Hernia repair: types of hernia, keyhole and open surgery, and recovery

A hernia is where part of an internal organ, such as the bowel, pushes through a gap or weak area in the muscle that holds your organs in place. Repair is usually carried out by a consultant general surgeon, and some surgeons concentrate on abdominal wall and hernia surgery or upper gastrointestinal surgery for hiatus hernias. The British Hernia Society, whose stated aim is to promote safe, effective and high quality hernia surgery in the UK, publishes information for patients.

Most hernias are managed as day-case or short-stay surgery, with anaesthetists, theatre staff and nurses working with the surgeon. Specialist abdominal wall units may take on recurrent hernias and complex repairs after earlier surgery.

Where the hernia occurs shapes how it feels and how it is treated. The NHS describes the following common types.

The NHS says an inguinal hernia may not need treatment if it is not causing symptoms. Repair is offered if it causes pain, or to prevent complications such as a blocked bowel or a strangulated hernia, where the blood supply to trapped tissue is cut off. In adults, the NHS says surgery is usually recommended for umbilical hernias because they are unlikely to get better on their own, though someone who is unwell with another condition such as liver disease may not be fit enough for an operation.

Hiatus hernias are different. The NHS says many do not need treatment, and symptoms are managed with smaller meals, raising the head of the bed, weight loss, avoiding food close to bedtime, and medicines such as antacids and alginates. Surgery is considered only when other treatments have not worked and symptoms are very bad.

The NHS describes two main approaches for an inguinal hernia: laparoscopic (keyhole) surgery through a few small cuts in the tummy, or open surgery through one larger cut in the groin. You may have a general anaesthetic or, in some cases, a local anaesthetic. The surgeon pushes the hernia back into place and usually places a thin sheet of mesh over the weak area, held with small stitches, although sometimes stitches alone are used.

Umbilical hernias are usually repaired through cuts near the hernia, closing the gap by stitching the muscles together, with mesh for larger defects, in 30 to 60 minutes according to the NHS. Hiatus hernia repair is usually done by keyhole surgery under general anaesthetic, and the NHS says it can take up to 6 weeks before you can eat what you want, with some bloating or swallowing difficulty for a few months and a chance of further surgery. Anti-reflux procedures such as fundoplication are sometimes combined with hiatus repair.

After an inguinal repair the NHS says it is normal to have some bleeding from the wound for a couple of days, pain for a few days, and bruising or swelling for a couple of weeks. Keyhole surgery can cause bloating or shoulder-tip pain for a couple of days. Most people need at least 1 to 2 weeks off work, or up to 6 weeks if the job involves heavy lifting, should not lift or strain for at least 4 to 6 weeks and should check before driving again.

Complications are uncommon but include wound infection, a lump or swelling at the site, damage to the bowel, blood vessels or bladder, blood clots, and the hernia coming back. Surgeons discuss mesh, including its benefits in reducing recurrence and the small risk of chronic pain or infection, as part of consent.

On the NHS, a GP examines you and, if repair is appropriate, refers you to a surgical clinic. The decision about whether to operate takes into account symptoms, size, type and your general health. Waiting times vary by area and urgency, and a hernia that has become obstructed is treated as an emergency.

Privately, you may see a consultant surgeon directly, often with an ultrasound or CT scan arranged if the diagnosis is uncertain. Costs depend on the type of hernia, whether keyhole or open surgery is used, the hospital, anaesthesia, mesh and follow-up. Ask for an itemised price, what is covered if there is a complication or recurrence, and the surgeon's experience with your type of repair.

• Ask whether keyhole or open repair is better for your hernia, and whether mesh will be used.

• Ask how long you will need off work and when you can drive, lift and exercise.

• Bring a list of medicines, particularly blood thinners, and tell the team about smoking, weight and chronic cough, which can affect healing and recurrence.

• Get help from NHS 111 if a hernia becomes painful, you feel sick or vomit, your tummy swells, you have a high temperature or you become confused.

• Call 999 if you have an umbilical hernia with very bad tummy pain that does not go away, the lump is more swollen with a colour change, you cannot pass wind or poo, or you are being sick. Do not drive yourself to A&E.