What Is Hernia Repair Surgery?

Surgeons picking mesh off an instrument tray

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Hernia surgery is a medical procedure to repair an abdominal defect common to men and women that happens when a weakness in a muscle allows organs or tissue to bulge through.

The scope of surgery depends on the severity of the condition. Hernias range from barely noticeable to life-threatening, depending on the size of the defect and the organs involved.

In some cases, hernia surgery is performed to remove the annoying or unsightly bulge; in other cases, severe organ damage and even death can occur if surgery is not performed immediately to repair the problem.

Purpose of Surgery

Your doctor will determine if your hernia requires surgery. Some hernias may be recommended for surgical repair based on discomfort, severity, and in certain cases, medical emergency.

Hernias generally occur in the groin, abdomen, within the torso, or as a result of a previous abdominal surgery. The types of hernia that could require surgery include:

  • Inguinal: One of the most common hernias. A weakness in the muscle of the groin allows a section of the intestine to bulge through. The first sign of an inguinal hernia is usually an unexplained bulge in the groin area.
  • Femoral: Similar to an inguinal hernia, but differentiated by its location relative to the inguinal ligament. A hernia in the groin area above the inguinal ligament is an inguinal hernia; below the ligament, it is a femoral hernia.
  • Epigastric: Protrusions of fat or sometimes intestine through the abdominal wall between the navel and the breastbone.
  • Umbilical: The second most common hernia in adults, where the abdominal wall is weakened at the point of the umbilical cord (belly button).
  • Hiatal: The upper part of the stomach protrudes through the diaphragm, a hole usually occupied by the esophagus. It can be associated with gastroesophageal reflux disease (GERD).
  • Obturator: part of the intestine passes through the gap between the bones of the front of the pelvis.
  • Incisional: A weakness in the muscle of the abdomen allows the tissues of the abdomen to protrude, but the weakness is caused by the incision made in a prior abdominal surgery.

Hernias do not heal on their own. They can remain asymptomatic for a long time and be generally benign, but they can also worsen, sometimes quickly.

A hernia that bulges out with abdominal pressure (lifting something heavy, straining for a bowel movement) but returns inside the body when the pressure is gone or with gentle pressure from the outside, is referred to as "reducible" and aren't as severe.

However, hernias that remain in the “out” position are “irreducible" or “incarcerated," and surgery may be indicated.

An incarcerated hernia can become an emergency if it “strangulates,” meaning that the bulging tissue loses blood flow. This can be life-threatening and requires immediate surgery.

When to Call a Doctor

A hernia becomes an emergency when there is severe pain at the site, often caused by a lack of blood flow to the tissue bulging through the muscle. Also, if a hernia changes color, such as gray/ashen or dark red/purple, blood flow may have been cut off and the hernia is strangulating.

Risks and Contraindications

The following risks of hernia surgery are possible but generally uncommon:

  • Post-repair pain
  • Infection, potentially of the wound or the surgical mesh used for repair
  • Adhesion (different tissues sticking together)
  • Hernia recurrence
  • Constipation (bowel obstruction can be serious)
  • Urinary incontinence or difficulty urinating
  • Incisional hernia
  • General anesthesia side effects such as lung infection or pneumonia

Overweight patients are at a higher risk for wound infection, mesh infection, recurrence, and overall postoperative complications. In non-emergency surgical situations, it's possible your doctor will ask you to lose weight before scheduling surgery.

Before Surgery

Your surgeon will provide a comprehensive set of directions to follow leading up to your surgical procedure. Following them will prevent any delays or complications on the day of your procedure. Some pre-op directions may include:

  • Pre-operative physical exam to determine your wellbeing and to look for any possible conditions that would prohibit surgery.
  • Curtail the use of non-steroidal anti-inflammatory medications a week before surgery (aspirin and ibuprofen).
  • Fasting the day before surgery.
  • Preparing for a hospital stay, if needed (bringing everything with you that you may want/need while recovering).
  • Bathing with antibacterial soap pre-surgery.

During Surgery

There are two types of hernia surgery:

Open surgery: The surgeon makes a single incision at the hernia site and the bulging tissue is either removed or pushed back into the body.

Laparoscopic surgery: The surgeon makes a series of small incisions around the hernia and uses a laparoscope (a thin lighted tube with a camera) to see. Gas may be pumped under the skin to expand the area for the surgeon to work. Instruments are inserted through the other incisions to repair the hernia.

Every hernia surgery is unique and your surgeon may use different techniques depending on your individual case.

Anesthesia: Your surgeon may recommend general anesthesia (you're knocked out for the entire procedure) or regional anesthesia (an epidural injection in your spine that numbs you from the waist down).

Some research has shown regional anesthesia patients had lower post-operative pain scores after inguinal hernia repair and began pain medication later than general anesthesia patients. Your doctor can help guide which method is best for your case.

Stitches and mesh: Your surgeon will repair your hernia with stitches, but may also use surgical mesh to strengthen the repair. Mesh can be non-absorbable (a permanent implant) or absorbable (designed to degrade over time as the tissue heals and strengthens).

According to the FDA, research has consistently shown lower rates of hernia recurrence when mesh is used. It is worth noting that past complications from surgical mesh were associated with recalled products that are no longer on the market.

After Surgery

There is no standard recovery from hernia surgery as there are many types of hernias. Some hernia surgeries are large and extensive procedures, while others can be performed on an outpatient basis with the patient returning home the same day. In most cases, patients can return to normal activity in two to four weeks.

Your surgeon will give you specific instructions to follow during immediate post-op recovery and long-term (this will include physical limitations such as no lifting). Don't deviate from them.

The most important post-surgical activity is being vigilant for the most common hernia surgical complications.

Notify your doctor immediately if you experience any abnormalities in your recovery and healing.

You'll also want to prevent an incisional hernia later on (where tissue protrudes from a previous surgical incision), so protect your incision while it heals. When you rise from a seated position, sneeze or cough, or bear down from a bowel movement, gently hold pressure on the incision until the activity is over.

Follow-Up

Most surgeons will schedule a follow-up appointment about two weeks after surgery. The content of that first follow-up will depend on how extensive your procedure. The basic evaluation will check to see that recovery is normal, pain is well-controlled, and no post-op infections exist.

This appointment may also include bandage and wound evaluation, as well as checking on any wound draining (again, depending on the complexity of your procedure).

Normal activities can usually be resumed by four weeks post-surgery, but follow your surgeon's instructions in this regard. This is especially important for lifting any weight greater than 15 pounds.

Further out from surgery, be vigilant for any returning symptoms that could indicate a recurrence of hernia (which could require another surgical repair). Contact your doctor immediately if this is the case.

A Word From Verywell

Hernia surgery isn't generally serious, but it can be. If surgery is recommended, your surgeon will be your primary source of information specific to your case, helping you understand what to expect before, during, and after the procedure.

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Article Sources
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  4. Bakota B, Kopljar M, Baranovic S, Miletic M, Marinovic M, Vidovic D. Should we abandon regional anesthesia in open inguinal hernia repair in adults?. Eur J Med Res. 2015;20:76. doi:10.1186/s40001-015-0170-0

  5. U.S. Food and Drug Administration. Hernia surgical mesh implants.

  6. National Health Services. Inguinal hernia repair recovery. Updated June 14, 2018.

  7. Johns Hopkins Medicine. What to expect after hernia surgery.

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