Understanding hernia surgery
A hernia happens when an organ or fatty tissue pushes through a weak spot in the muscle wall that is meant to hold it in. Most people first notice it as a soft bulge in the groin, at the navel, or along an old surgical scar — one that becomes more obvious when standing, coughing or lifting, and often disappears when lying down.
The important thing to understand is that the muscle gap does not close by itself. Belts and trusses only hold the bulge in temporarily; they do not repair anything. Left alone, a hernia usually gets slowly larger, and a small proportion become trapped (incarcerated) or lose their blood supply (strangulated) — a surgical emergency that carries far higher risk than a planned repair.
Dr. Ankur Patel repairs hernias using laparoscopic and robotic-assisted techniques. Instead of one long incision over the hernia, three keyhole ports are used, the defect is closed from the inside, and a wide sheet of surgical mesh is laid across the weak area to reinforce it. Because the abdominal muscles are not cut open, pain is markedly lower and most patients walk within hours.
Complex cases — very large ventral hernias, hernias that have recurred after previous surgery, and hernias in patients with obesity or diabetes — form a significant part of his referral practice.
Types & classification
The commonest type, in the groin. Far more frequent in men. Repaired laparoscopically by TEP (totally extraperitoneal) or TAPP (transabdominal preperitoneal) mesh placement.
A bulge at or just beside the navel. Common after pregnancy, in obesity and with long-standing abdominal distension.
Occurs through the scar of a previous abdominal operation, where the healed muscle layer has given way. Often large and may need abdominal wall reconstruction.
Lower in the groin than an inguinal hernia and more common in women. Has a higher risk of becoming trapped, so early repair is usually advised.
The stomach slides up through the diaphragm into the chest, causing acid reflux and heartburn. Treated with laparoscopic fundoplication when medication fails.
Less common defects in the midline above the navel, or along the lateral abdominal wall.
A hernia that has returned after earlier repair. Usually best approached through a different plane from the first operation — this is specialist work.
Symptoms & causes
Symptoms to look for
- A visible or palpable bulge in the groin, navel or over an old scar
- A dragging, heavy or aching sensation, worse by the end of the day
- Pain on coughing, straining, lifting weight or climbing stairs
- The lump gets bigger on standing and reduces on lying flat
- In inguinal hernias, discomfort or swelling extending into the scrotum
- Warning signs of strangulation: sudden severe pain, a lump that will not go back in, vomiting, fever, redness over the swelling — go to an emergency department immediately
Common causes & risk factors
- A congenital weakness in the abdominal wall present since birth
- Chronic cough — smoking, asthma, long-standing bronchitis
- Chronic constipation and straining at stool
- Difficulty passing urine due to an enlarged prostate
- Heavy manual work or repeated weight lifting
- Obesity and rapid weight gain
- Previous abdominal surgery, particularly after wound infection
- Pregnancy, ascites and anything that raises intra-abdominal pressure
- Smoking and poor collagen quality, which weaken tissue healing
When to see a surgeon
- You can see or feel a new lump in the groin, at the navel or over a scar
- An existing hernia is enlarging, or aching more than it used to
- You have groin pain on exertion even without a visible bulge
- Go to an emergency department at once if the lump becomes hard and painful, will not push back, or you start vomiting
How it is diagnosed
In most cases a hernia is diagnosed by examination alone — standing, lying and while coughing. This remains the single most reliable test.
Useful when the hernia is small, intermittent, or when the diagnosis is uncertain — for example groin pain without an obvious lump.
Reserved for large, complex, recurrent or incisional hernias, to map the exact size of the defect and its contents before planning reconstruction.
For suspected hiatus hernia, to assess the stomach, the oesophagus and any reflux damage.
Blood counts, sugar, kidney and liver profile, ECG and, where indicated, a cardiac or respiratory assessment before anaesthesia.
Treatment options
The appropriate option depends on your diagnosis, examination and general health. Your clinician will explain the benefits and risks of the available approaches.
Occasionally reasonable for a very small, painless inguinal hernia in an elderly patient with significant medical risk. It is a considered decision, not a way of avoiding surgery — and it is reviewed regularly.
The standard approach for groin hernias. Three 5–10 mm ports, mesh placed behind the muscle where abdominal pressure holds it in position. Lowest post-operative pain and fastest return to work; both sides can be repaired in one sitting.
For umbilical and incisional hernias. The defect is closed and reinforced with a composite or retromuscular mesh, avoiding the long painful incision of open repair.
Adds wristed instruments and 3D vision, which helps with fine suturing in complex, recurrent or very large defects where the mesh must be placed in a precise tissue plane.
Still the right operation in selected cases — very large scrotal hernias, patients unfit for general anaesthesia, or emergency presentations with bowel compromise.
For hiatus hernia with reflux: the hernia is reduced, the diaphragm repaired, and the top of the stomach wrapped to recreate a valve.
Preparing for treatment
- Blood tests, ECG and anaesthetic review are completed a few days beforehand
- Stop smoking as early as possible — it materially lowers the risk of recurrence
- Blood thinners, diabetes medication and some blood pressure tablets may need adjusting; bring a full list of what you take
- Nothing to eat for 6 hours and no clear fluids for 2 hours before surgery
- Treat any cough, constipation or urinary difficulty before an elective repair
- Arrange for someone to drive you home and stay with you for the first night
The procedure, step by step
- AnaesthesiaYou are put fully to sleep under general anaesthesia. You will feel and remember nothing of the operation.
- AccessThree small ports, 5–10 mm each, are placed. Carbon dioxide gas creates working space so the surgeon can see the abdominal wall from the inside.
- Reduction of the herniaThe contents of the hernia sac — fat, or a loop of bowel — are gently drawn back into the abdomen and the sac is dissected free.
- Defect closureThe muscle gap is closed with strong sutures wherever the anatomy allows, which reduces recurrence and seroma formation.
- Mesh reinforcementA wide sheet of lightweight polypropylene or composite mesh is spread over the whole weak area with generous overlap, and fixed with absorbable tacks, sutures or glue.
- ClosureGas is released, ports are removed and the tiny incisions are closed with absorbable sutures and covered with a waterproof dressing.
- Recovery roomYou wake within minutes, are given pain relief, and are usually sitting up and sipping fluids within two to three hours.
Recovery timeline
- Day 0Sit up and walk a few hours after surgery. Light fluids, then a normal diet the same evening. Most patients go home the same day or the next morning.
- Days 1 – 3Mild soreness and some shoulder-tip discomfort from the gas, both settling with simple painkillers. Walk around the house regularly. Dressings stay dry.
- Days 4 – 7Shower normally once cleared. Desk work, driving short distances and light routine are generally fine by the end of the first week.
- Weeks 2 – 4Gradually increase walking. Avoid lifting more than 5 kg, gym work and abdominal exercises. First follow-up review in this window.
- Week 4 – 6Return to gym, sport, manual work and unrestricted lifting once reviewed and cleared.
- Long termMesh integrates permanently into the tissue. Recurrence after a well-executed laparoscopic mesh repair is low — typically quoted at 1–3%.
Benefits of this approach
- Three small cuts instead of one long incision
- Substantially less post-operative pain
- Day-care or single-night stay for most repairs
- Return to desk work within about a week
- Both sides repaired in one sitting for bilateral hernias
- Lower rate of wound infection and chronic groin pain
- Occult hernias on the other side can be detected and fixed at the same time
- Cosmetically far better healing
Risks & possible complications
Every operation carries risk, and you should hear about it before you consent rather than afterwards. These are discussed individually at consultation in the context of your own health.
- Seroma — a temporary fluid collection at the site, usually settling on its own
- Bruising, and in groin repairs some scrotal swelling for a week or two
- Urinary retention, more common in older men, occasionally needing a short-term catheter
- Chronic groin pain in a small minority
- Recurrence, quoted at roughly 1–3% after laparoscopic mesh repair
- General anaesthetic and, rarely, injury to bowel, bladder or vessels — discussed in detail at consultation
What affects the cost
- Type and size of the hernia, and whether one or both sides are involved
- Laparoscopic, robotic or open technique
- Grade and size of mesh used, and the fixation method
- Whether the hernia is a first repair or a recurrence
- Room category and length of stay
- Anaesthesia, pre-operative investigations and follow-up visits
- Most hernia repairs are covered by health insurance and by government schemes where applicable — the clinic assists with cashless approval paperwork