Do I need hernia surgery ?
You may not need surgery and the rest of this page may not be needed. Reading about the Type of hernia and the Natural History and Symptoms should help sort this out for you.
Surgery is the only effective means of fixing a hernia. Non operative compression with belts or prosthesis or a truss are not very effective. (This is largely because they do not comply with Pascals law). Trus were common when surgery was risky and a lot of men had no other choice. If a hernia is troublesome it can now almost always be repaired.
There are 3 key parts to every hernia repair no matter where it is or what type of hernia.
1. Dissect out the hernia
2. Push the contents back
3. Close the hernia defect. There are several ways to do this - with sutures or mesh or a combination of both.
The ideal repair will involve suture closure of the defect with or without a mesh reinforcing layer, placed on the outside or the inside of the abdomen facing the bowel (Laplace again). This can be done either at open surgery or via a keyhole laparoscopic operation.
How does surgery work ?
That's it ?
Why are there different operations?
Surgical repair is divided into an Open (meaning an incision) or a Keyhole approach.
The various operations suit particular patients and particular hernia. Each operation has its own risks & advantages.
In addition surgeons often have a favourite technique that they are trained in and trust.
Hernia operations have changed over time. However the older operations are still useful in some patients.
You might like to discuss this choice.
Am I too old & unfit to have an anaesthetic ?
Nearly all patients will be able to have surgery if it is needed. For example in some patients uncomplicated groin hernia can be routinely repaired under regional or local anaesthetic. This is generally very safe.
Will Mesh be used ?
Surgical mesh has been used in traditional open hernia operations for a long time. Mesh is made from several surgical grade materials and comes in different shape, thickness and stretchability. Mesh can be coated with other material to improve its performance and can be permanent or absorbable. Mesh gradually gets incorporated into the bodies connective tissue and becomes very strong.
Mesh is widely used in the repair of most types of hernia. It covers the defect without tension and can be secured over a broad area. However mesh is not always needed especially if the defect is small and not under tension. The defect can be repaired by approximating the tissue with sutures. Mesh can be added as a reinforcing layer.
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Mesh is commonly used with keyhole surgery but is also used during open surgical repair of many hernia.
The 'Difficult' Hernia
There a few very complicated hernias where further surgery is not a great idea. The surrounding muscle wall may be severely weakened or thinned out or the hernia is at a site where it is difficult to get a good fixation of the mesh eg in the side of the abdomen after an open kidney operation. There may be residual infection or the patient may not be fit enough for a big operation. However this is rare and it is unusual not to be able repair most hernia.