A guide to hernia surgery: Who needs it?

In my years of practice, I’ve done many surgeries, with one of the most common being hernia repair surgery. Since hernias can happen to almost anyone due to the nature of how a hernia is formed, I thought it would be good to share my knowledge of hernias and how to treat them should surgery be required.

What is a hernia?

A hernia occurs when a body part or part of an organ pushes through into an area where it should not, such as a muscle or tissue. For example, when the intestine protrudes through a weak area in the abdominal wall, that is a hernia. 

Most hernias occur in the abdominal area; though they can also appear in the upper thigh and groin areas, especially for men. While the majority of hernias are not life threatening, they do not go away on their own and can be dangerous if they progress. Surgery (herniorrhapy) is then the only way to remove or fix a hernia.

What are the symptoms of a hernia?

There are many different types of hernias that appear in different ways and locations, but one of the most obvious symptoms is a bulge or lump that has previously never existed before. You may find that the lump is more prominent when you’re standing up. You’re also more likely to feel it when you cough, stand up or bend down. There might also be some discomfort or pain around the affected area. 

Certain types of hernias, like hiatal hernias, carry more specific symptoms such as chest pain, heartburn and trouble swallowing. If not, most hernias do not have specific symptoms. Many of my patients in fact were not aware they had a hernia and were only referred to me during their annual medical checkup. 

Since we’re on this topic, I strongly recommend everyone to regularly go for full body checkups to detect conditions that we otherwise wouldn’t know about, such as hernias.

When do I need surgery for a hernia?

Most hernias increase in size over time and will not resolve on their own. In some cases, there is the risk of the bowel getting trapped within the hernia — when that happens, it is considered a medical emergency and you must get surgery as soon as possible. If you experience nausea, vomiting, fever or sudden pain at the hernia site, see a doctor immediately. 

However, not all hernias must be repaired. As a rule of thumb, I recommended surgery only if:

  • The hernia is affecting your quality of life, is causing discomfort or limiting your activities 
  • The hernia is increasing in size 
  • The bowel might have a risk of getting trapped in the hernia

What causes a hernia?

Hernias are typically caused by muscle weakness and strain. Depending on what caused the hernia in the first place, the hernia can develop quickly and suddenly or over a long period of time. 

The following can cause muscle weakness or strain which can eventually lead to a hernia:

  • A congenital condition present from birth that developed in the womb 
  • Ageing 
  • Damage due to an injury or side effect from surgery 
  • Chronic coughing 
  • Pregnancy 
  • Being overweight or obese 
  • Strenuous exercise or heavy lifting 
  • Chronic constipation 
  • Fluid in the abdomen

To add on, factors like having a family history of hernias or smoking put you at a higher risk of developing a hernia.

Diagnosing a hernia

To better understand your condition, I will first conduct a physical examination to feel for your bulge, which can be in your abdominal or groin area. I will also ask some questions, like:

  • When did you first notice this lump?
  • What other symptoms do you have? 
  • Is there anything in particular that might have caused the lump to form?
  • What do you do for work and in your free time? Do you exercise rigorously, lift heavy weights or smoke? 
  • Is there anyone in your family history with hernias?
  • Have you undergone any surgeries in your abdomen or groin area?

To confirm my diagnosis, I might send you for tests, including:

  • Abdominal ultrasound 
  • CT scan 
  • MRI scan 
  • Endoscopy if a hiatal hernia is suspected

Types of hernia surgeries

Hernia repair surgery can be done either under general anaesthesia or local anaesthesia. You will be awake under local anaesthesia but won’t feel any pain at the site of surgery. 

There are two ways of operating on a hernia:

Traditional hernia repair
An incision several inches long is made near the hernia. Once the herniated body part is clearly visible, it will be gently pushed back into place. The weakness or hole is then repaired with stitches and the outer skin incision closed with stitches too. Most surgeons including myself use a synthetic mesh patch to repair hernias. These patches help to reduce tension and pain on the repair and reduce the likelihood of the hernia returning.

Laparoscopic hernia repair
A harmless gas is first injected into your abdomen for more room to work in. A laparoscope and several other small instruments are then inserted through several separate small incisions in the abdomen. The herniated body part is pulled back into place with the tools available. A mesh patch may be positioned over and secured with surgical clips. Once all is done and your abdomen is deflated, the small incisions are closed with surgical tape or sutures. 

Between the two, traditional hernia repairs are known for having a longer track record of success. But laparoscopic surgery is less painful and has a shorter recovery time. Laparoscopic surgery must also be done under general anaesthesia. Ultimately, it depends on your preferences.

How long is the recovery period?

Most people can resume work and other light activities a few days after surgery. If your job requires manual labour, it is best to wait for at least two weeks. With regards to activities like sports, I’d advise to wait it out for about 4 to 6 weeks. 

During this down period, be sure to monitor your incision to see if it bleeds or becomes red and swollen. 

I hope this post helped you gain a better understanding about hernias. As usual, if you have any questions, feel free to drop me a line.