Hernia FAQ

What is Hernia?

It is the protrusion (bulge) of abdominal viscera through a weakened part of abdominal wall.

  • Both men and women can get a hernia.
  • One may be born with a hernia (congenital) or develop over a period of time.
  • A hernia does not get better with time, nor will it go away by itself (except very small congenital naval hernia). It always grows bigger with time.


What are the common types?

The common types of hernia occur in the groin (inguinal), belly button (umbilical) and at the site of a previous operation (incisional). There are many more types but are rare.

What is the incidence in the Indian population?

About 10% of the adult male population will suffer from a hernia at some period during their life time. The incidence of inguinal hernia is more in males and incisional/ umbilical hernias occur commonly in females.


How it can be detected or what are its symptoms?

It is usually easy to recognize a hernia. One may notice a bulge under the skin or may feel pain and observe a swelling popping out, when one lifts heavy objects, during urination or bowel movements or during prolonged standing, sitting or coughing.

The pain may be sharp initially or a dull ache that becomes worse towards the end of the day or after physical activities.


What is strangulation of Hernia?

Severe continuous pain, redness and tenderness are signs that the hernia may be entrapped or strangulated. These symptoms are a cause for concern and should immediately be reported to a surgeon for emergency surgery.


Once detected, when and how should Hernia be treated?

Once detected the hernia should be treated as early as possible because it provides the best results. The natural course of a hernia is a slow increase in size over a period of time. Also, early operation will prevent complications like obstruction and strangulation. Surgical results of a large hernia are not as good as the results following an early operation.


Can hernia be life threatening?

It can be life threatening if strangulation of a loop of bowel occurs in the hernia.


What is the treatment for a hernia?

Surgery is the only cure for majority of hernias unless and until there are contraindications to surgery due to poor general health or organ failure. All other methods like truss etc. are not only useless but also worsen the situation by causing damage to the muscles due to constant pressure (hence less blood supply to the muscle).


What are the types of surgery available for curing a hernia?

  • Laparoscopic surgery (also known as Minimal Access Surgery/ Minimally Invasive Surgery/ Endoscopic surgery/ Keyhole Surgery)
  • Conventional Open Surgery


How is the Laparoscopic repair for a hernia done?

In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a trocar (a small hollow tube) allowing the surgeon to view the hernia and the surrounding area on a video screen. Other trocars are inserted which allow the surgeon to work in the abdomen. The hernia is repaired from behind the abdominal wall. A piece of surgical mesh is fixed over the hernia defect and held in place with small surgical staples or stitches. Usually 2 to 3 small incisions are necessary. This operation can be performed under general/ regional/ spinal/ local anaesthesia.


What are the advantages of Laparoscopic Surgery over the conventional open surgery?

Laparoscopic surgery causes less pain and patients are mobile within hours after surgery. They are also allowed to resume all activities after 4 -5 days and can go back to work within 5-7 days. Another advantage is that both sides can be operated on simultaneously without any extra pain or stay. The cosmetic results are excellent.


Is it necessary to use the mesh in all the cases?

Yes. Now world over there is consensus that the use of mesh is desirable in majority of the cases to strengthen the wall whether it is done conventionally or endoscopically. Only the childhood hernias are repaired without using a mesh.


Is Laparoscopic surgery safe?

Yes, when performed by a trained surgeon in a well equipped centre, used to managing these operations regularly, it is a safe surgery with excellent results.

We started performing Lap. groin hernia repairs in 1991 as one of the first centers in India to offer laparoscopic hernia repair. Over these years we have built a formidable experience. Initially groin hernias were repaired through an intra abdominal approach( T.A.P.P. repair ). Since 1996, we started a technique called Total Extraperitonial repair (T.E.P.). Lap Hernia repair is definitely recommended in bilateral and recurrent hernia after open surgery. By using a large piece of prosthetic material like prolene mesh of 12×15 cm the incidence of recurrence is almost negligible. In our own series of the last 1800 cases we have seen no recurrence with Lap repair of groin hernia. Our target is a zero recurrence rate.


How is Incisional Hernia treated?

Laparoscopic repair of ventral incisional Hernia started gaining popularity since 1993 when it was first introduced by Dr LeBlanc from U.S.A. The major advantage over conventional open repair is the marked reduction in recurrence rate (less than 4% as compared to 16% in open repair), less wound related complications and faster recovery.

In laparoscopic technique the mesh is placed from inside the abdomen in the sublay fashion and fixed with sutures and fixing devices on to the peritoneum. We have been performing this procedure routinely and our recurrence rate is 2% and infection rate is 1.8%. It is the ideal procedure for recurrent Incisional hernia. The patient recovery and return to work is very quick compared to open surgery. The use of very high quality Dual mesh is ideal if cost is not a problem otherwise there are cheaper options like prolene mesh or Ultrapro mesh. This procedure is carried out with only three ports.

With hernias larger than 8cm defect, we now offer a newer technique called AWR (Abdominal Wall Reconstruction). In this large Prolene 20 X 30 or 30 X 30 size mesh is placed in retro muscular plane. This technique carries very low recurrence rate. Very few centers in India are offering this newer technique.


Image acknowledgment: Hernia Center Southern California