Hernia treatment depends on its location, the discomfort it causes and the risk of tissue becoming trapped. Hernias in the groin, upper thigh, navel and a previous surgical scar are not all assessed in the same way. The choice between open and laparoscopic surgery also depends on these differences.
In adults, the opening in an abdominal wall hernia does not usually close on its own. However, this does not mean that every hernia needs immediate surgery when it is found. Some painless hernias can be monitored under medical supervision, while others are better treated with planned surgery without delay. Sudden severe pain and a bulge that is stuck may be an emergency.
What lies behind the bulge?
The abdominal wall consists of layers of muscle and strong connective tissue that hold the organs in place. Fatty tissue or part of the bowel can bulge out through a weak point in these layers. The swelling seen beneath the skin is the visible part of the hernia; the underlying problem is the opening or weak area through which it protrudes.
The weakness may be present from birth, increase with age or develop along the incision from a previous operation. Persistent coughing, straining and excess weight, which increase pressure inside the abdomen, can contribute to the development and enlargement of some hernias. A bulge first appearing while lifting something heavy does not prove that this one action caused the whole problem.
A swelling disappearing when you lie down does not mean the opening has closed. The tissue moves back inside, but the weak area remains. A belt or support garment may provide temporary relief for some people, but it does not repair the hernia. Abdominal exercises do not close an existing opening either; an exercise that causes pain should not be continued.
What difference does the location make?
An inguinal hernia occurs where the lower abdomen meets the thigh. The bulge is usually more noticeable when standing and straining. The severity of symptoms and examination findings influence the timing of surgery. Not every swelling in this area is a hernia, so the diagnosis is established through examination.
A femoral hernia lies slightly below the groin. It needs particular consideration in women. Because of the risk of tissue becoming trapped and losing its blood supply, planned surgical assessment of a femoral hernia should not be delayed. A small bulge does not mean the hernia is safe.
An umbilical hernia develops at or near the navel. In adults, treatment depends on its size, whether it causes pain and whether it is growing. Some umbilical hernias in children may close over time, but this does not apply to adults. The surgical options discussed in this article are for adult patients.
An incisional hernia develops at the site of a previous surgical incision. There may be one or several weak areas along the scar. Previous wound infection, smoking and other factors that affect healing are taken into account. Repairing the abdominal wall in a large hernia may be more complex than closing a small opening.
In a hiatal hernia, part of the stomach passes into the chest through the opening in the diaphragm for the oesophagus. The diaphragm is the muscle separating the chest and abdominal cavities. This hernia does not usually produce a bulge under the skin, and its treatment differs from that of abdominal wall hernias. Sometimes the main symptom is reflux, when stomach contents flow back into the oesophagus; finding a hernia alone does not make surgery necessary.
How is the opening repaired during surgery?
In an open approach, an incision is made near the hernia, the protruding tissue is returned to its normal position and the weak area is repaired. In laparoscopic surgery, the surgeon works with a camera and instruments through small incisions. The details of the operation depend on the type and size of the hernia, previous procedures and the patient's general health.
A mesh implant is used to reinforce the repair in many abdominal wall hernias. This is a medical material that supports the weak area. Mesh may help reduce the likelihood of the hernia returning, but risks such as infection and persistent pain are also discussed. Sutures alone may be suitable for some small openings; the decision is not the same for every hernia.
Laparoscopic Hernia Surgery may help reduce wound-related problems and shorten hospital stays in selected patients. An open approach may be needed for large, complex abdominal wall repairs. The use of mesh in a hiatal hernia is assessed separately; the principles for abdominal wall hernias do not automatically apply to it.
Treatment of a trapped hernia at the site of a previous scar can be seen in the video of Laparoscopic repair of an incarcerated incisional hernia. The video contains surgical footage intended for adults and shows one specific case.
Which changes mean you should not wait?
Incarceration can occur when the tissue in the hernia sac cannot return to its normal position. If its blood supply is also affected, this is called strangulation. This requires emergency treatment because the bowel may be damaged.
Emergency help is needed if the bulge suddenly becomes painful and hard, no longer disappears as before, the skin over it becomes red, or vomiting, abdominal swelling or inability to pass wind and stool develops. Do not try to force the hernia back in. The absence of fever does not rule out a dangerous condition.
What affects recovery time?
Going home sooner may be possible after a small, planned repair; extensive abdominal wall surgery may mean a longer hospital stay and a longer period of help at home. Light activity usually begins early. Prolonged bed rest is not the aim of recovery.
A return to light everyday tasks may be possible within days or a few weeks. Heavy lifting, physical work and extensive repairs require longer. Specific restrictions depend on the extent of surgery; the date an acquaintance returned to work is not a suitable guide for your own recovery.
Wound care, pain relief and the timing of follow-up should be explained before you leave hospital. If you develop increasing pain, fever, pus draining from the wound, persistent vomiting or inability to pass urine, contact the surgical team that day.