Hernia repair

A hernia is a bulge that appears when tissue, such as fat or a loop of bowel, pushes through a weak spot in the muscle wall. Hernia repair pushes the bulge back and strengthens the weak spot, usually with stitches and a thin mesh. It can be done through one cut over the hernia (open surgery) or a few small cuts using a camera (keyhole surgery), depending on the hernia and your general health.

Surgery is usually advised for a hernia that causes pain or gets in the way of daily life. A small hernia with no symptoms may not need an operation, but hernias seldom go away by themselves and tend to grow, so many are eventually repaired. Repair also prevents a hernia becoming stuck.

The team will tell you how to prepare for your operation.

You may have a general anaesthetic (asleep), a regional one (numb from the waist down) or a local one with a medicine to relax you. An open repair goes like this:

1. A cut is made over the hernia.
2. The hernia is pushed back into place.
3. The weak area is strengthened with stitches, and usually a mesh is stitched over it.
4. The cut is closed.

In keyhole repair, a few small cuts are made in the lower tummy and the same repair is done from inside using a camera, with gas giving room to work. It usually takes 30 to 90 minutes.

Most people go home the same day; some stay overnight. Wound pain, a little bleeding for a couple of days, and bruising or swelling around the wound or genitals for a couple of weeks are common, as is shoulder pain after keyhole surgery. Paracetamol helps, as does holding a hand over the wound when you cough or sneeze. Keep the wound clean and dry. Walk gently and build up, and eat fibre-rich food to avoid straining. People are usually told to avoid heavy lifting for at least 4 to 6 weeks and not to drive until the team agrees.

Get urgent advice for pus, increasing pain or heavy bleeding at the wound, a fever, ongoing vomiting or a swollen painful tummy. Chest pain or severe breathing difficulty needs emergency care.

Serious problems are uncommon. Risks include wound infection; a lump or swelling at the site for weeks or months; a large painful bruise in the groin or genitals; groin pain or numbness lasting over 3 months; damage to nearby bowel, bladder, blood vessels or nerves, or to the testicle if its blood supply is harmed; blood clots in the leg veins; and the hernia coming back. The general risks of anaesthesia and surgery also apply.

The outcome is usually very good, with the bulge gone and the discomfort eased. In some people the hernia returns. A healthy lifestyle, including a healthy weight, helps lower the risk of another hernia. Contact your surgeon if a bulge comes back or pain does not settle.