Hernia repair

What is hernia repair?

A hernia is a bulge where part of the bowel or other tissue pushes through a weak spot in the abdominal wall. Common sites are the groin, the belly button and old surgical scars. Hernia repair is an operation that returns the tissue to place and strengthens the wall, often with a mesh.

Hernias are named by where they occur, such as groin (inguinal), belly button (umbilical), or through a previous surgical scar (incisional). The contents may slide in and out, which is why the lump can come and go. A hernia that cannot be pushed back and becomes painful is a warning that the blood supply may be compromised.

What causes a hernia?

A hernia develops where the abdominal wall is weak, either from birth or after a previous operation. Straining from heavy lifting or constipation, pregnancy, persistent coughing and excess weight raise the pressure inside the abdomen and push tissue through the weak spot.

• A natural weakness in the abdominal wall
• Straining from heavy lifting or constipation
• Pregnancy and increased pressure
• Previous surgery leaving a weak area
• Coughing and excess weight

What are the symptoms?

A hernia usually shows as a bulge under the skin that grows when standing, coughing or lifting and shrinks when lying down. It can cause aching or a dragging feeling, and pain on straining. Some hernias cause little pain, so a painless lump still needs to be checked.

• A bulge under the skin
• Aching or a dragging sensation
• Pain when coughing, lifting, or straining
• A lump that returns when standing
• Discomfort that worsens through the day

When should I see a colorectal surgeon?

Seek urgent help if a hernia becomes painful and firm and cannot be pushed back, or if the skin over it turns red or tender. Vomiting, a bloated abdomen, or being unable to pass stool or wind alongside a hernia also needs emergency care, because the bowel may be trapped.

The warning signs below need prompt attention.

• A painful lump that will not go back in
• Red or tender skin over the lump
• Vomiting and inability to pass stool or wind
• Sudden severe pain

How is it diagnosed?

A hernia is usually diagnosed by examination, with you standing and lying down. Dr Wong feels for the bulge and checks whether it goes back in. Ultrasound or CT is used if the diagnosis is unclear, and your fitness for surgery is assessed before an operation is planned.

• Examination standing and lying down
• Ultrasound or CT if the diagnosis is unclear
• Assessment of symptoms and fitness for surgery

What are the treatment options for a hernia?

Hernia treatment depends on the type, size and your symptoms. Small painless hernias can be watched. Most others are repaired by open or laparoscopic keyhole surgery, usually with a mesh, though selected hernias are repaired without one. A trapped hernia needs emergency surgery.

• Open repair with mesh
• Laparoscopic keyhole repair
• Repair without mesh in selected cases
• Watchful waiting for small, painless hernias
• Emergency surgery if the bowel is trapped

What are the risks and complications?

After hernia repair, the hernia can come back. Other risks are pain or numbness near the wound, infection including mesh infection, bruising or fluid collection, and injury to nearby structures.

• Recurrence
• Pain or numbness after surgery
• Infection, including mesh infection
• Bruising and fluid collection
• Injury to nearby structures and anaesthesia risks