What Type of Hernia Requires Surgery?

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Hernias don’t usually get better on their own. They tend to get bigger and put you at risk of life-threatening complications. Surgery may be required, but not all hernias need surgery immediately and some may not need treatment at all if they don’t become symptomatic.

So, what type of hernia requires surgery? Unfortunately, it is not that simple. There are a number of factors that should be considered when deciding to have hernia surgery. One factor is the type of hernia as some types of hernia are more likely to become strangulated or cause a bowel obstruction than others. You should also consider the content of your hernia, for example, if it contains part of your bowel or muscle, you may be at risk of strangulation or obstruction; your symptoms and their impact on your daily life; and your general health.

A highly experienced West Valley Hospital hernia surgeon can discuss with you whether your type of hernia requires surgery or not, taking into consideration the type and content of your hernia, your risk of complications, any symptoms you are experiencing, and your health.

Surgery and the severity of hernia symptoms

Strangulated and obstructed hernias are medical emergencies requiring surgery as soon as possible.

  • Strangulation - occurs when the blood supply has been cut off to a section of organ or tissue that is trapped in the hernia. Strangulated organs will die and need removing quickly to prevent you from becoming seriously ill.
  • Obstruction - sometimes called an incarcerated hernia, happens when a tissue such as your bowel becomes trapped. It can lead to strangulation if left untreated.

Other hernias recommended for surgery are hernias that are causing you pain or discomfort, or growing larger.

You may be able to watch and see if you need hernia surgery if your hernia is small or causes no symptoms. Watchful waiting may also be recommended if you have a reducible hernia that goes away when you lie down or you can push it back into your abdomen. Some people being treated for other conditions, such as those receiving chemotherapy, may also wait and watch.

Surgery and the type of hernia

Whether to have surgery is also based on the type of hernia you have. For example, surgery is almost always recommended straight away if you have a femoral hernia due to a higher risk of complications developing.

Similarly, surgery is recommended for most adults with an umbilical hernia as it is unlikely that their hernia will get better by itself and the risk of complications is higher. However, young children with an umbilical hernia are generally advised to wait and see if it disappears by the age of four or five providing it isn’t large. Surgery may then be recommended if the hernia hasn’t gone by this time.

If you have an inguinal hernia, surgery is usually recommended if it causes pain, severe or persistent symptoms, or if any serious complications develop.

Not everyone with a hiatal hernia requires surgery. Most hiatal hernias do not cause symptoms, so surgery is not usually necessary. Many people are able to treat any mild symptoms, such as heartburn, acid reflux, or gastroesophageal reflux disorder (GERD), with medication or lifestyle changes.

What are the different types of hernia?

Your muscles are usually strong and tight enough to keep your organs and intestines in place. However, a hernia can develop if there are any holes or weak spots in your muscles that an internal organ or tissue can push or protrude through. A hernia most often occurs in your abdomen or groin.

The most common types of hernia include:

  • Inguinal hernia - sometimes called a groin hernia. It occurs when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh into an area called the inguinal canal. Inguinal hernias are by far the most common type of hernia, with men being far more susceptible to them they have a small hole in their groin muscles where blood vessels pass through to their testicles.
  • Femoral hernia - also happens when fatty tissue or part of your bowel pokes through into your groin at the top of your inner thigh. With a femoral hernia, the tissue or bowel passes through a weak spot in the abdominal wall into an area called the femoral canal. They are much less common than inguinal hernias and occur more frequently in older women due to the wider shape of the female pelvis.
  • Umbilical hernia – is caused by fatty tissue or a part of the bowel poking through a weak spot in the surrounding muscle wall of your belly button. It appears as a painless lump in or near your belly button. Umbilical hernias are very common in infants and young children, especially in babies who were born prematurely. Some adults are susceptible to umbilical hernias such as those who are overweight or have persistent heavy coughs.
  • Hiatal hernia - occurs when part of your stomach moves upward into your chest through an opening in your diaphragm. Hiatal hernias are common in people over 50 years old. They rarely have any noticeable symptoms. However, they can cause gastro-oesophageal reflux disease (GORD) where stomach acid leaks into your oesophagus if the valve at the bottom of your oesophagus is prevented from working properly. Treatment can relieve GORD symptoms such as heartburn, chest pain, an unpleasant sour taste in your mouth, and swallowing problems.

Other types of hernia include:

  • Incisional hernia – occurs when tissue protrudes through the site of an abdominal scar such as a scar left from a previous surgical operation. They are especially susceptible in the first six months following surgery, when the tissues are healing from the incision.
  • Epigastric hernia – occurs when fatty tissue pushes out through the abdominal area between your belly button and your breastbone, called the epigastrium. Usually, they are small hernias that are present at birth.
  • Spigelian hernia - is a rare type of hernia that occurs in your abdominal wall slightly to the side of your abdominal muscle called the spigelian aponeurosis and below your belly button.
  • Diaphragmatic hernia - is a rare birth defect where there is an abnormal opening in the diaphragm that allows part of the organs from your stomach to move into your chest.

What is considered to be a large hernia?

A hernia that is left untreated, may become very large. Over time, hernias tend to get bigger as the muscle wall of your abdomen gets weaker and more tissue bulges through. A large abdominal hernia is classed as a hernia larger than 10 cm. If you have a large hernia, your doctor will recommend hernia surgery.

Is hernia major or minor surgery?

Hernia surgery can be major or minor surgery. It depends on whether it is done through open surgery or minimally invasive surgery. Both types of surgery aim to put the protruding tissue back in place. Sometimes a type of mesh is implanted in the area to provide extra support for the weakened muscle.

Open surgery makes a larger incision and allows your surgeon to see and access the hernia directly. It is classed as major surgery and has a longer recovery.

Minimally invasive surgery, called laparoscopic hernia repair, makes smaller incisions and uses tiny instruments to perform the hernia repair with the help of a laparoscope which is a slender tool with a tiny video camera and light on the end. It is classed as minor surgery and patients benefit from smaller scars, fewer complications, shorter hospital stays, and a faster recovery. 

Whether you have major or minor hernia surgery will depend on the size and type of hernia, your past medical and surgical history, and your surgeon’s expertise. Your West Valley hernia surgeon will advise on the best type of surgery for you. Our hernia surgeons are highly experienced in laparoscopic hernia surgery and will recommend this surgery option if it is the most ideal operative approach for the individual patient. 

How long is the recovery time for hernia surgery?

The recovery time for hernia surgery will depend on whether you have open or minimally invasive hernia surgery.

Open hernia surgery has a recovery time of up to six weeks and minimally invasive hernia surgery has a recovery time of around two weeks. Recovery times will vary from patient to patient.

At a glance

  • A hernia occurs when part of your internal body pushes through a weakness in a muscle or surrounding tissue wall.
  • Inguinal and femoral hernias are the most common types of hernia. They push through your groin into the inguinal or femoral canal.
  • Umbilical hernias push through near your belly button. They are common in infants and young children.
  • Hiatal hernias occur when part of your stomach moves up into your chest.
  • Not all hernias need surgery. Non-symptomatic and small hernias do not usually need surgery.
  • Strangulated and obstructed hernias require emergency surgery.
  • Hernias that are causing you pain or growing larger are typically recommended for surgery.
  • Surgery for femoral hernias is usually recommended straightaway.
  • Adults with umbilical hernias are usually recommended for surgery. Children may wait and have surgery if their umbilical hernia is still there when they reach age four to five or if it is large.
  • Inguinal hernias may need surgery depending on their size and symptoms.
  • Hiatal hernias rarely require surgery.
  • Large hernias are 10cm or larger.
  • Hernia surgery can be major (open) or minor (laparoscopic) surgery.
  • Recovery time for hernia surgery is quicker for laparoscopic surgery compared to open surgery.

Highly skilled and experienced surgeons at West Valley Hospital regularly perform hernia surgery without waiting. They utilise the latest techniques and dedicated endoscopy suites whilst being supported by expert staff and on-site imaging technologies if required.

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