Understanding hernias
What is a hernia?
A hernia occurs when tissue pushes through a weakness in the surrounding muscle or tissue wall. Common abdominal wall hernias include inguinal hernias in the groin, femoral hernias, umbilical hernias, incisional hernias and the less common Spigelian hernia.
Hiatus hernia is different because it involves the stomach and diaphragm and is covered separately under Upper GI & Reflux.
Learn more about hiatus hernia repair on the Upper GI & Reflux Surgery page.
Symptoms
How a hernia may present
A hernia may cause a visible bulge, pain or discomfort with lifting, coughing or bending, or a feeling of heaviness or pressure. Some hernias cause very few symptoms and are discovered during examination or imaging.
Diagnosis
Assessment and imaging
Diagnosis is often made by physical examination. Ultrasound, CT or MRI may be helpful when the diagnosis is uncertain, when the hernia is complex or when planning repair.
Treatment
Watchful waiting or repair
Small hernias causing little or no discomfort can sometimes be monitored. Surgery is generally recommended when symptoms develop or there is a significant risk of complications. Femoral hernias warrant particular attention because of their greater risk of trapping bowel.
Many hernias can be repaired using open, laparoscopic or robotic techniques. Minimally invasive repair may reduce postoperative pain and allow faster recovery. The most appropriate approach depends on the type and size of the hernia, previous operations and individual circumstances. Mesh is commonly used to strengthen repairs and reduce recurrence.
Recovery
After hernia surgery
Many patients return home the same day or the following morning. Bruising, swelling and temporary discomfort are common. Walking is encouraged early, while heavy lifting and strenuous activity should follow individual postoperative instructions. Driving can resume when it is safe to perform an emergency stop and pain medication is no longer impairing concentration.
Urgent symptoms
When to seek immediate care
Sudden severe pain at the hernia, vomiting, inability to pass gas or a bowel motion, or increasing redness and tenderness can indicate incarceration or strangulation and require urgent medical assessment.
Risks of hernia surgery
Important risks and complications
As with any operation, laparoscopic inguinal hernia repair has general surgical risks as well as risks specific to the groin, keyhole approach and surgical mesh.
General risks
These include infection, bleeding, chest complications, heart attack or stroke, blood clots in the legs or lungs and—in rare circumstances—death. Urinary retention, bruising, swelling and a temporary fluid collection called a seroma can also occur after surgery.
Hernia-specific risks
The hernia can recur and some patients develop persistent groin discomfort or chronic pain. Injury to bowel, bladder or major blood vessels can occur; bowel perforation can cause leakage of bowel contents, peritonitis or sepsis and may require further surgery. In men, the spermatic cord or blood supply to the testicle can rarely be injured. Keyhole surgery may need to be converted to open surgery.
Mesh-related problems can include infection, chronic pain, migration or adhesion to bowel; rarely, further surgery or mesh removal may be required.