or the bowels. 
  • Haematoma – a small amount of bruising is normal, but sometimes it can appear very dramatic and be accompanied by pain and swelling. 
  • Deep vein thrombosis – this is a clot in the leg that can potentially travel to the lung, causing a pulmonary embolism. This is a risk with any surgery and your surgeon will offer you compression stockings and blood-thinning medication to reduce your risk. It is also recommended that you stay mobile after the surgery to improve blood circulation and promote healing of the repair. 


What are the long-term risks of hernia repair? 

The following are longer term risks of undertaking a hernia repair: 

  1. Recurrence of the hernia – the risk of this happening is 1 in 200. 
  2. Long term discomfort in your groin area. This occurs in 5% of cases. We do not understand why this happens, but it may be due to nerves becoming trapped during the surgery. This is more likely to occur in patients who have a small hernia or whose main symptom before the surgery is pain. 
  3. Infection of the mesh – this is rare, occurring in only 1 in 500 cases. If this happens, the mesh needs to be removed and there is then a risk of the hernia recurring. 


What do I need to do before my surgery? 

You will be invited to a pre-operative assessment at the hospital. This will allow the team undertaking your surgery to assess your fitness to have the operation, and will involve doing some blood tests, finding out which medications you are taking, and then giving you the details of your surgery. You’ll be able to ask questions at this point too. 

Should any medical problems be identified during this assessment you may need to have it treated before undergoing surgery. 


What should I look out for after my surgery? 

If you experience any of the symptoms below, you should contact your hospital or GP for advice: 

  • Severe abdominal, groin, or testicle pain 
  • Loss of appetite with nausea and vomiting 
  • Fever or flu-like symptoms 
  • Redness or swelling at the site of your wounds 
  • Pain in your calves or increasing breathlessness. 


What do I need to know about my recovery after surgery? 

1. Keep mobile – this will help circulation and reduce your risk of thrombosis (blood clots). If you feel tired, take small periods of rest, and if possible, avoid sleeping through the day. You should be back to your normal levels of activity and able to return to work after about two weeks. However, if your job involves heavy lifting, it could be as long as six weeks before you can return to work. 

2. Diet – A good balanced diet will help your body to heal. It is also important to stay hydrated. 

3. It is common to have some bruising over your scar, which will usually settle within a week. If there is increasing pain or redness over the scar, you might have an infection- this will require further treatment, and you should contact your surgeon for advice. 

4. You should be able to drive within 3-4 days, but this is an assessment you need to make yourself as you must be comfortable sitting down and operating your brake pedals. Check with your insurers before you start driving again.