Protrusion of contents of the abdomen through a weakness in the abdominal wall

Why is an operation needed?
    • Incarceration- The contents getting stuck in the hernia lump and not going back in the abdominal cavity
    • Obstruction- Trapping of bowels in the lump leading to blockage of lumen
    • Strangulation- Compromise of blood supply to the bowel leading to necrosis
How is the hernia repaired?
  • Open Surgery-
    • Incision made over the lump to dissect the hernia and identify the defect
    • The defect is then repaired either with stitches or a surgical mesh
  • Laparoscopic Surgery-
    • Laparoscopic instruments inserted through holes in the abdomen
    • Any defect is then repaired by use of a special mesh

Abdominal wall hernias occur due to an abnormal protrusion of contents of the abdomen (bowels) through a weakness in the abdominal wall causing a lump.

The most common sites of weakness are:

  • Umbilical/Paraumbilical Hernia- area in and around the umbilicus is a site of natural weakness in the way babies develop in the womb.
  • Epigastric Hernia – Area along the midline above the umbilicus.
  • Incisional Hernia – Any old incisions on the abdomen due to prior surgery are potential weak spots.
  • Lateral Hernia- Any hernias away from the midline (Spigelian) or in the loins are rare but known to occur due to anatomical weak spots.
Do I need an operation?
  • Most people with a hernia present with pain and discomfort with an increase in the size of the hernia over time and repairing the hernia will alleviate the pain.
  • Only surgery can repair the hernia as it will not go away on its own.
  • Hernia is a potentially dangerous condition requiring emergency surgical repair due to:
    • Incarceration- The contents may get stuck in the hernia lump and not go back in the abdominal cavity resulting in a hard lump causing severe pain.
    • Obstruction- If the bowels get trapped in the lump it can blockage of its lumen leading to pain abdominal distension and vomiting.
    • Strangulation-In more serious cases the blood supply to the bowel can get compromised leading to necrosis (death) of the bowel affected.
How is the Hernia repaired?
  • Surgery to repair any abdominal wall hernias is usually performed under a general anaesthesia.
  • The operation can be undertaken laparoscopically (keyhole), however the decision regarding the approach (laparoscopic/open) is taken upon assessment of each individual case.
  • The extent and duration of surgery depends:
    • Hernia- Site and size of hernia and recurrent or incisional hernia
    • Patient factors- BMI and general fitness
  • Open Surgery-
    • The incision is usually made over the lump (length depending on the size of the lump) to dissect the hernia from surrounding structures and identify the defect.
    • The defect is then repaired either with stitches or a surgical mesh depending on the size of the hernia and patient’s individual characteristics.
  • Laparoscopic Surgery-
    • It is performed by inserting laparoscopic instruments through 3-4 tiny holes at the side of the abdomen and the hernia is repaired from the inside.
    • The defect is then repaired by use of a special mesh which is secured with staples.
Are there any alternatives?
  • There are no other effective treatments for the management of abdominal wall hernia.
  • If the hernia is small and does not cause you any discomfort, then leaving it alone may be entirely appropriate.
  • There may be certain situations where your doctor may think avoiding surgery may be a safer option – this usually relates to the presence of other medical issues and complexity of the case.
How long will I be in hospital?
  • Most patients with small hernias will come into hospital on the day of their operation and will be able to go home later the same day (day stay).
  • Surgery for recurrent and incisional hernias can be very complex and involve a prolonged stay in the hospital with intensive care support if needed.
What complications can occur?

Small abdominal hernia repair is a routine operation with very few risks, however surgery for large recurrent and incisional hernias carry significant morbidity and each individual risk will be explained during the consent process.

  • Early Complications:
    • Damage to internal structures (bowel)
    • Wound infection or hematoma (blood collection)
    • Seroma (clear tissue fluid collecting in the space left by the hernia)
    • Your intestines can get blocked by getting caught in scar tissue causing intestinal obstruction which might need surgery (this is rare)
    • Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE)
  • Delayed Complications:
    • Unsightly scarring
    • Recurrence of the hernia