Hernia Surgery - What should I know?

Does my hernia even need to be repaired?

In short, not always. Even though the basic assumption is that surgeons work to do surgery, this is not always true. If a hernia isn’t causing symptoms, is at low risk of causing future problems or you have other medical problems that make surgery unsafe, there may be a role for simply watching the hernia to ensure it doesn’t get worse. Just because you see a surgeon doesn’t mean you have to have surgery.

What are the alternatives to having hernia surgery?

If a hernia isn’t repaired, it will either stay the same or get worse over time. It will not get better by itself. However, if surgery isn’t the right option, hernias can be managed by avoiding certain activities (e.g. heavy lifting) or with trusses or specially designed hernia belts.

It’s important to know that hernias can happen all over the body (e.g. hiatus hernia or groin hernia) and the specifics of deciding upon the surgery route vary between individuals. The results are dependent on many factors. It’s always important to talk through the specifics with your surgeon and bring up any questions or expectations you have.

What are the options for fixing a hernia?

The right answer depends on you and the specific nature of the hernia and it’s size/ location etc. In broad terms, the surgery is done via a traditional, open approach or via a key-hole (laparoscopic/ robotic) approach. The other notable decisions are around whether mesh is required (see below)

To mesh or not to mesh?

In some types of hernias (e.g. groin hernias), the use of surgical mesh is both safe and effective. Mesh is used to strengthen the area and repair the hernia by providing support.  Without mesh, the risk of the hernia coming back can be as much as 10x higher.

In other specific incidences, there are some hernias (e.g. hiatus hernia) which are almost always repaired without mesh.

It’s important to raise any concerns with your surgeon to understand your options and non-mesh alternatives.

Mesh Position Statement – New Zealand Association of General Surgeons – READ MORE

How do I pick the best hernia surgeon for me?

There really is no such thing as the ‘best hernia surgeon.’ Most general surgeons in New Zealand repair hernias on a regular basis with excellent outcomes. As long as you’re looked after by someone who is trained in the surgery (e.g. a General Surgeon) and does it regularly, you’re in safe hands. Depending on the type of hernia you have, it may be worthwhile for you to see someone who can offer the bespoke approach (open, laparoscopic or robotic) for you.

Why is there still a lump after my groin hernia surgery?

Longstanding hernias have often made a space for themselves and stretched out the skin and connective tissue around them – hence the lump. After surgery, when the hernia is fixed, that potential space still exists and the body thus fills it up with fluid. This is called a seroma. It usually settles down in time and doesn’t need any specific treatment as the body reabsorbs the fluid. It’s usually best not to drain the fluid as sticking needles increases the risk of bleeding and infection and the body will reabsorb it in time anyway. If the lump feels hard, it may be a blood clot or very rarely, an early recurrence of the hernia. It is reasonable to expect your surgeon will investigate all these options appropriately.

After hernia surgery will it be painful and will I feel any altered sensation?

Most patients who have hernia surgery (especially groin hernia surgery) have some form of altered sensation. Ongoing pain is uncommon. All of this, however, is part of the healing process and settles down in the first few weeks after surgery. The different hernia orifices have nerve endings and in the case of groin hernias, are pathways for nerves to travel through. Less than 5% of people have ongoing symptoms that last beyond 6 months and in this case, there are options available to treat symptoms.

What happens if my hernia comes back?

The risk of a hernia coming back is low but not zero. If a hernia comes back, it doesn’t necessarily mean that you or the surgeon are to blame. In many cases, the inherent risk factors (e.g. age, weight) that led to the hernia in the first place still exist. Depending on the type of hernia, type of recurrence and symptoms etc, it is often possible to repair the hernia again.