What is Hernia Repair Surgery?
A hernia is when an internal part of the body, such as the intestine, bowel or muscle, pushes through a weakness in the muscle wall or surrounding tissue. This may present as a lump on the body somewhere between the hips and chest.
Hernias don’t go away on their own and hernia removal surgery is the only way to get rid of these unpleasant lumps. There are two different types of hernia surgery that we carry out at the Cadogan Clinic. Open surgery involves making an incision in the abdomen and pushing the hernia back in and using stitches and/or special surgical mesh to keep it in place. Alternatively, the surgeon may use keyhole surgery (laparoscopy) for hernia repair which involves several small incisions and the use of fine surgical instruments. This method is less invasive and comes with a faster recovery time. The surgeon will decide on the best method of hernia repair taking into account the type of hernia, the content of the hernia, the symptoms you are experiencing and your general health.
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Why do people have it?
There are a number of reasons why a person may decide to undergo hernia repair surgery.
- The hernia is causing pain
- The hernia is causing digestive discomfort, including heartburn, acid reflux, difficulty swallowing or bloating
- The hernia is getting worse
- The hernia is preventing you from carrying out day-to-day tasks
- The hernia is causing you to feel self-conscious, causing you to avoid certain activities, for example, swimming
- The presence of the hernia is having a negative impact on your romantic relationships
- The hernia is causing you to feel anxious or depressed
Who is suitable?
Cadogan Clinic considers individuals fit for hernia repair, if all of the following are true of them:
- Physically and psychologically fit and healthy
- Have realistic expectations of what can be achieved by surgery
You may also be experiencing one or more of the following:
- Pain or discomfort caused by a hernia
- Worsening hernia symptoms
- Other symptoms such as heartburn or acid reflux
- Issues with self-confidence, caused by the presence of a hernia
- Anxiety or depression triggered by the presence of a hernia
The cost of Hernia Surgery
How does Hernia Repair Surgery work?
There are two types of hernia repair surgery that we carry out here at the Cadogan Clinic - open surgery and keyhole surgery.
Open surgery is the more invasive of the two hernia surgeries. This procedure sees the surgeon make an incision in the groin and the hernia is pushed back inside the body, with stitches or a synthetic mesh used to strengthen the abdominal wall and hold everything in place. Open hernia repair takes around one hour to perform under a general anaesthetic.
A laparoscopy is more commonly known as keyhole surgery. Laparoscopy is a minimally-invasive surgical procedure which allows the surgeon to see inside the abdomen and pelvis without having to make large cuts through the skin. A small incision measuring just 1-1.5cm is made near the belly button. A tube is then inserted into this opening and carbon dioxide gas is pumped into the abdomen, lifting the wall of the abdomen to give the surgeon a clear view of the internal organs. The laparoscope, which has a light source and a camera, is then inserted through this tube. The pictures from the camera are displayed on a monitor so the surgeon can have a good view of what is going on inside the body.
There are two different types of laparoscopic hernia repair- Transabdominal preperitoneal (TAPP) and Totally extraperitoneal (TEP). In TAPP, surgical instruments are inserted through the muscle in the abdominal wall and the lining which covers the organs, called the peritoneum. The surgeon peels back a flap of the peritoneum to cover the hernia and a piece of surgical mesh is used to strengthen the weakened area in the abdominal wall. TEP is a new laparoscopic technique that allows the surgeon to carry out hernia repair without entering the peritoneal cavity.
Once the repair is complete, the incisions in the skin are sealed with stitches.
Laparoscopic hernia repair is carried out under a general anaesthetic and takes around an hour to complete. This type of surgery is carried out as a day case, which means you will be allowed to go home on the same day, accompanied by a friend or relative.
Both keyhole and open surgery for hernias are safe and work well and the risk of the hernia returning is similar for both types of hernia repair. Keyhole surgery generally results in less pain and a faster recovery time than open hernia repair surgery as the incisions are smaller. Your surgeon will discuss the best option for you based on the type of hernia you have, the hernia symptoms, your medical history and general overall health.
The meshes used in hernia repair surgery are strong and are similar to the first meshes used to treat pelvic organ prolapse. There have been many press reports about the negative effects of using this type of mesh in gynaecological procedures. This is because the vagina is different to the abdominal wall and does not require the same type of heavy-duty mesh as that used in hernia repair. The risk of complications of using mesh in hernia repair surgery is much lower than the risk of complications when it is used to treat pelvic organ prolapse. If you have any concerns, please discuss these with one of our expert surgeons, who will be happy to put your mind at rest.
There are a number of different types of hernia, including inguinal, femoral, umbilical and hiatus hernias.
Inguinal hernias
These are the most common type of hernia and mainly affects men. An inguinal hernia presents as a lump or swelling in the groin or as an enlarged scrotum. The lump may be painful and may disappear when you lie down. An inguinal hernia appears when fatty tissue or a part of the bowel or intestine pokes through a weak spot in the abdominal wall into the inguinal canal, at the top of the inner thigh. It is more common in older people, as the abdominal muscles weaken with age, and repeated straining.
Femoral hernias
Femoral hernias present as a painful lump in the inner upper part of the thigh or groin. This happens when fatty tissue or part of the bowel pushes through a weak spot in the abdominal wall into the femoral canal. The lump can often be pushed ‘back in’ or it may disappear when you lie down. Coughing or straining may cause the lump to appear.
Femoral hernias are rare and tend to affect more women than men. They are linked to ageing and obesity. Femoral hernias can appear as a result of repeated strain on the stomach, for example carrying a heavy load or straining on the toilet if you are suffering from constipation.
Hiatus hernias
A hiatus hernia is caused by part of the stomach moving upwards into the chest by squeezing through the gap in the diaphragm. It is very common in people aged over 50.
Many people will experience no hiatus hernia symptoms but others may experience symptoms such as heartburn, acid reflux, bloating or difficulty swallowing. Hiatus hernias may be caused by the diaphragm becoming weak with age, or pressure on the stomach, for example pregnancy or being overweight. Lifestyle changes can help to ease hiatus hernia symptoms, but only surgery can get rid of them.
Umbilical hernias
Umbilical hernias occur when fatty tissue or part of your bowel pokes through the stomach close to the naval, appearing as a painless lump. This type of hernia is very common in infants and young children, particularly premature babies, and may get larger when laughing, crying, coughing or going to the toilet. It may get smaller when lying down.
In children, an umbilical hernia often disappears by the age of four or five years. However adults can also develop umbilical hernias. If left untreated, an umbilical hernia will worsen over time.
Diaphragmatic hernias
This type of hernia occurs when the abdominal organs move into the chest through an opening in the diaphragm. This type of hernia can also affect infants if their diaphragm has not developed properly in the womb.
Incisional hernia
If a surgical wound in the abdomen has not healed properly, some tissue can bulge through the incision site. This is called an incisional hernia.
Epigastric hernias
Fatty tissue poking through the abdomen, between the belly button and the lower part of the breastbone is known as an epigastric hernia.
Spigelian hernias
Spigelian hernias occur when part of the bowel bulges through the side of the abdominal muscle. They are usually found below the belly button.
Muscle hernias
Often caused by a sporting injury, muscle hernias usually affect the legs. As the name would suggest, this type of hernia occurs when part of the muscle pokes through the tissue.
Hernia Surgeons
We have invited a selection of the country's very best consultants to join us at the Cadogan Clinic so that you can be sure that whatever the nature of your treatment, you will be seeing one of the top practitioners in the country.
How is a hernia diagnosed?
Hernias can be quite prominent and often a physical examination is enough to diagnose the presence of a hernia. This involves pushing down on the abdomen with the hands to check whether there is a lump present. The doctor will also ask you about your symptoms.
If the doctor suspects you may have a femoral hernia then an ultrasound scan may be called for. An X-ray on the abdomen may be carried out to check for a bowel obstruction. An obstructed bowel is a medical emergency.
What is the recovery time from Hernia Repair Surgery?
The hernia repair surgery recovery time depends on the type of surgery performed. A laparoscopic hernia repair generally has a faster recovery time.
Depending on which type of hernia surgery you have, you may be able to return to work and your regular day-to-day activities within a couple of weeks of your hernia repair.
If you have had a laparoscopic hernia repair, you may also find you have some pain in your shoulders. This is because of the presence of carbon dioxide gas used to lift the wall of the abdomen. This is normal and the gas will naturally disperse.
Some patients make a complete recovery in four weeks, but should continue to avoid heavy lifting for two to three months after surgery.
Patients who have undergone open surgery must avoid strenuous activity and exercise for four to six weeks after their hernia repair.
You should avoid smoking as this can delay the recovery process. Make sure you follow all the aftercare instructions issued by your surgeon.
Cadogan Clinic’s on-call nursing service is open 24/7 during your recovery period to help with any questions or queries that you may have.
Frequently Asked Questions
How painful is hernia surgery?
Hernia surgery itself is not painful as the procedure is carried out under a general anaesthetic. Your groin will feel sore and uncomfortable after the procedure, but over-the-counter painkillers will help with this.
Applying gentle pressure to the wound will help make you feel more comfortable when sneezing or coughing. Straining when going to the toilet should be avoided, so it is important to drink lots of water, eat vegetables, fruit and high-fibre foods and perhaps take a mild laxative if it helps.
How do I know if my hernia needs surgery?
If you have a hernia, it is important to go to the doctor to determine which kind of hernia you have, even if it is not causing you any pain or discomfort. Some types of hernia, like an inguinal hernia, are more likely to become strangulated or cause a bowel obstruction than others and these will need to be operated on in order to avoid these complications. Your hernia will also need surgery if it contains part of your bowel, muscle or any other tissue as this increases the risk of obstruction or strangulation. Surgery will also be required if your hernia symptoms are severe, getting worse or affecting your ability to carry out everyday tasks.
What happens if a hernia is left untreated?
If left untreated, there is a risk of strangulation, where the blood supply is cut off to the section of the organ or tissue trapped in the hernia. There is also a risk of obstruction if a piece of bowel has entered the hernia and become stuck. A strangulated hernia and obstructed bowel are medical emergencies.
What are the first signs of a hernia?
Often the first sign of a hernia is the appearance of a lump or bulge that you can see and feel. This bulge may be painful or painless and may disappear when laying down. In the case of hiatus hernia, you may find that you start to develop digestive discomfort.
What Causes Hernias?
Hernias are caused by a combination of pressure and an opening or weakness in the muscle. This weakness may be present at birth or develop later in life.
Pressure in the abdomen may be caused by lifting or pulling heavy objects, straining when going to the toilet, pregnancy and persistent coughing. You are at a greater risk of developing a hernia if you are obese, smoke or if you do not eat a healthy, balanced diet.
What happens if a hernia is left untreated?
If left untreated, hernia symptoms may get worse and there is ongoing risk of bowel obstruction or strangulation, which are both medical emergencies.
If you have a hernia and experience sudden, severe pain, vomiting, difficulty going to the toilet or if the hernia becomes firm, tender or can’t be pushed back in, then you should seek immediate medical assistance.
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