Hernia Clinic

At Spire Bushey Hospital we have an excellent team of general surgeons who are highly experienced in treating and rehabilitating those suffering with hernias. We are able to book a patient in for an initial consultation at the hernia clinic very swiftly, often the next day, and after a clinical assessment from one of our consultant surgeons, if necessary, we are able to book the patient in for surgery quickly and efficiently with excellent results.

What is a hernia? 
Who develops a hernia? 
What are the symptoms of a hernia? 
Are hernias dangerous? 
Should my hernia be repaired? 
Sportsman’s hernia (Sportsman’s groin, athletic pubalgia etc.) 
Treatment options 
Traditional vs Keyhole surgery 
Which operation is best for me? 
What to expect after surgery? 
What are the potential complications? 
When can I drive? 
When can I return to work? 

What is a hernia?

The abdominal wall is made up of 3 interwoven sheets of muscle. Although very strong, points of weakness do exist and, if stressed, these weak points may be torn open allowing a sac of the stomach lining (the peritoneum) to push through the defect. The “ hernial sac” may be empty or may contain part of the abdominal contents, commonly intestine.

The common sites for a hernia are;

  • The groin

There are 2 types of groin hernia, the medical names are inguinal and femoral. The inguinal type is most common in males and tends to sit higher up in the groin. Femoral hernias are more commonly seen in women and tend to appear very low down in the groin. The latter can be more troublesome and should prompt early specialist advice.

  • The umbilicus
  • The midline of the abdomen above the umbilicus
  • In a previous surgical scar (“incisional hernias”)

Who develops a hernia?

Hernias are very common. In children and young adults, there is frequently a congenital (present from birth) weakness. The development of a hernia is promoted by stressing the abdominal wall, as in heavy lifting, straining in the toilet or a chronic cough.

What are the symptoms of a hernia?

Typically, an ache or discomfort is noticed when the hernia first appears, followed by the appearance of a swelling. The size of the swelling is dependent on the pressure in the abdomen and is usually more obvious on standing or after exertion. Commonly, the swelling is less apparent first thing in the morning but becomes more obvious during the day.

Are hernias dangerous?

Hernias in themselves do not threaten health but are associated with the risk of "strangulation". This is a rare but emergency situation in which part of an internal organ becomes trapped in the hernia, threatening its blood supply. The patient will feel great pain in the hernia and become rapidly unwell. Urgent medical advice should be sought.

Should my hernia be repaired?

Once a hernia has appeared, the abdominal pressure will always act to increase its size, a process which may occur over weeks or months. The only exception to this is that some umbilical hernias in small children may resolve spontaneously.

It is therefore generally recommended that hernias are repaired unless there is a serious medical condition directly preventing surgery. Increasing discomfort or inability to make the hernia go back inside may forewarn of strangulation and are indications for immediate repair.

Sportsman’s hernia (Sportsman’s groin, athletic pubalgia etc.)

Groin pain afflicting sportsmen and women is a common and debilitating condition, particularly affecting runners and footballers. It covers a spectrum of conditions from “groin strain” to full-blown inguinal herniation. Diagnosis can be difficult and is usually based on clinical history and examination together with diagnostic ultrasound or MRI scanning. Treatment options include physiotherapy and steroid injection. Surgical intervention is a last resort.

Treatment Options

The best and most practical option is a surgical repair. The use of a truss (a surgical belt) is not recommended as they frequently do more harm than good.

In all hernia operations, the aim is to return the protruding contents into the abdomen (“reducing the hernia”) followed by repair of the torn muscle. When the defect in the muscle is relatively small, repair can be achieved by simple stitching in one or more layers. When the defect is larger, it is better to reinforce the damaged area using sheets of synthetic material called mesh.

Most meshes are made of surgical plastic or specially processed animal tissue. They do not dissolve but are gradually incorporated into the tissues and cannot be felt.

Traditional vs Keyhole surgery

Implantation of mesh can be achieved by more than one method. In the traditional (or “open”) operation, an incision is made over the hernia, which is deepened through the layers until the defect is identified. The mesh is then implanted and fixed in place with stitches or clips, following which the outer layers are closed. Keyhole (or “laparoscopic”) operations are usually performed by inserting a telescope inside the abdomen and placing the mesh over the defect from the inside, again fixing the mesh with clips or stitches. As technology has evolved, most hernias are now amenable to laparoscopic repair. This even includes large incisional hernias.

Which operation is best for me?

This will, of course, be discussed and advised in any consultation. Keyhole operations leave less of a scar and tend to result in a quicker return to normal activity. They are, however, more complicated and therefore, more prone to complications such as bleeding.

The operation may be performed under general ("asleep") or local ("awake") anaesthesia. General anaesthesia is to be preferred in most instances (and for all keyhole procedures) unless there is a specific medical contra-indication as it is more relaxing for both patient and surgeon. In order to have a general anaesthetic, your stomach must be completely empty for at least 6 hours prior to the time of operation (no food or drink).

Hernia operations take from 45 minutes to 1 hour to perform. At the end of the operation, local anaesthetic will be injected into the wound to minimize pain. Sometimes after groin hernia, this results in numbness or even weakness spreading down the leg which resolves after a few hours.

What to expect after surgery

Inevitably, there will be some discomfort from the wounds but, depending on the type of operation, simple painkillers should be sufficient. The majority of hernias are now repaired as day-cases, not requiring overnight stay.

What are the potential complications?

Hernia surgery is very safe. In some instances, it is not possible to complete a keyhole operation and conversion to an open approach is required. Very occasionally, excessive bruising or swelling occurs which may necessitate a return trip to the operating theatre. A minority of patients react to the mesh by producing fluid around it. This appears as a painless swelling which resolves by itself after a number of weeks. Infection of the mesh is a rare but troublesome problem, virtually abolished by antibiotics given during surgery.

When can I drive?

Not for at least 1 week and thereafter when you feel fully in control.

When can I return to work?

This obviously depends on the operation you have had and your type of employment. For groin hernias, I normally recommend 2 weeks away from office duties and 4 - 6 weeks away from heavy manual work. Similarly, heavy gardening, lifting suitcases or vigorous gym exercise should be avoided for 4 weeks. These times may be reduced following a keyhole operation.

For all other activities, please allow common sense to prevail. In general, if you are causing discomfort in the wound then you are over-doing it.

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