Once an abdominal hernia occurs it tends to increase in size. If your hernia is not painful, is not getting larger, and is not trapped, you may choose to wait to have surgery. If you choose to wait, it is important to contact your doctor if you feel the hernia is getting bigger or if you experience sudden pain in the hernia. There are benefits and risks with both waiting and surgery. You should discuss both options with your doctor.

If after discussion with your surgeon, you have decided to adopt a watch and wait approach, it is important to avoid strenuous physical activity such as heavy lifting or straining with constipation. Some patients may find that a truss makes them more comfortable.

It is important to contact you doctor immediately if your hernia is getting bigger, more painful, if you develop nausea, vomiting, constant pain or discomfort in the hernia, or if the bulge does not return to normal when lying down or when you try to gently push it back in place. Ultimately, surgery is the treatment in almost all cases.

There are risks to not repairing a hernia surgically. Left untreated, a hernia may become incarcerated, which means it can no longer be reduced or pushed back into place. With an incarcerated hernia the intestines become trapped outside the abdomen. This could lead to a blockage in the intestine. If it is severe enough it may cut off the blood supply to the intestine and part of the intestine might actually die.

When the blood supply is cut off, the hernia is termed "strangulated." Because of the risk of tissue death (necrosis) and gangrene, and because the hernia can block food from moving through the bowel, a strangulated hernia is a medical emergency requiring immediate surgery. Repairing a hernia before it becomes incarcerated or strangulated is much safer than waiting until complications develop.

With traditional surgery, up to 10% of hernias can recur after operation.

With modern techniques and in the experienced hands of surgeons at The Scottish Hernia Centre, recurrence rates of less than 1% can be expected with inguinal and femoral hernia repair.

Recurrence rates of around 5% can be expected after incisional hernia repair with mesh (up to 1/3 will recur if no mesh is used).

Surgery is considered the only cure, and the prognosis is excellent if the hernia is corrected before it becomes strangulated.

There are two ways to fix an inguinal hernia

Open/Tension Free Repair

This is performed from the outside through a 2-3 inch incision in the groin or directly over the hernia. The incision will extend through the skin, underlying fat layer to allow the surgeon to get to the hernia and defect or hole in the muscle layer.

The contents of the hernia replaced back in the abdomen. A repair is then usually performed using a small piece of surgical mesh to cover the defect or hole. Surrounding tissue grows through the mesh, strengthening the area of weakness and permanently holding it in position.

This technique is usually performed with a local anaesthetic and sedation but may be performed using a spinal or general anaesthetic.

Any operation may be associated with complications. These include a small risk of bleeding and infection. There is a small risk of damage to the blood vessels that supply the testicle or to the vas deferens (the sperm tube coming from the testicle).

Laparoscopic surgery also carries a small risk of injury to the urinary bladder and the intestines. Difficulty urinating after surgery is not uncommon and may require a temporary tube or catheter into the bladder.

Any time a hernia is repaired it can come back. This long-term recurrence rate after an open mesh repair is very low (1% or less). The long-term recurrence rate after laparoscopic repair is also low although perhaps not quite as low as after open operation.

Most hernia operations are performed on a day-case basis i.e. you will usually be able to go home on the same day that the operation is performed. You should refrain from eating or drinking after midnight on the night before your operation. You should shower the night before or the morning of the operation. Some preoperative testing may be required depending on your medical condition and the type of anaesthesia needed for your operation.

 If you take medication on a daily basis, discuss this with your surgeon as they may want you to take some of your medications on the morning of surgery with a sip of water. If you take aspirin, blood thinners (e.g. warfarin) or arthritis medication you need to discuss with your surgeon the proper timing of discontinuing these medications before your operation.

Following the operation, you will be transferred to the recovery room where you will be monitored carefully until you are fully awake. Depending on the timing of surgery and your recovery, you may be able to be discharged home on the day of surgery. Alternatively, you may require an overnight stay.

With any hernia operation, you can expect some soreness. This will be mostly during the first 24 to 48 hours. You are encouraged to be up and about the day after surgery. Most patients can get back to normal activities within a short amount of time.

These activities include showering, driving, walking up stairs, lifting, work and sexual intercourse. A follow-up appointment will generally be made for between 2 and 8 weeks after your operation.

If you have prolonged soreness and are getting no relief from the prescribed pain medication, you should notify either your own GP or the hospital. similarly, if you begin to have fever, chills, vomiting, are unable to urinate, or experience drainage from your incisions, you should call the hospital immediately.

Laparoscopic/keyhole surgery

For many hernias, it is possible to perform the repair using keyhole techniques (laparoscopic surgery). In this type of surgery, a long thin tube which has a camera attachment is passed through a small cut in the skin. This allows the surgeon to perform the operation by looking at a television monitor that is attached to the camera.

The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh is fixed over the hernia defect and held in place with small surgical staples.

Three small incisions are usually necessary. This operation is usually performed with general anaesthesia or occasionally using regional or spinal anaesthesia. This technique may allow the patient to enjoy a shorter recovery time and experience less post-operative discomfort.

When synthetic meshes (many are made from polypropylene which is similar to nylon) were first introduced more than 30 years ago, the manufacturers tended over-engineer the mesh. These early heavyweight meshes were very robust but were more than 10 times stronger than they needed to be. The heavier the mesh, they more it shrank and we now also increasingly of the opinion that patients are more likely to get long-term discomfort with these heavier meshes.

As a consequence, manufacturers have introduced a range of newer lightweight meshes. Some of these are partly absorbable to further reduce the amount of synthetic material that stays in long-term. Others companies have also introduced a sticky side to the mesh (a little like Velcro) to allow the mesh to stay in place so the surgeon does not need to introduce any stitches (again, a potential cause for discomfort after operation.

At the Scottish Hernia Centre, we use the latest high tech meshes to minimise discomfort and reduce the risk of longer term pain.