Hernias

Hernias are very common. They occur where there is a weakness in the muscles of the abdominal wall. Over time the lining of the abdominal cavity ‘bulges’ through the weak area to produce a lump. The commonest sites to get a hernia are in the groin region (inguinal or femoral hernia), at the umbilicus (umbilical hernia) or at the scar from a previous operation (incisional hernia).

Small hernias that don’t hurt or interfere with your daily activities can usually be safely left alone.

However, hernias may:

get bigger over time
cause pain or discomfort
get a portion of bowel trapped within them which then gets squeezed - a strangulated hernia

To relieve the symptoms of a hernia and to prevent it getting bigger or causing symptoms at a later stage, the hernia should be ‘fixed’. The best operation to fix a hernia will depend on the size and site of the hernia. Generally, hernias can be fixed either with an open operation or with keyhole (laparoscopic) surgery but sometimes one approach may be better than the other. Most hernias are repaired by using some synthetic mesh to strenghten the weakness in the abdominal wall.

The majority of hernia operations are performed as a day case procedure and most patients are back to full activities within a couple of weeks.

You can also get an internal hernia through the muscle of the diaphragm; this is called a hiatus hernia and may present with symptoms of heartburn or pain on eating. Troublesome hiatus hernias can be fixed surgically with an operation similar to a laparoscopic fundoplication.

Q. What is a hernia?

A. The abdominal or tummy wall is made up of layers of muscle and fibrous tissue. A weakness in the abdominal wall allows the lining and contents of the abdomen to protrude as a lump or swelling called a hernia. The commonest places for this to occur are:

Inguinal - in either groin and frequently extending down towards the scrotum in men. They can be either unilateral (one side only) or bilateral (both groins)
Umbilical - at the belly-button
Incisional - at the site of a previous operation scar
Ventral or epigastric - in a line between the umbilicus and the lower part of the breast bone
Femoral - again in the groin but a little lower down at the top of the thigh

Q. Who should have a hernia operation?

A. Traditionally it was thought that all hernias needed to be fixed as they were only likely to get bigger, cause pain or become complicated. In fact, some smaller hernias can be safely left alone if they are causing no problems. Hernias should be fixed if they are causing pain or discomfort are likely to cause problems. I am happy to advise you as to which is your best option.

Q. What does the operation involve?

A. This depends partly on the size and position of the hernia. Generally hernia operations involve pushing the hernia back and then reinforcing the weakened abdominal wall with stitches or mesh. The majority of operations are performed under a general anaesthetic although occasionally some inguinal and femoral hernias are repaired under a local anaesthetic. Most hernia operations are performed as a daycase procedure.

Sometimes it may be beneficial to perform the operation laparoscopically, otherwise known as keyhole surgery. However, keyhole surgery isn't always the best option and I can advise you accordingly.

Q. Will there be pain?

A. You must expect some pain after any hernia operation. This will depend on the type of hernia and surgery you have had. You will be given analgesia to control the pain and allow you to mobilise. In most people, the pain has settled within a week or two.

Q. What are the risks of the operation?

A. Generally a hernia operation is a safe and straightforward procedure for the vast majority of people. However, no surgery is without risk and sometimes problems do occur:

Bruising can sometimes appear in the first week after the operation and occasionally can be fairly impressive extending across the abdominal wall or down to the genitalia in men. This is rarely anything to be worried about and will usually resolve spontaneously.
Some men have difficulty passing urine immediately after groin surgery. Very occassionally a catheter needs to be inserted into the bladder to drain the urine but this is often removed within a day or so when urine is passing normally.
Nerves that supply sensation to the skin around a hernia can get damaged or bruised during the operation. This may leave a small area of numbness beneath the wound but this often becomes unnoticeable within a short time.
A proportion of hernias will recur and the chance of this happening depends partly on the type of hernia and how it was repaired. The risk of recurrence is small (less than 5%), may take years to happen and the recurrent hernia can be fixed.
Wound infection can occur after any operation with an incision. If the scar becomes increasingly red, swollen and painful or the wound starts to discharge fluid hen you may require some antibiotics.

Q. What can I expect to do after the operation?

A. We encourage you to mobilise from the day of your operation. It will be uncomfortable initially but you will not do yourself any harm. Gradually increase your activities each day. Most people are back to everyday activities within two to three weeks. You may start sporting activities as soon as you feel comfortable enough to do them. It would be advisable to avoid anything that requires heavy lifting for two weeks.

'Do what you feel you can do' is probably the best advice.

It is common to feel a ridge beneath the wound of an inguinal hernia once the swelling has settled. This is just where the superficial muscle layer has ben repaired.

You should gradually resume your normal activities, as you feel able.
You can shower, bathe and get the wounds wet after 24 hours.
Don’t soak for too long and gently dab the wounds dry for a few days.
Most people return to work within two weeks of surgery depending on your job.
You can drive as soon as you are safe to do so and for most people this is about 7-10 days after surgery.

Q. What should I look out for after the operation?

A. Bruising and swelling are common after this type of surgery and will usually settle spontanesouly over a few weeks. You should contact the ward where you had the operation, or my secretary, if you develop:

a persistent temperature (>38ºC)
worsening abdominal pain
redness or discharge from the wound

If you don’t get a response from them then you may need to contact your GP but you shouldn’t need to see your GP routinely.

For more information there is a patient information leaflet about recovering from an inguinal hernia repair from the Royal College of Surgeons.

I would also recommend this video by Mr Nick Markham, Consultant Surgeon from North Devon Healthcare NHS Trust who clearly explains about inguinal hernias and their treatment.