Overview of hernia surgery
Hernia surgery is an operation to push the contents of a hernia back into place and strengthen the weak spot in the abdominal wall, often with a synthetic mesh, by open or keyhole surgery. A hernia is when part of the contents of your abdomen (tummy) pushes out through a weak spot in the abdominal wall, inside a pouch called a hernia sac. A hernia can be present from birth or develop later in life. Over time it usually gets bigger, and as well as a swelling and pain, it can cause more serious problems.
The most common places are the groin (inguinal hernia), the belly button (umbilical hernia) and the area of an old surgical scar (incisional hernia). The typical sign is a swelling under the skin with pain, especially when you lift something heavy, cough or are constipated. The pain often starts suddenly and feels sharp. It may ease when you rest.
The abdominal wall naturally has weaker areas where a hernia can form. Age, pregnancy and childbirth, previous operations and heavy lifting make a hernia more likely. In children, a hernia is usually present from birth. In adults, the main factors are heavy lifting, straining to pass urine, a long-term cough and constipation.
Who is it for?
A hernia is treated with surgery, because it does not go away on its own and usually gets bigger over time. Hernia belts (trusses) and similar supports do not replace an operation, and they can make later surgery more difficult.
Which type of operation is suitable depends on where the hernia is, how large it is, whether you have had previous operations and on your general health. Your surgeon discusses the options with you before the operation.
If the pain becomes constant, or the skin over the swelling turns red, seek medical help straight away. These can be signs that the contents of the hernia are trapped, which needs urgent treatment.
Risks
Hernia surgery is a common operation, but like any operation it carries risks. General risks include bleeding or bruising around the wound, swelling, infection of the wound or, rarely, of the mesh, and reactions to the anaesthetic. After an operation in the groin, some people have pain or discomfort in the area for a while.
A hernia can also come back after it has been repaired, sometimes years later. Following the advice you are given about lifting and activity in the weeks after the operation, and treating a long-term cough or constipation, helps to protect the repair. During keyhole surgery, there is also a small risk of injury to organs inside the abdomen, such as the bowel or bladder.
Preparation
Before hernia surgery, your surgeon examines you and decides, together with you, which type of operation and anaesthetic suit you. Depending on your age and health, you may have blood tests or other tests. Tell your surgeon about all the medicines you take, especially blood-thinning medicines, because some may need to be stopped for a while before the operation.
If the operation is done under general or spinal anaesthesia, you will be told not to eat or drink for a set time beforehand. If you smoke or drink alcohol, stopping before the operation helps your recovery and wound healing. As you may not be able to drive straight after the operation, it is a good idea to arrange for someone to take you home. Finally, the possible risks and benefits are discussed with you and you give your written consent.
What happens
Before the procedure
Your surgeon decides which type of operation suits you. After previous operations, or with certain other health conditions, keyhole surgery may not be suitable. In that case the hernia can be repaired under local anaesthetic with a synthetic mesh.
On the day
The operation can be done as open surgery or as keyhole (laparoscopic) surgery.
Open surgery: the area around the hernia is numbed with local anaesthetic and repaired using the method your surgeon has chosen. Sometimes the operation is done under spinal anaesthesia (an injection in the lower back that numbs the lower half of the body).
Keyhole surgery: a thin instrument with a special camera (laparoscope) is passed through a small cut in the abdominal wall. Watching on a screen, the surgeon uses two more small openings to place a mesh on the inner side of the abdominal wall and fixes it with small surgical clips.
After the procedure
After open surgery under local anaesthetic, you can often go home the same day, sometimes after only a few hours. After keyhole surgery, recovery is usually quicker and there is less pain.
Aftercare
At home, get up and walk regularly, as this helps your recovery. Some pain and swelling around the wound are normal in the first days and can be treated with painkillers. Avoid heavy lifting and strenuous activity for as long as your surgeon advises, and try not to strain when you go to the toilet. You can gradually return to your usual activities as you feel able. As part of your follow-up, a routine blood test check is done at 6 months.
When should you contact your doctor?
Contact your doctor straight away if you have:
- a high temperature or shivering (chills)
- increasing pain, redness or swelling around the wound
- fluid or pus coming from the wound
- difficulty passing urine
- nausea or vomiting that does not stop
- a new swelling in the area of the operation
You may also find it useful to read about other keyhole operations on the abdomen, such as gallbladder removal and reflux surgery.