Hernia Repair

Hernia repair is a surgical procedure used to fix a condition where an organ or tissue pushes through a weak spot in the muscle or tissue wall that normally holds it in place. Most hernias occur in the abdomen or groin, and while not all require immediate treatment, surgery is often the only way to permanently repair the problem and prevent complications.

Table of contents

• What is hernia repair?
• Who needs hernia repair?
• Types of hernia surgery
• Types of hernias treated with surgery
• Preparing for hernia repair surgery
• What happens during hernia repair surgery
• Recovery and what to expect at home
• Risks and benefits of hernia repair
• When to call your doctor
• Hernia recurrence

What is hernia repair?

Hernia repair, also known as herniorrhaphy, is surgery to fix a hernia^[1]. A hernia occurs when part of an internal organ or body part protrudes through a weak area in the muscle or tissue that contains it^[5]. Most commonly, a small portion of the intestine or a piece of fat pokes through a weak area in the muscular wall of the abdomen, causing an abnormal bulge under the skin, usually near the groin or navel^[5].

During hernia repair surgery, the surgeon pushes the organ and herniated tissue back into place and reinforces the barrier holding it there using stitches or surgical mesh—a material made from synthetic or biological materials that strengthens the weakened area^[1].

Hernia repair surgery is very common. According to the FDA, surgeons perform more than 1 million hernia surgeries in the United States annually, and about 20 million hernia surgeries are performed worldwide each year^[1].

Who needs hernia repair?

Not all hernias require immediate treatment, but most eventually do since they usually worsen over time^[1]. The majority of hernias require some type of surgical approach, as lifestyle changes including diet modifications or exercise are not enough to repair the condition^[4].

You may need hernia repair surgery if the hernia is causing discomfort or limiting your activities, if the hernia is growing larger, or if you and your doctor are worried about the risk of the bowel getting trapped^[5]. Hernias can create bulges where interior tissue presses outward through a tear or gap in a muscle or tissue wall, and they can cause unpleasant symptoms like pressure, discomfort, or pain^[1].

If your hernia becomes painful or gets in the way of your daily living, your doctor may advise surgery. Even if the hernia does not cause pain, surgery can be considered in some cases to prevent future complications^[2].

Some situations require emergency hernia surgery. Sudden and severe hernia pain or tenderness can be a warning sign of a hernia sac that’s stuck or strangulated—when the blood supply to the trapped tissue is cut off. This is life-threatening^[2]. Other signs that you need emergency hernia surgery include a bulge that doesn’t go back inside the abdomen as it once did, a bulge that’s suddenly larger, bloating, fever, nausea or vomiting, or redness where the hernia is^[2].

Types of hernia surgery

There are three main types of hernia repair surgery^[1]:

Open (traditional) hernia repair surgery: A surgeon makes a single incision (cut) that allows them to operate on the herniated tissue. They put the organs and tissue back into place and use surgical instruments to stitch the tissue back together to make it stronger. Surgeons often use surgical mesh to reinforce the tissue^[1]. The size of the incision depends on the size of the hernia—a small hernia might only require an incision of half an inch, while larger hernias need bigger openings^[4].

Laparoscopic hernia repair surgery: During laparoscopy, or “keyhole surgery,” your surgeon uses several tiny cuts (usually three or four) to operate. Your surgeon inserts a thin tube with a tiny video camera called a laparoscope that projects images of your insides onto a screen. They insert surgical instruments into the other incisions that allow them to repair the hernia^[1]. The largest incision is typically half an inch^[4].

Robotic hernia repair surgery: This type of laparoscopic surgery uses robotic surgical instruments to operate. Your surgeon works at a console driving the technology used to repair the weakened tissue causing your hernia^[1].

As a general rule, open surgery is used for hernias that are very small or very large. Those that fall in between can be treated laparoscopically^[4].

Types of hernias treated with surgery

Different types of hernias can be treated with surgery^[4]:

Inguinal hernia happens when fatty or intestinal tissues bulge through the inguinal canal, or groin. It is the most common type of hernia among men, affecting 25 percent of them in their lifetimes, compared to 2 percent of women^[4]. Most hernia surgeries treat inguinal hernias^[1].

Ventral hernia is a bulge of tissues through an opening, or defect, in the wall of the abdominal muscles. The most common types of ventral hernias are umbilical hernias (belly button) and incisional hernias, which occur at the site of a previous surgery that weakened the abdominal wall^[4].

Femoral hernia may be at the upper leg, vaginal area, or groin, and is more common in women. It occurs in deeper passages called femoral canals and presents a higher risk of complications if not repaired^[11].

Hiatal or para-esophageal hernia occurs when part of the stomach or other organs from the abdomen protrude into the chest cavity through an opening in the diaphragm^[4].

Preparing for hernia repair surgery

Your healthcare provider will determine whether you’re a candidate for hernia surgery and which type is best. Preparation involves several steps^[1]:

Your doctor will review your medical history, including whether you’re pregnant, and review your medications, including herbs and supplements you’re taking. They may order blood tests or imaging to ensure you’re healthy enough for surgery^[1].

About one week before your hernia repair, your doctor may ask you to stop taking aspirin and other medications that could increase the risk of bleeding^[5]. You will be asked not to eat or drink anything beginning the night before surgery (except medicines). This will reduce the risk of vomiting during surgery^[5].

On the day of your surgery, you should wear loose-fitting clothing. You’ll also need to arrange to have someone drive you home after surgery^[5].

What happens during hernia repair surgery

The specific process depends on the surgery you need—open, laparoscopic, or robotic^[1].

You’ll receive medicines that prevent pain. You’ll likely need general anesthesia that puts you to sleep for laparoscopic surgery. For open surgeries, you may only need local or regional anesthesia, where you’ll be awake for surgery but the pain will be blocked in the area being operated on^[1].

In open surgery, your surgeon makes a cut near the hernia. The hernia is located and separated from the tissues around it. The hernia sac is removed or the hernia is gently pushed back into your abdomen. Your surgeon then closes your weakened abdominal muscles with stitches. Often a piece of mesh is also sewn into place to strengthen your abdominal wall^[3].

In laparoscopic surgery, the surgeon makes three to five small cuts in your lower belly. A laparoscope is inserted through one of the cuts. A harmless gas is pumped into your belly to expand the space, giving your surgeon more room to see and work. Other tools are inserted through the other cuts to repair the hernia using the same repair methods as open surgery, including mesh placement^[3].

The procedure generally takes less than one or two hours to complete^[5]. For most people, a hernia repair does not require overnight hospitalization^[5]. However, you may go home within 24 hours for small hernia procedures but may need to stay in the hospital longer for more complex repairs. The average length of stay for patients with a complex hernia repair is 1.5 days^[6].

Recovery and what to expect at home

After surgery to repair your hernia, you are likely to have pain for a few days. You may also feel tired and have less energy than normal. This is common. You should feel better after a few days and will probably feel much better in 7 days^[16].

For several weeks you may feel discomfort or pulling in the hernia repair when you move. You may have some bruising near the repair site. This is normal^[17].

Activity

Rest when you feel tired. Getting enough sleep will help you recover. Try to walk each day, starting by walking a little more than you did the day before. Walking boosts blood flow and helps prevent pneumonia and constipation^[16].

Avoid strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay. Avoid lifting anything that would make you strain^[16]. For the first three days, do not lift anything more than 5 pounds. After three days, do not lift anything more than 10 pounds until two weeks. You can lift up to 15 pounds until four weeks^[21].

Most people are able to return to work within 1 to 2 weeks after surgery. But if your job requires that you do heavy lifting or strenuous activity, you may need to take 4 to 6 weeks off from work^[16].

You may shower 24 to 48 hours after surgery, if your doctor okays it. Pat the cut (incision) dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay^[16].

Diet

You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Drink plenty of fluids (unless your doctor tells you not to)^[16].

You may notice that your bowel movements are not regular right after your surgery. This is common. Avoid constipation and straining with bowel movements. Be sure you are eating plenty of fiber, 25-30 grams per day. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative^[16].

Medicines

Your doctor will tell you if and when you can restart your medicines. Take pain medicines exactly as directed. If the doctor gave you a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, you can take an over-the-counter medicine^[17].

If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics^[16].

Incision care

If you have strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off. Wash the area daily with warm, soapy water, and pat it dry. Don’t use hydrogen peroxide or alcohol, which can slow healing^[16].

If you notice any bleeding from the wound, press firmly on the area with a clean cloth or towel for 10 minutes. If the bleeding does not stop, contact your doctor immediately^[24].

Risks and benefits of hernia repair

Benefits

An operation is the only way to repair a hernia. You can return to your normal activities and, in most cases, will not have further discomfort. Surgery is the best treatment for a painful hernia. It’s the only way to get rid of it and the pain it causes^[2].

Risks

Possible risks of hernia surgery include^[6]:

• Return of the hernia
• Infection
• Injury to the bladder, blood vessels, or intestines
• Continued pain at the hernia site

General risks for anesthesia and surgery include reactions to medicines, breathing problems, bleeding, blood clots, or infection, nausea and vomiting^[3]. For inguinal hernia specifically, there may be damage to other blood vessels or organs, damage to the nerves, damage to the testicles if a blood vessel connected to them is harmed, and long-term pain in the cut area^[3].

Risks of not having an operation

If you don’t have surgery, your hernia may cause pain and increase in size. If your intestine becomes trapped in the hernia pouch, you will have sudden pain, vomiting, and need an immediate operation^[12]. Leaving the hernia untreated only makes the condition worse, and pressure and pain will increase not just with strenuous activity, but also with every cough or sneeze^[4].

When to call your doctor

Call your surgeon if you have^[6]:

• Severe pain
• Stomach cramping
• Chills with a high fever (higher than 101°F)
• Odor or drainage from your incision
• Redness or swelling around your incision
• Nausea or vomiting

Sharp abdominal pain and vomiting can mean that the intestine has slipped through the hernia sac and is strangulated. This is a surgical emergency and immediate treatment is needed^[6].

Hernia recurrence

Most people never experience complications or further need for hernia surgery after their repair. In fact, in a study of 221 people who received laparoscopic surgery for a hiatal hernia, only one required a secondary repair reoperation^[22].

However, sometimes the hernia comes back. A hernia recurrence may appear as a bulge at the repair site and cause pain, nausea, and vomiting. This can result in an incisional hernia, which occurs due to tissue protruding through the incision after surgery^[18].

The repair can break down because of problems with infection, improper healing, or issues with the initial repair during the surgery. Left untreated, it can cause problems like an incarcerated hernia (trapping of the intestines), digestive obstruction, or a strangulated hernia caused by a loss of blood supply^[18].

To fix hernia recurrence, you need surgery again. Options include open surgery or laparoscopic surgery, depending on whether the recurrent problem is simple or complex^[18].