Hernia surgery | Top Doctors

A hernia occurs when an internal part of the body, such as an organ or fatty tissue, pushes through a weakness in the surrounding muscle or tissue wall. Consultant bariatric, upper GI, general, and laparoscopic surgeon Mr Aruna Munasinghe specialises in advanced repair techniques designed to reinforce these weak points and prevent the condition from returning.

While many hernias cause little pain, they don’t resolve on their own and typically require surgical intervention to avoid complications like strangulation. This article explains the clinical approach to achieving durable, long-term success in hernia management.

What defines a successful and long-lasting hernia repair?

A successful hernia repair is defined by the permanent closure of the defect and the restoration of abdominal wall integrity with a low risk of recurrence. In the UK, approximately 100,000 hernia repairs are performed annually, making it one of the most common surgical procedures.

Modern long-lasting results are largely attributed to the "tension-free" repair method. Historically, surgeons simply stitched the edges of the muscle defect together, but this created tension that often led to the stitches tearing through the tissue.

Current clinical data shows that using a prosthetic mesh to bridge the gap reduces the recurrence rate from approximately 15 per cent to less than 2 per cent for most common hernias.

When is surgery necessary to ensure health?

Surgery is recommended when a hernia causes persistent discomfort, grows in size, or poses a risk of becoming trapped (incarcerated). If the blood supply to the trapped tissue is cut off, it becomes a medical emergency known as a strangulated hernia.

Elective surgery allows for a planned, meticulous approach which generally results in better long-term outcomes than emergency procedures. Surgeons assess the size of the defect and the strength of the surrounding muscle to determine the most stable repair method for the individual patient.

How do surgeons choose the best repair method?

The choice of technique is tailored to the patient’s lifestyle, the hernia's location, and the necessity for a durable reinforcement. Both open and minimally invasive approaches ensure the abdominal wall is adequately supported.

Laparoscopic (Keyhole) repair: Surgeons use small incisions and a camera to place a mesh behind the abdominal wall, which is often preferred for quicker recovery and lower infection rates.
Open mesh repair: A direct incision is made over the hernia to push the tissue back and secure a mesh over the weakened area.
Robotic-assisted surgery: An evolving technique that provides high precision for complex or recurrent hernias, allowing for intricate suturing in difficult areas.
Component separation: A specialised technique for very large hernias where abdominal muscle layers are shifted to close the gap before mesh reinforcement is added.

What can patients do to prevent a hernia from returning?

Long-term success depends heavily on the healing phase and the patient’s adherence to post-operative guidelines during the first six to eight weeks. Avoiding heavy lifting and managing chronic coughs or constipation reduces the internal pressure on the new repair while the tissue incorporates the mesh.

Studies indicate that smoking cessation and maintaining a healthy body mass index (BMI) significantly improve the strength of the scar tissue. By following a structured recovery plan, the vast majority of patients can return to full physical activity without the fear of the hernia recurring.

References

British Hernia Society. (2023). Management of Groin Hernias: National Guidelines.
NHS England. (2024). Hernia Repair Overview and Recovery.
National Institute for Health and Care Excellence (NICE). (2022). Laparoscopic surgery for inguinal hernia repair (TA83).
Annals of Surgery. (2021). Long-term outcomes of mesh versus non-mesh repair in abdominal wall hernias.