Mr Clark is one of the countries most experienced hernia surgeons. He runs a specialist hernia clinic at the Brighton Nuffield available to private and NHS patients. Contact the team to arrange an appointment.
What is a hernia?
A hernia is a weakness or defect in the muscles of abdominal wall, most notably in the groins. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing a lump or bulge which can be felt by the patient. Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions.
All hernias should be referred to see a specialist surgeon to discuss treatment options.
Why do people get hernias?
Hernias can be present from birth (congenital) or develop over time (acquired) as a result of a particular event. In the groin this can be as a result of a sports injury such as groin strain or following heavy exertion that puts strain on the groin, for example heavy lifting or prolonged coughing.
What are the different types of hernias?
There are many different types of hernia some more common than others. The most common variety being groin hernias which are described as being either inguinal or femoral, these terms relate to the anatomical location of the hernia in the groin. Other commonly seen hernias include umbilical hernias which protrude through the belly button and are common in children and pregnant women and incisional hernias which occur at the site of previous operations on the abdomen and represent a more complex surgical problem.
Groin hernias can affect both groins at the same time, we describe this as having bilateral hernias. A laparoscopic repair should be undertaken in this situation where possible.
Hernias affect men far more commonly than women. Women get femoral hernias more commonly than men and these carry a higher risk of strangulation or obstruction (see below) and therefore groin hernias in women should always be referred urgently to see a specialist regardless of symptoms.
How is a hernia diagnosed? What are the usual symptoms of a hernia?
Hernias usually present as a lump or swelling which is noticed by the patient or their doctor. The lump is usually most apparent when standing or straining and often disappears when reclining. Pain can be experienced at the site of the lump, especially when lifting a heavy object. Groin hernias in men can cause swelling of the scrotum.
Symptoms which require urgent medical attention include excruciating abdominal pain, loss of appetite, nausea and vomiting as they can indicate a strangulated or obstructed hernia.
Why is mesh, a foreign body, used for hernia repair?
Mesh has been scientifically proven to achieve the most effective repair of most hernias and in particular groin hernias, with the lowest risk of recurrence. There are certain specific situations where mesh is not required, for example with small umbilical (belly button) hernias.
Can the mesh be rejected?
Extensive research has been done and continues to go into Mesh technology. Mesh used to repair hernias is known to be very safe and there is no evidence to suggest that mesh is ever rejected by the body. Mesh can become infected which can necessitate its removal but this is rare.
Should I use a hernia belt as treatment?
There is little evidence for the use of hernia belts or trusses. Elasticated supports or supportive underwear can help to minimise symptoms from a hernia, but this is not a substitute for surgery and a symptomatic hernia should be repaired at the earliest opportunity thereby removing the need for supports.
What happens if I leave my hernia untreated?
Once a hernia has developed, it will tend to enlarge and cause discomfort. If a loop of bowel gets caught in the hernia, it may become obstructed or its blood supply may be cut off. This can become a life-threatening situation.
The majority of hernias can be repaired effectively, with minimal risk. Therefore we recommend that hernias are repaired when diagnosed, unless there are serious medical problems which make it too risky.
How long does it take to recover after hernia surgery?
This depends on the type of hernia, the technique used to repair it, and in the case of groin hernias whether one or both sides requires repair. For the majority of hernias recovery is faster after a laparoscopic or ‘keyhole’ operation.
Following laparoscopic surgery for groin hernias patients can return to normal activity almost immediately as comfort allows, including exercise and driving. Specific advice will be given to individual patients based on occupation and lifestyle.
Treatment choices for groin hernias
Open Surgery versus Laparoscopic Surgery
Open surgery involves a 6-10cm cut in the groin to expose the weakness in the muscles and allow it to be repaired with stitches and mesh. Laparoscopic surgery (also known as minimally invasive or keyhole surgery) is performed through three very small incisions, the largest being approximately 1cm long through which a mesh is placed to repair the weakness.
The risk of long term groin pain and numbness are reduced by laparoscopic repair. The risk of hernia recurrence (the hernia coming back) is significantly lower with laparoscopic surgery provided the surgery is performed by a specialist. For the majority of patients this can be done as day-case surgery.
Other types of hernia require discussion with a specialist to decide on the most appropriate technique of repair.
What is a Recurrent Hernia?
Recurrence is when a previously repaired hernia returns, which implies that the repair has failed. This can occur within days or after many years. All forms of hernia repair carry a risk of recurrence. There is strong evidence that this risk is minimised by seeing a specialist hernia surgeon. In the case of groin hernias the risk of recurrence following a laparoscopic repair by a specialist is 1%, in non-specialist hands the risk can be in excess of 10%. Recurrent groin hernias should always be considered for laparoscopic repair.
I have a hernia, what should I do?
Contact my team directly or ask your GP to refer you and we will arrange an appointment for you immediately.