Hernia Surgery

A hernia will not resolve on its own as the weakness or hole in the abdominal wall can only be corrected surgically. Hernias can enlarge and cause discomfort over time. Depending on how narrow the passage is for abdominal contents to move through, the blood supply accompanying the bulge may become restricted or bowel may become entrapped in the hernia, causing obstruction. This is a potentially life-threatening situation (strangulation of the hernia) requiring emergency repair. Hernias which are repaired in a planned elective setting often result in better outcomes for patients.

Many of the risk factors are related to increased intra-abdominal pressure, which both weaken the abdominal wall and encourage abdominal contents to be pushed outside. These include:

• Obesity

• Pregnancy

• Smoking and other causes of ongoing coughing (e.g. respiratory illness)

• Excessive physical activity

• Congenital (some are naturally born with weaknesses in their abdominal muscles)

• Previous surgery

Hernias can usually be diagnosed clinically, by examining you in the office. Patients are often the best guide to pinpoint where the lump is for the surgeon! In some cases, the hernia may be small or complicated requiring further imaging (ultrasound or CT). Sometimes further imaging is required for patients who have alternative causes for pain (e.g. muscle strain) in that region with no obvious lump to examine.

Some patients have lived with their hernias for years. While surgery is often recommended due to the risk of strangulation (see above) or the hernia becoming more troublesome, each patient is assessed on a case by case basis. Non-operative options (e.g. a truss, close observation) may be appropriate in the short term for patients with a high risk medical background or who do not wish to have surgery. Ultimately, a hernia will not resolve on its own as the weakness or hole in the abdominal wall can only be corrected surgically.

The surgical principles of hernia repair involve entry into the space around the hernia either via keyhole surgery or open approach. The minimally invasive approach is usually reserved for primary groin hernias in appropriate patients. The hernia contents are then reduced back into the abdomen and the muscle defect is repaired. Usually a mesh is placed in this space to strengthen the abdominal wall and reduce the risk of the hernia coming back.

Depending on the type of hernia, Dr Brown will counsel you on the specific risks. General considerations for hernia repair include recurrence (the hernia returning), mesh related complications (e.g. infection), injury to the hernia contents requiring repair (e.g. bowel), bleeding and chronic pain.

Hernia surgery is performed under general anaesthesia. Some patients go home the day of surgery, but more commonly you would stay overnight. Most patients will be able to return to work and drive by one week with limits on heavy lifting between four to six weeks post-operatively.