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Abdominal hernia repair

Published by Bupa's health information team, March 2010.

This factsheet is for people who are having an abdominal hernia repair, or who would like information about it.

Abdominal hernia repair involves pushing the hernia back into the abdomen and repairing the weakened muscle.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About abdominal hernia repair
Diagnosis of abdominal hernia
What are the alternatives to surgery?
Preparing for abdominal hernia repair
What happens during abdominal hernia repair
Animation - open hernia repair
Animation - keyhole hernia repair
What to expect afterwards
Recovering from abdominal hernia repair
What are the risks?
Questions and answers
Related topics
Sources

About abdominal hernia repair

Abdominal hernia is a bulge or swelling that occurs when abdominal organs such as your gut (intestine) pushes through a weakness in the muscle of the abdominal wall. Abdominal hernias are named according to the position of the weakness in the abdominal wall. The most common types of abdominal hernia are femoral and inguinal hernias - they appear in the groin area.

An abdominal hernia isn't dangerous in itself, but if left untreated it's likely to grow and become painful (this is called an incarcerated hernia). There is a risk that the blood supply to the protruding gut may be cut off (this is called a strangulated hernia), causing life-threatening conditions such as gangrene and peritonitis. A strangulated hernia is usually very painful and requires urgent surgery.

Femoral and inguinal hernias are at risk of becoming incarcerated and strangulated because of their narrow neck. The risk of having a strangulated femoral hernia is about one in five at three months and about one in two at 21 months.

If you think you have a femoral or inguinal hernia, it's important that you seek medical advice.

Diagnosis of abdominal hernia

Your GP will ask your about your symptoms and examine you. He or she may also ask you about your medical history.

If you have a swelling in your groin that appears when you stand up, lift or strain, you may have a hernia. Your doctor will check if the lump can be pushed back in. There is a risk that the hernia can cause serious illness if it's left untreated.

Your doctor will usually recommend that you have a hernia repair.

What are the alternatives to surgery?

Abdominal hernias in general get larger with time and don't go away without treatment. Belts and trusses don't reduce the risk of incarceration or strangulation. The only reliable treatment is surgery.

Preparing for abdominal hernia repair

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

The operation is usually done as a day-case procedure under general anaesthesia. This means you will be asleep during the operation. Alternatively you may prefer to have the surgery under local anaesthesia. This will completely block any feeling in the groin area and you will stay awake during the operation. A sedative may be given with a local anaesthetic to help you relax. Your surgeon will advise which type of anaesthesia is most suitable for you.

If you have a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, stockings.

What happens during abdominal hernia repair

The operation takes 30 to 50 minutes depending on the method used.

There are two main types of abdominal hernia repair - open and keyhole (laparoscopic). Your surgeon will recommend which is suitable for you.

Open surgery

A small single cut (about 5 to 10cm long) is made in your groin, and the bulge is pushed back into place. A synthetic mesh is usually stitched over the weak spot to strengthen the abdominal wall. Your skin is closed with dissolvable stitches and covered with a dressing.

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Keyhole surgery

There are two techniques for keyhole surgery - transabdominal pre-peritoneal (TAPP) and totally extraperitoneal (TEP).

In a TAPP operation, the mesh is inserted through the lining of your abdomen (peritoneum). In TEP, the mesh is attached without cutting through your peritoneum. TEP is more difficult to do but reduces the risk of damage to the organs in your abdomen.

During keyhole procedure, three small cuts (1 to 2cm long) are made on your lower abdomen under general anaesthesia. Your surgeon will insert a tube-like telescopic camera (laparoscope) so he or she can view your hernia on a monitor. The hernia is repaired and the cuts closed with dissolvable stitches.

There's a chance your surgeon may need to convert your keyhole operation to open surgery. This is only done if it's impossible to complete the operation safely using keyhole technique.

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What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off. You will usually be able to go home when you can walk and pass urine.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

A nurse will give you advice about caring for your healing wound before you go home. You may be given a date for a follow-up appointment.

Dissolvable stitches will disappear in seven to 10 days.

Recovering from abdominal hernia repair

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

General anaesthesia temporarily affect your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you are in any doubt about driving, always follow your doctor's advice and please contact your motor insurer so that you are aware of their recommendations.

You will need to take it easy in the first few days. You should be able to return to normal activities after about two weeks. Light exercise, such as walking, will help to speed up your recovery.

You should eat plenty of vegetables, fruit and high-fibre foods such as brown rice and wholemeal bread and pasta. This helps to prevent constipation, which can cause straining and discomfort.

You should be able to return to work once you feel able but if your work is strenuous and involves heavy lifting or puts a strain on your abdominal muscles, first seek advice from your doctor.

What are the risks?

Abdominal hernia repair is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this operation.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure, for example feeling sick as a result of the general anaesthetic.

Side-effects of abdominal hernia repair may include:

difficulty in passing urine
pain, numbness, swelling or bruising in the abdomen and groin area - wearing close-fitting underwear may ease any discomfort
for men, some scrotal swelling for a few days

The side-effects are usually milder after keyhole surgery.

Complications

Complications are when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Possible complications of abdominal hernia repair include:

build up of blood or fluid in the space left by the hernia
in men, painful swelling of the scrotum or testicles
in men, damage to blood vessels supplying the testicles - resulting in permanent damage to one or both testicles
damage to tissues in the abdomen such as the bladder or bowel
damage to nerves - resulting in numbness in the groin area
re-occurrence - the hernia may develop again

The exact risks are specific to you and will differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.