Hernia Surgery

What is a Hernia?

A hernia in the tummy (abdominal) wall is one of the commonest surgical conditions worldwide. It arises because the inside of the tummy is naturally at a higher pressure than the outside. Under this higher pressure an area of natural weakness in the tummy wall can weaken further over time. This allows the thin, inside lining of the tummy wall to push through the weakness and create a bulge that is visible on the outside – a hernia.

Most hernias appear slowly over months or years and only gradually become discernible. For others it appears suddenly because of some strenuous activity. The commonest symptom from a hernia is discomfort in the bulge or groin. Many patients have no symptoms at all except for the bulge. The bulge is usually more visible when standing, coughing, or straining and will disappear when lying flat.

As the weakness physically affects the structures of the tummy wall it is not reversible using exercise, tablets, or creams and most will require correction with an operation.

Small hernias such as those seen on a scan without a visible bulge and minimal symptoms may not require surgery. However, hernias that are visible, increasing in size or with symptoms of discomfort will require surgery to remove the bulge and repair the weakness. Patients with a small bulge but significant pain need to be assessed in case the pain is coming from something other than the hernia.

An unusual cause for hernia pain is when part of the bowel becomes trapped in the hernia bulge and starts to lose its blood supply. This condition is called strangulation. It usually occurs in larger and longer established hernias. Hernia strangulation requires emergency surgery. Although this condition is rare an elective hernia repair is usually offered to patients with a hernia to prevent this from occurring.

At New Victoria Hospital our nationally-acclaimed Hernia Surgeons offer the latest cutting-edge surgical investigations and treatment to deal with a range of hernia types and investigate hernia related pain.

This management is part of a multidisciplinary team that includes experienced nurses, specialist physiotherapists and our Hernia Consultants who make sure every patient who has a hernia or undergoes private hernia surgery at New Victoria Hospital enjoys the highest standards of care in a comfortable and friendly environment.

What is a Hernia?

The majority of hernias occur through an area of natural weakness in the tummy wall and are named after the area of weakness.

The most common hernias are found in the groin, others occur through the middle of the tummy wall and are collectively called ventral hernias while there are a few unusual hernias at other sites.

Inguinal Hernia – This is the commonest type of abdominal hernia. The hernia bulge tracks along the inguinal canal just above the oblique crease at the bottom of the tummy wall on either side. A subtype of the inguinal hernia is the Sportsman’s hernia. It is often associated with significant chronic or occasionally sudden groin pain in very active individuals and may be due to tearing of tissues in and around the inguinal canal.
Femoral Hernia – the hernia bulge tracks along the femoral canal at the top of the inner thigh next to the pubic bone but below the inguinal canal.

Ventral Hernias

Umbilical/Paraumbilical Hernias – the hernia bulge pushes through the natural weakness found at the navel (belly button).
Epigastric Hernia – the hernia bulge pushes through a small weakness in the tough layer of the tummy wall called the linea alba found between the six pack muscles. These occur above the navel.
Incisional Hernia – a special type of ventral hernia in which the deeper layer of an old abdominal wound breaks down and the hernia bulge protrudes through under the skin.

Rare Hernias

These include Spigelian, obturator and lumbar hernias

Hernias may occur elsewhere in the tummy wall such as in and around the diaphragm – hiatus hernia and diaphragmatic hernias, or between folds of the bowel within the tummy cavity – internal hernias. They may also occur in the leg where muscle pushes through the tough layer of fascia surrounding them and can be felt under the skin. These are not covered here.

Diastasis Recti (Divarication of Rectus Abdominis)

Some patients experience a condition where the six pack muscles move apart and stretch the tissue between them, the linea alba. This creates a long triangular shaped bulge, down the middle of the tummy from bottom of the breastbone to the navel seen when starting to sit forward. It most often occurs after pregnancy or in patients who have put on weight around the middle and stopped exercising. Although the bulge is often called a hernia by non-hernia specialists, it is not a true hernia as there is no specific point of breakdown where the tummy lining bulges through. Most patients do not require surgery for this condition. It should be noted that if a patient wants to correct this type of bulge surgically, Insurance Companies consider it to be cosmetic and will not fund the operation.

When Does a Hernia Require Surgery?

If you have been diagnosed with a hernia a number of factors will be taken into account by a Hernia Consultant when deciding whether surgery is required:

The type of hernia - strangulation or obstruction is more likely in certain types of hernia so a specialist may feel it is best to remove that risk.

The content of the hernia- if the hernia contains bowel that cannot be pushed back into the tummy cavity (reduced) the chances of strangulation increases.

It’s Impact on daily life - if a hernia is stopping a person from carrying out exercise or their daily activities, or has discomfort that is intrusive; repairing it may be the only way the issues can be rectified.

Hernia Treatment at New Victoria Hospital

There are two main surgical methods that we use to treat hernias at New Victoria Hospital:

Open surgery - a surgeon makes an incision close to the hernia, allowing a surgeon to remove the bulge and repair the weakness. This type of surgery is usually performed under general anaesthetic although in certain circumstances can be performed under local or regional anaesthetic.
Keyhole (laparoscopic) surgery - a surgeon makes several small cuts away from the site of the hernia to introduce a camera and long, slim instruments inside the tummy and down to the hernia site. A less invasive form of surgery, it is mostly used for patients with groyne hernias, particularly where there is a hernia in both groynes or a recurrent groyne hernia following previous open surgery. This type of surgery is always performed under general anaesthetic.

Your surgeon will discuss with you the relative merits of the types of surgery, type of anaesthetic and your suitability for each operation at your consultation. Straight forward hernia surgery usually takes about 45 minutes, and most people can go home the same day or the day after surgery.

In both types of surgery the Surgeon will usually use a synthetic mesh, often made of polypropylene, to cover the hernia weakness, after removing the bulge. There has been a significant amount of publicity in the press about mesh over the past few years, particularly mesh used in the pelvis for some types of bladder operation. This is not the same as using mesh for hernia surgery but for patients concerned about the use of mesh in hernia surgery the Royal College of Surgeons of England and British Hernia Society have each drawn up statements that may be useful.

Although most hernias can be diagnosed after an examination, for those that require a scan patients at New Victoria Hospital enjoy point-of-care access to a state-of-the-art imaging suite that boasts the very latest imaging equipment, including MRI, CT and ultrasound.