This can cause pain and other unpleasant symptoms, especially when you’re moving around or lifting heavy objects. Often, hernias get worse over time, with more tissue pushing through the affected muscle. If a hernia isn’t managed and properly treated, it can lead to severe and potentially life-threatening complications. (1) You may also be a candidate for watchful waiting if you have any heath conditions that raise the risk of complications from hernia repair surgery. According to NYU Langone Health, factors that may contribute to deciding to watch and wait include:
Being 70 or olderReceiving chemotherapyHaving a stent or pacemakerHaving heart failureHaving had a heart attack
If you decide in favor of watchful waiting, you’ll need to see your doctor once a year or if and when symptoms associated with your hernia get worse. (2) The type of surgery your doctor recommends will depend on the exact nature of your hernia and the complexity of the repair. For example, a repair may be more complex if you’ve had previous abdominal surgeries. There are two basic types of surgery for hernia repair: open and laparoscopic. (3)
Open Hernia Repair
For this method, you may be under either general anesthesia or local anesthesia with sedation. Your surgeon will make a large incision in your groin or abdomen, push the hernia back into your abdomen, and repair the weakened muscle where the hernia occurred. Fixing the muscle may involve either sewing it shut or, if the tissue isn’t healthy enough to do that, reinforcing it by inserting a piece of mesh in the area. Once the repair is complete, your incision will be closed using sutures (stitches), staples, or surgical glue. (4) There are a few different subtypes of open hernia repair:
Lichtenstein repairShouldice repairBassini repairPlug-and-patch repair
A Lichtenstein repair is often used to treat inguinal hernias, the most common type of hernia. This type of hernia occurs in the groin area. In this procedure, your surgeon makes an incision in your groin, pushes your intestine or tissue back inside the abdomen, and closes off and removes the sac that was holding the tissue. Your surgeon then places mesh over the weakened area of muscle. Over time, new tissue will grow over the mesh and reinforce your abdominal wall. An advantage of using mesh is that it doesn’t put any strain or pressure on your abdominal wall, which reduces the risk of another hernia developing. In a Shouldice repair, after pushing your intestine or other tissue back into your abdomen, your surgeon creates flaps with four layers of tissue known as fascia. These layers of tissue are then overlapped and sewn together using steel sutures, which helps strengthen the weakened area of muscle. In a Bassini repair, your surgeon pulls together muscles to cover the original hole in your abdominal wall and sutures them together. This type of surgery is usually done only when a mesh repair isn’t possible, such as when part of your intestine must be removed due to hernia complications. In a plug-and-patch repair, your surgeon places a plug made of mesh in the hole created by the hernia. This plug is then secured by suturing a patch over it. (3)
Laparoscopic Hernia Repair
Laparoscopy is a minimally invasive method that uses several small incisions in your abdomen to perform the operation. It’s typically performed under general anesthesia. Your abdomen is inflated with gas, and your surgeon inserts a flexible tube containing a light and tiny camera in one incision to guide the surgery. Surgical tools are inserted into the other incisions. Laparoscopy can result in quicker healing and less discomfort and scarring than an open hernia repair. It can also help your surgeon avoid scar tissue from a previous hernia repair. But according to the Mayo Clinic, laparoscopic hernia repair may carry a higher rate of surgical complications and hernia recurrence than open hernia repair. (4) There are two main types of laparoscopic hernia repair:
Totally extraperitoneal repairTransabdominal preperitoneal repair
In a totally extraperitoneal repair, your surgeon makes three incisions in your abdomen and inserts a balloon that’s inflated to make the area more visible. Tissue is removed from the hernia’s sac, and mesh is placed over the weakened muscle area. The incisions are closed using sutures. A transabdominal preperitoneal repair is similar, except that it’s performed using only one incision in the groin. (3) RELATED: 7 Surprising Facts About Anesthesia Some hiatal hernias cause no symptoms at all, or only mild ones. Symptoms are typically those of gastroesophageal reflux disease (GERD), in which stomach acid moves up into the esophagus. A surgical repair is typically needed only when symptoms of GERD can’t be controlled through lifestyle changes and medication. To repair a hiatal hernia, your surgeon will pull the entire stomach back into your abdomen, repair the valve at the bottom of your esophagus if necessary, and make the hole in your diaphragm smaller so that your stomach stays in place. (5) This type of hernia occurs in 1 out of 6 children, according to the Cleveland Clinic. It’s caused by an opening in the abdominal wall that’s present at birth. (6) Over 90 percent of umbilical hernias heal on their own by age 3 or 4, the Cleveland Clinic notes — so your doctor probably won’t recommend surgery before that time. (6) If needed, surgery to repair an umbilical hernia involves general anesthesia and a small incision at the base of the navel. Your surgeon will push the intestine back in place, remove the hernia’s sac, and reinforce the weakened muscle wall with several layers of sutures. (6)
