What is a hernia repair?
A hernia repair is an operation to repair a hernia. As outlined in the section on Abdominal Wall Hernias, hernias are weaknesses or "defects" in the muscular/tendinous part of the abdominal wall. This part of the abdominal wall essentially holds everything inside and when there is an area of weakness, it allows a part of the inside to bulge out. As expected, this protrusion (lump) is worse when the patient strains their abdomen. Just imagine squeezing a balloon when there is an area of weakness – there will be a bulge.
The aim of the hernia repair operation is therefore to close this weakness to prevent this bulge.
Why do you need to repair a hernia?
This is also outlined in the Abdominal Wall Hernias section. Briefly, whenever something from the inside bulges out, there is a risk that it can get trapped outside, potentially "strangulating" it from its blood supply. This is a complication known as "strangulation" of a hernia. Not all hernias are likely to strangulate - a discussion with your surgeon regarding the risks and benefits of the operation should be made on an individual basis.
How are hernias repaired?
The basic principle of a hernia repair is to close and reinforce the area of weakness. There are three general steps:
- Find and define the area of weakness
- Contents of the hernia is inspected for injury. Sometimes, the bowel or other structure protruding through the weakness in the abdomen (called the “hernia defect”) can be damaged if it is squeezed tightly by the abdominal wall. If significant damage has occurred, the loop of bowel (or whatever entrapped structure) may require surgical removal
- Repairing of the defect. Once clearly defined, one can decide how to repair of defect. If the defect is small, it can be stitched closed. If it is large, a piece of plastic netting (“mesh”) can be placed to cover the hole. The use of a mesh is important in larger hernias as it reinforces the defect and reduces the chance of recurrence.
The time for the surgery depends on the type and complexity of the hernia repair. A simple groin or umbilical hernia can take less than an hour, whilst a complex incisional hernia can take many hours.
Caption: Examples of meshes used in hernia surgery. These meshes are made of a non-dissolvable material (polypropylene) and the holes in between fibres allow for the body to grow into it. Mesh is used to reinforce the hernia defect and leads to decreased risk of recurrence. Source: from Doctoroftcm under CC BY-SA 3.0 licence
What are the risks of surgery?
Like any operation, there are risks. Firstly, there are risks associated with the anaesthetics - this risk is related to the patient's age and medical issues.
With regards to surgical risks, the specific risks of surgery include:
- Recurrence - The risk of recurrence (the hernia coming back after surgical repair) varies depending on the type of hernia. In general, the larger the hernia, the greater the risk of recurrence. Also, anything which causes straining in the abdomen can increase the risk of recurrence – constipation, prostate problems leading to straining on urination, chronic cough and obesity. These factors should generally be sorted out before the hernia operation to minimise the risk of recurrence. In general, the risk of recurrence should be less than 1 in 20 operations.
- Damage to the contents of the hernia – If the hernia contains intestines or other abdominal contents, this may be damaged during the operation. Furthermore, the hernia itself may also cause damage to these structures by "strangulating" it. Sometimes the surgeon needs to remove this part of the bowel because of the damage.
- Damage to surrounding structures – This depends on the area of the hernia. For instance, in the groin, the blood vessels supplying the testicles may be damaged.
- Injury to the nerve in the groin and chronic pain – Specifically in groin hernia surgery, there is a nerve which supplies a patch of skin in the scrotum or labia. This may be damaged during surgery which may cause chronic pain. Some surgeons routinely cut this nerve to prevent the possibility of long term pain but this will result in a small patch of numbness in the scrotum/labia.
Are there any particular instructions after surgery?
Apart from general advice regarding dressings and wound care after surgery, we recommend that the patient not lift anything heavy for about 6 weeks after the operation. The reason for this is that lifting heavy objects (say, more than 10kg) can cause straining of the abdominal muscles which may potentially cause the hernia to come back.
I am having hernia surgery, do you have any further information regarding this operation?
Yes. We have created an information sheet for our patients undergoing hernia surgery. Do note that this is generic information and may not apply specifically to your circumstance.
If you are undergoing surgery with us at CESA, our surgeons will explain everything to you in detail with information which is tailored to your specific circumstances. Also, feel free to ask your surgeon any questions which may not be covered in the information sheet.