By Dr Ananya Mandal, MD
As soon as a hernia is diagnosed, a doctor will need to decide whether or not surgery is required to repair it.
Although hernia that are left untreated do not usually resolve on their own, they do not necessarily worsen either and sometimes the benefits of surgery do not necessarily outweigh the risks.
However, some forms of hernia are more dangerous than others and are at risk of becoming strangulated or causing bowel obstruction, for example.
Depending on how serious the symptoms are and the patient’s general health status, a doctor may decide that surgery is the most appropriate treatment approach.
Treatment outline for hernia
- Surgery is usually recommended in cases of hernia that are likely to become strangulated or cause obstruction. In cases of uncomplicated hernia, the contents of the hernia are pushed back into the cavity they are usually contained in and the weakness in the wall is then mended. This type of operation is called herniorrhaphy.
- In cases of complicated hernia that has resulted in an obstruction or strangulation, the herniated organ is first checked to see if it is healthy and resection is performed if necessary.
- In cases of large defects in the muscle wall that cannot be bridged and repaired using herniorrhaphy and sutures, a mesh prosthesis may be required. If large defects are pulled together for repair, they may further weaken the wall leading to recurrence of the hernia after the surgery. Instead, a surgical mesh is placed over the opening (in the case of anterior repair) or under the opening (for posterior repair). This technique is sometimes referred to as “tension free” repair because the muscles are not pulled together and mended under tension. Studies suggest that tension free repair is associated with lower rates of hernia recurrence and faster recovery than tension suture techniques.
- Laparoscopic hernia repair – Unlike open surgery, where a large incision is required to perform the repair, laparoscopic or keyhole surgery is minimally invasive and requires only small incisions to be made for the insertion of a camera and surgical instruments. Images of the inside of the abdomen are relayed to a TV monitor to guide the surgeon so that surgery can be targeted and accurate.
Reviewed by Sally Robertson, BSc
Last Updated: Aug 19, 2014