Hernia Surgery

A hernia occurs when an organ (usually the bowel) pushes through a weakness in the tissues which make up the abdominal wall. As a result, you may notice a swelling in the affected region, which typically can be pushed back or disappears when lying flat.

When the lump appears, whether small or large, it may cause discomfort or pain, although in most cases it causes few, if any symptoms. Many are treatable with watchful waiting or elective repair, but some require urgent attention to prevent serious complications. The most frequent types of hernia are inguinal and umbilical hernias.

• Inguinal hernia — through the inguinal canal in the groin (most common; more frequent in men).
• Femoral hernia — through the femoral canal just below the groin (less common; more frequent in women).
• Umbilical hernia — at or near the navel (common in infants; also seen in adults).
• Hiatal (hiatus) hernia — part of the stomach pushes up through the diaphragm into the chest.
• Incisional hernia — occurs at the site of a prior abdominal surgical incision.
• Epigastric and other ventral hernias — occur along the midline of the abdominal wall.

The commonest sign of a hernia is a swelling or a lump in the affected region, which can become painful when carrying out normal or strenuous activities such as lifting. Pain can also occasionally be felt even in a hernia at an early stage, when the swelling is barely evident.

If you notice any of these symptoms, it is best to consult a specialist to avoid neglecting the hernia and prevent it from increasing in size and causing further problems.

A hernia is mainly caused by a combination of weakness and pressure at specific points in the abdominal muscles. This pressure causes the organ to be pushed through the opening of the muscle. It can be a congenital weakness, or it can develop over the years.

Other causes that may cause weakness include excessive exertion such as heavy lifting, continuous cough and being overweight.

Depending on the hernia and its severity, some can be managed conservatively with lifestyle changes and a special hernia truss.

However, surgery is the usual treatment for inguinal, femoral and umbilical hernias as the body is unable to heal a hernia without intervention.

Mesh repair has become the standard technique for fixing inguinal hernias, as it is an extremely safe and effective way of repairing most hernias. Mr Lamah uses specialised mesh, which is very strong yet soft, designed to improve the outcomes of the hernia repair. However, not all hernias (especially in young people) require the use of mesh.

Occasionally it may be deemed safe to wait and watch and monitor the hernia. Surgery becomes an emergency for hernias that cause severe pain or that have developed complications.

Most groin and abdominal wall hernias are diagnosed by physical examination (standing, coughing/straining).

Sometimes, radiological imaging may be needed to confirm the diagnosis or assess the contents and possible complications. This is usually with ultrasound, CT or MRI scan.

• Recurrence of the hernia.
• Surgical site infection or bleeding.
• Chronic postoperative pain or nerve irritation.
• Mesh-related complications (rare): infection, seroma, or mesh-related pain.
• Anaesthesia-related risks.

Mr Lamah will also discuss individualised risks and benefits at the time of your consultation.

Recovery time

This depends to some extent on the type of hernia you have and the procedure required. Most patients undergoing inguinal or umbilical hernia surgery are able to go home the same day ('day case surgery'). Patients undergoing more extensive surgery, such as for example large incisional hernias, may have to stay in the hospital for a few days.

Discomfort is usually mild to moderate and, in most cases, only requires over-the-counter medication, although opioid-based medication may sometimes be needed as well.

Follow-up appointments

Mr Lamah does not normally follow up patients who have undergone straightforward groin or umbilical hernia repair, but of course will see any patients who have experienced any problems or who have undergone more complex procedures.

Postoperative restrictions

After surgery, you will be asked to avoid lifting heavy objects for the first few weeks, and you can drive whenever it becomes safe to do so; in practice this means 4 to 6 weeks after surgery.