Hernia Surgery

A hernia happens when there’s a defect in the abdominal wall (groin, belly button, prior incision, etc.), letting tissue protrude and cause a lump, discomfort, or pain—especially when coughing, lifting, or standing.

Hernia surgery aims to put the bulging tissue back where it belongs and close/reinforce the hole to prevent it from popping out again.

There are multiple approaches:

Open repair

• A small incision is made over the hernia.
• The protruding tissue is gently pushed back inside.
• The defect is closed with sutures, and usually a mesh patch is added to reinforce the area.
• Often done with local anesthesia plus sedation or general anesthesia.

Minimally invasive (laparoscopic or robotic) repair:

• Several tiny incisions.
• The abdomen is inflated with gas; a camera and instruments are used from the inside.
• The hernia opening is covered from the inside with mesh and secured (tacks/sutures/glue), sometimes with stitches closing the defect first.
• Always done under general anesthesia.
• Typically less post-op pain and quicker return to activity for many patients, especially for bilateral or recurrent hernias.

What is “mesh” and why use it?

• Mesh is a medical-grade net-like material that spreads tension across a larger area, lowering recurrence rates compared with stitches alone for most adult hernias.
• Types include synthetic (most common) and biologic (used selectively). Your surgeon chooses based on hernia type, size, location, and your health.

Step-by-step (typical flow)

1. Anesthesia and prep: You’re made comfortable/asleep; the skin is cleaned.
2. Access: Incision(s) are made—one larger for open, a few small for minimally invasive.
3. Reduce the hernia: The bulging tissue is returned to the abdomen; any hernia sac is addressed.
4. Repair and reinforce: The hole is closed (if appropriate) and reinforced—usually with mesh.
5. Close and recover: Incisions are closed with sutures or glue; you go to recovery.

Your surgeon will provide you with guidance on how to prepare. You can expect instructions on eating and drinking, including that you stop eating or drinking the night before surgery.

If you smoke, you will be advised to stop to improve healing outcomes. Depending on your weight, you may be advised to diet and exercise to reduce surgical risks and improve healing outcomes.

Hernia surgery is common, and considered low risk, but, as with all surgery, carries inherent risks, such as bleeding, infection, blood clots, and anesthesia complications.

Risk depends on hernia type (inguinal, umbilical, ventral), technique (open vs laparoscopic/robotic), mesh use, your health, and surgeon experience.

In rare cases, there is a risk of:

• Recurrence (hernia comes back)
• Chronic pain (inguinal neuralgia or discomfort >3 months), sometimes from nerve irritation or scar
• Mesh-related issues (if mesh used): infection, rejection, contraction, or adhesions; sometimes requires mesh removal (uncommon)
• Injury to nearby structures:
  • Inguinal repairs: nerves, blood vessels, spermatic cord/vas deferens (may affect fertility in rare cases), testicular blood supply (can cause testicular atrophy—rare)
  • Ventral/umbilical repairs: bowel injury or obstruction; adhesions
• Bleeding/hematoma requiring return to OR (rare)
• Anesthesia complications (heart/lung issues, blood clots/PE—rare)

In most cases, delaying hernia surgery does come with significant risks:

• Worsening pain, pressure, and a bulging
• Defects often grow over time, making later repair more complex with bigger mesh and longer recovery.
• Incarceration: hernia contents get stuck and can’t be pushed back in, causing pain and potential bowel blockage.
• Strangulation: trapped intestine loses blood supply (emergency). Higher complication rates and risk of bowel resection than elective repair.
• Skin/soft-tissue changes: thinning skin, ulceration, large hernia sacs that complicate repair.
• Reduced quality of life: activity avoidance, deconditioning, weight gain, core weakness.
• Higher emergency surgery risk: emergencies have more complications, infections, and recurrence than planned operations.