Overview and FAQs

Overview and FAQs

There is much information, and disinformation, about hernias available.  I have tried to clarify and simplify as much as possible, and answer most of the common questions. The things you might really want to know are :-

What is a hernia?

How are hernias named?

How do I know if I have a hernia?

Diagnosing the hernia

Is there always a swelling?

How are hernias treated?

Do I need an operation?

What happens if I do nothing?  Is ‘watchful waiting’ a good option?

Is surgery the only option?

What operation should I have?

What about keyhole surgery?

How do I know which operation is best for me?

What about after surgery?

What is a hernia?

A hernia is simply a hole or defect in the abdominal wall through which your insides can protrude. Hernias are common and occur at natural points of weakness such as the groin or the navel (umbilicus), or at the site of a scar from a previous operation.

When you stand up, cough or strain your ‘insides’ push out through the hole so you see or feel a swelling under the skin. The swelling will usually disappear when you lie down.

I believe there always has to be a swelling to make the diagnosis.   Without a swelling the diagnosis of hernia is really unlikely.  The swelling should be visible when you stand or cough.

How are hernias named?

Usually hernias are described by where the hole is in the abdominal wall* –  read more

How do I know if I have a hernia?

You can see or feel the swelling).  You may feel discomfort but only when you are standing and the hernia protrudes.  The discomfort should subside very soon after you lie down, or push the swelling back.  Severe pain is very very unusual (but see strangulation).

With inguinal (groin) hernias  there is sometimes a sensation of discomfort in the testicle or a burning feeling into the top of the thigh.

With other abdominal hernias there is sometimes abdominal pain.

(read more)

Diagnosing the hernia

The diagnosis can be confirmed by an experienced surgeon examining you, and usually no further tests are necessary. Scans, ultrasound, CT or MRI are not specific enough.  They may “see”and report a “hernia”.  But that does not mean that what they see is the cause of your symptoms..Special tests – read more

What happens if I do nothing, if I just leave it?

The hernia will gradually enlarge in size, become more uncomfortable and more of a nuisance. Sometimes (rarely) a piece of bowel becomes trapped in the hernia. This is called strangulation. It is a dangerous situation and requires an emergency operation. It is one of the reasons that it is often better to deal with the hernia early.  BUT do not be scared into having an operation with bad advice from an inexperienced surgeon.

How are hernias repaired?

The modern way of repairing hernias is to use a mesh or gauze to cover the hole, rather than sewing the edges of the hole together as used to be done. Read this overview. 

The recent adverse publicity about mesh (disinformation, out of context) means that non-mesh methods are being used again. If you have concerns regarding mesh read this.

With any of the techniques they have to be carried out correctly and this is where the skill and experience of the surgeon is important.

Open , mesh or non-mesh, or laparoscopic (keyhole) surgery

All methods are good but only when carried out by an experienced surgeon.

How do I know which operation is best for me?

Discuss this with your surgeon. He should present the options and explain the ‘pros and cons’.  Both open local anaesthetic repair and laparoscopic (keyhole) repairs  are specialised techniques, not carried out by all surgeons.

I have had some problems with my heart in the past and I am worried about having a general anaesthetic.

Many hernias can be repaired using local anaesthetic.  This means that the area of the hernia is made numb with an injection of local anaesthetic ( such as you would have at the dentist).  After the first small injection you feel nothing and you remain awake while the hernia is repaired ( please note – local anaesthetic is not an injection in the back ).  To read more about the anaesthetics used click here.

Still have questions? 

You can email me on martinkurzer@hje.org.uk

You can also contact Martin Kurzer at:

St John and St Elizabeth’s Hospital
Grove End Road, London NW8 9NH

020 3370 1014 for appointments