Hernia Surgery: The Complete Guide
Hernia surgery is the only cure for adult hernias and one of the most common operations in the world. Laparoscopy and modern meshes have made it safe, with fast recovery.
Contents
When do you need hernia surgery?
- A symptomatic hernia (pain, heaviness, limiting work or sport).
- A hernia that is growing.
- Femoral hernia — almost always.
- Inguinal hernia in children and in women.
- Incarcerated or repeatedly incarcerated hernias.
- Strangulated hernia — emergency surgery.
Selected cases may be observed: treatment without surgery.
Principles of repair
Whatever the technique, hernia repair means: identify the hernia, reduce the contents or excise the sac, close or narrow the defect, and reinforce the wall — usually with mesh — to prevent recurrence.
Types of hernia surgery
Open surgery
- Lichtenstein repair: the gold-standard open inguinal repair since the 1980s; a tension-free mesh through a 5–7 cm incision; feasible under local anaesthesia.
- Shouldice repair: multilayer suture repair without mesh, excellent in specialist centres.
- Open umbilical/epigastric repair with preperitoneal mesh, or sutures for very small defects.
- Open abdominal wall reconstruction: Rives-Stoppa, TAR and component separation for large incisional hernias. See incisional hernia.
Laparoscopic surgery
| Technique | Full name | Concept | Use |
|---|---|---|---|
| TAPP | Transabdominal preperitoneal | Enter the abdomen, open the peritoneum, place mesh behind it | Inguinal & femoral |
| TEP | Totally extraperitoneal | Work entirely outside the abdominal cavity | Inguinal & femoral |
| eTEP | Extended TEP | Expand the retromuscular space | Large inguinal, midline & incisional |
| IPOM | Intraperitoneal onlay mesh | Coated mesh inside the abdomen | Ventral hernias |
| TAR (lap/robotic) | Transversus abdominis release | Posterior component release | Large hernias |
Advantages: less pain, faster return to work, less chronic pain than open inguinal repair, bilateral repair through the same ports, detection of occult hernias, fewer wound infections and better cosmesis.
Disadvantages: usually requires general anaesthesia, specialised expertise with a longer learning curve, and higher equipment costs.
Robotic surgery
Same principles with 3D vision and articulated instruments — useful in complex hernias and abdominal wall reconstruction, but costlier and less widely available.
How does the surgeon choose?
Hernia type, location and size; unilateral or bilateral; primary or recurrent (and the previous approach); age and fitness for general anaesthesia; previous abdominal surgery; patient preference and occupation; and surgeon expertise — a decisive factor.
Anaesthesia
General for laparoscopy and most large hernias; spinal for open inguinal repair; local with sedation — an excellent option for Lichtenstein repair in selected patients.
Preparation
- Pre-operative tests: blood tests, glucose, kidney function, ECG as appropriate.
- Stop smoking 4–6 weeks before.
- Weight control, especially for large ventral hernias.
- Control diabetes and blood pressure.
- Review medications, especially blood thinners — never stop them without medical advice.
- Fasting as instructed (usually 6 hours for food).
- Treat cough, constipation and prostate problems.
- Arrange help at home for the first days.
How long does it take?
| Operation | Approximate time | Stay |
|---|---|---|
| Unilateral inguinal hernia | 30–60 min | Usually day case |
| Bilateral laparoscopic inguinal | 60–90 min | Day case or one night |
| Umbilical / epigastric | 30–60 min | Day case or one night |
| Medium incisional hernia | 1–3 hours | 1–3 days |
| Giant hernia reconstruction | 3–6 hours | Several days |
| Laparoscopic hiatal hernia | 1.5–3 hours | 1–2 days |
Success rates
Most patients become symptom-free and return to normal life. Recurrence after specialist mesh inguinal repair is low; it is higher in large incisional hernias, smokers and obesity. Studies consistently show that specialisation and volume in hernia surgery improve outcomes.
Next: recovery after hernia surgery, hernia mesh and possible complications.
Frequently asked questions
Is hernia surgery dangerous?
Can hernia surgery be done under local anaesthesia?
Do I need mesh?
Can both sides be repaired in one operation?
Scientific references
- HerniaSurge Group. International guidelines for groin hernia management. Hernia 2018
- Bittner R et al. Update of guidelines for laparoscopic treatment of ventral and incisional hernias (IEHS). Surg Endosc 2019
- Lichtenstein IL et al. The tension-free hernioplasty. Am J Surg 1989
- Novitsky YW et al. Transversus abdominis muscle release. Am J Surg 2012
⚠ This website is for health education and does not replace a medical examination. If you develop sudden severe pain at a hernia, vomiting, or the bulge changes colour, go to the emergency department immediately.