What is a Hernia Repair (Hernia Surgery) and how does it work?

A hernia occurs when a tissue or organ (most typically a loop of bowel) pushes through an opening in a muscle or wall within the body. Over time, even the smallest hernia can cause discomfort and swelling. Hernia repair is a type of corrective surgery in which the bulging of tissue or muscle is pushed back behind the muscle wall that normally contains it. The procedure is quite common and in 2016 alone, there were 12,601 hernia cases in Hong Kong^[1].

In this article, we will introduce everything you need to know about hernia repair – from hernia diagnosis to the process and complications of hernia surgery. While there are many types of hernia and each procedure will be slightly different, this is a general overview of the process. You should contact a general practitioner if you experience any symptoms of hernia or a general surgeon if you would like to get a second opinion about your hernia surgery. 

How do you get a hernia?

Generally, a hernia happens when a loop of bowel pushes through a muscle tissue gap. Hernias are also more likely to happen in places of previous surgical intervention due to the presence of scar tissue. You might also get a hernia because of muscle weakness or straining from heavy lifting. Pregnancy can also lead to a partial weakening of abdominal muscles and increase the chances of hernia^[2]. 

Below is a non-exhaustive list of common types of hernia:^[3]

• Inguinal hernia:  a loop of bowel pushes through a weak point within the muscle wall in the groin or inner thigh
• Incisional hernia:  a hernia which occurs in the scar of previous surgery. Usually in the abdomen
• Hiatus hernia: happens when part of the stomach pushes through an opening in the diaphragm 

How is a hernia diagnosed? 

Most patients report symptoms such as pain or a visible bulge in the abdomen or groin area. The first diagnosis usually happens in general practitioner office, where the patient will be recommended for further diagnosis by a surgeon.

During the in-depth diagnosis, the doctor will have to touch the area of the apparent hernia. To further examine the hernia, a doctor might ask you to stand up and cough or strain, as this often makes a hernia more prominent, especially in the early stages of development. Soft-tissue imaging like an abdominal ultrasound, CT scan, or MRI^[3]may be prescribed to further examine the stage of the hernia.

Is hernia repair serious? 

The seriousness of the surgery depends on how long has the condition been present and how big it is. So it’s better to get hernia diagnosed early. In many cases, the doctor will be able to discuss a suitable timeline for your hernia treatment depending on the severity. In most cases, the surgery doesn’t have to be performed immediately.

The complications of an untreated hernia are potentially more serious than the surgery and recovery^[4].Potential complications without treatment include:

• Hernia obstruction: part of the intestine gets stuck in the muscle layer it is pushing through. If untreated, this may result in strangulation.
• Hernia strangulation: this occurs when the blood flow to the organ pushing through the muscle is cut off. This is an emergency which must be treated within hours. Symptoms of hernia strangulation include nausea, vomiting and abdominal pain.

Surgery for hernia repair

There are two kinds of hernia repair^[5]: herniorrhaphy and hernioplasty. Those two surgeries differ in terms of the method used to strengthen the muscle tissue. 

• During herniorrhaphy, the surgeon will stitch the healthy ends of weak muscles together to lessen the gap and prevent organs from pushing between the muscles again.
• In hernioplasty, a mesh patch is used to add an additional layer to the muscle, thus strengthening the tissue. This option has become more popular in the last decade, and about 90% of hernia repairs in the United States now use this method.^[6]

Based the specifics of your condition, the surgeon will be able to recommend the most suitable surgery. Hernia surgery in general can be done within a day, with the patient checking in and out on the same day. The full recovery time can take a few weeks^[8]. 

Anaesthesia during hernia repair

No matter which hernia surgery your doctor recommends, the whole process is always done under some form of anaesthesia. For open hernia repair, it may be done under general, regional (spinal) or even local anaesthesia. Laparoscopic hernia repair, on the other hand, is usually performed under general anaesthesia.

Having your surgery in private practice gives you more flexibility. Your anaesthesiologist will meet you before your surgery and you will have an opportunity to raise your questions about the anaesthetic.

Complications after hernia repair 

The types of possible post-surgery complications depend on the hernia location and the type of surgery[9]. In order to ensure the lowest chance of post-surgery complications, you should feel free to talk to your doctor about pain management, as well as the healing process of the selected type of hernia repair surgery. Choosing a surgeon that understands your individual health situation is key to ensuring fast and smooth recovery.

While some patients will experience post-surgery complications, an untreated hernia has a tendency to grow over time, can become uncomfortable and prevent you from performing daily life activities and ultimately has the potential to lead to more serious complications if not appropriately managed.

Hernia surgery with OT&P Healthcare 

OT&P has a dedicated general surgery service with a specialised team of general surgeons. They are experienced in providing diagnosis, tailored treatment and comprehensive aftercare for patients with all kinds of surgical conditions – from common to the most complicated health issues.

Our doctors also have preferential arrangements with Hong Kong’s best hospitals for outpatient care. If you have any recent health concerns or are already considering a surgery – feel free to book an appointment with us for a diagnosis or a second opinion consultation.

References

1. Aphernia.org. n.d. Hernia Statistics. [online] Available at: <http://www.aphernia.org/hernia-statistics.html> [Accessed 9 October 2020].

2. DN;, L. (n.d.). Does pregnancy increase the risk of abdominal hernia recurrence after pre-pregnancy surgical repair? [online] Available at: <https://pubmed.ncbi.nlm.nih.gov/27177521/> [Accessed October 28, 2020].

3. NHS. (n.d.). Health A to Z, Hernia. [online] Available at: <https://www.nhs.uk/conditions/hernia/> [Accessed October 28, 2020].

4. Mayo Clinic. 2019. Inguinal Hernia. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/symptoms-causes/syc-20351547> [Accessed 9 October 2020].

5. Huizen, J., 2017. Hernia Repair (Herniorrhaphy, Hernioplasty): Surgery, Types, And Recovery. [online] Medicalnewstoday.com. Available at: <https://www.medicalnewstoday.com/articles/319753> [Accessed 9 October 2020].

6. Funk, L., Perry, K., Narula, V., Mikami, D., & Melvin, W. (n.d.). Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. [online] Available at: <https://pubmed.ncbi.nlm.nih.gov/23860608/> [Accessed October 28, 2020].

7. NHS. (n.d.). Inguinal Hernia Repair. [online] Available at: <https://www.nhs.uk/conditions/inguinal-hernia-repair/> [Accessed October 28, 2020].

8. NHS. (n.d.). Inguinal Hernia Repair. [online] Available at: <https://www.nhs.uk/conditions/inguinal-hernia-repair/> [Accessed October 28, 2020].

9. Medical News Today. (n.d.). Hernia repair (herniorrhaphy, hernioplasty): Surgery, types, and recovery. [online] Avaiable at: <https://www.medicalnewstoday.com/articles/319753> [Accessed October 28, 2020].