Hernia Repair

Our practice provides general surgical services alongside specialist breast and oncological care. Hernia repair is one of the most commonly performed general surgical procedures we offer, and is available to patients who are established in our practice or referred for this service.

A hernia occurs when an organ or fatty tissue pushes through a weakened area in the surrounding muscle or connective tissue, creating a visible or palpable bulge. Hernias are extremely common, affecting people of all ages, and surgical repair is typically the definitive treatment. Left untreated, many hernias worsen over time and some can develop serious complications requiring emergency surgery.

What Is a Hernia?

The abdominal wall is a layered structure of muscle and connective tissue that holds the abdominal organs in place. When a section of this wall is weakened, the increased pressure from the abdominal contents can push through the defect, creating a protrusion called a hernia. The most commonly affected areas are the groin, the navel, and previous surgical incision sites.

Hernias range from small and barely noticeable to large and significantly symptomatic. Some cause little discomfort and can be managed conservatively for a period; others require prompt surgical attention, particularly if they become irreducible (unable to be pushed back in) or strangulated (where the blood supply to the herniated tissue is cut off, which is a surgical emergency).

Symptoms of a Hernia

The most characteristic symptom is a visible bulge or lump at the hernia site, which may be more prominent when standing, straining, or coughing, and may disappear or reduce when lying down. Additional symptoms can include a dragging ache or discomfort at the hernia site, particularly after prolonged standing or physical activity; pain or tenderness over the bulge; and, in inguinal hernias, discomfort or swelling in the groin extending into the scrotum in men.

A hernia that becomes suddenly painful, tender, hard, or cannot be pushed back in requires urgent medical assessment, as these features may indicate incarceration or strangulation, which are surgical emergencies requiring prompt intervention.

Types of Hernia

Inguinal Hernia

The most common type of hernia, an inguinal hernia occurs when tissue (often a loop of intestine or fatty tissue) pushes through a weakness in the lower abdominal wall into the inguinal canal in the groin. Inguinal hernias are far more common in men than women, due to anatomical differences in the inguinal canal. They typically appear as a bulge in the groin, which may extend into the scrotum in men. Inguinal hernias account for the majority of hernia repairs performed in our practice.

Femoral Hernia

A femoral hernia occurs when tissue protrudes through the femoral canal, a small passage at the top of the inner thigh just below the groin crease. Femoral hernias are more common in women than men and have a higher rate of complications (particularly strangulation) than inguinal hernias, meaning surgical repair is generally recommended promptly once diagnosed.

Umbilical Hernia

An umbilical hernia involves tissue pushing through a weakness around the navel. They are common in newborns and infants, where they often resolve without treatment by age four or five. In adults, umbilical hernias tend to enlarge over time and typically require surgical repair, particularly when symptomatic or enlarging.

Incisional Hernia

An incisional hernia develops through the scar of a previous abdominal surgical wound. The scar tissue, while strong in some ways, can represent a structurally weak point in the abdominal wall through which a hernia may develop, particularly in the months to years after surgery. Incisional hernias can range from small and easily managed to large and complex.

Hernia Repair Surgery

Hernia repair is most commonly performed as a day procedure or with one overnight hospital stay. The two main surgical approaches are open repair and laparoscopic (keyhole) repair.

Open Hernia Repair

Open repair is performed under general anaesthetic (or occasionally local or spinal anaesthetic) through a single incision of approximately 5 to 10 cm directly over the hernia site. The herniated tissue is returned to its correct position and the weakness in the abdominal wall is repaired, usually using a synthetic mesh placed over or under the defect to reinforce the repair and reduce the risk of recurrence (hernioplasty). The incision is closed with dissolving sutures.
Open repair has a long and well-established track record and remains the standard approach for many inguinal hernias. Recovery involves avoiding strenuous activity and heavy lifting for approximately six weeks, with most patients returning to desk work within one to two weeks.
In our practice, we primarily perform open inguinal hernia repair. For patients who are well-suited to laparoscopic repair (see below), we refer to specialist high-volume hernia surgeons with dedicated laparoscopic expertise.

Laparoscopic (Keyhole) Hernia Repair

Laparoscopic hernia repair uses several small incisions through which a camera (laparoscope) and fine surgical instruments are inserted. The surgeon views magnified images of the operative field on a monitor and performs the repair without the need for a large incision. A mesh is placed to reinforce the repair, and the incisions are closed with small sutures or clips.

The two main laparoscopic techniques for inguinal hernia repair are the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches, which differ in how the surgeon accesses the hernia space. Both are well-established and effective.

Laparoscopic repair is associated with less post-operative pain, a faster return to normal activities, and smaller scars compared to open repair. It is particularly well-suited for bilateral inguinal hernias (both sides repaired in the same operation), recurrent hernias (where previous open repair has failed), and femoral hernias.

Laparoscopic repair is not appropriate for all patients. It is generally not recommended for very large hernias, strangulated hernias, patients who have had significant prior pelvic surgery (which can make the laparoscopic approach technically difficult), or those who cannot tolerate general anaesthetic.

Recovery After Hernia Repair

Recovery is straightforward for the majority of patients. General guidance includes the following.

You can shower from the day after surgery and keep the wound area clean and dry until it has healed. Most patients can return home the day of or the day after surgery. Pain and swelling at the repair site are expected and managed with regular oral analgesia (paracetamol and anti-inflammatories). Avoid driving while taking stronger pain medications. Return to desk work and light activities is typically possible within one to two weeks. Strenuous activity, lifting, and vigorous exercise should be avoided for six weeks, or until cleared by your surgeon at your follow-up appointment.

Risks and Complications

Hernia repair is a safe and commonly performed procedure. Risks include reaction to anaesthesia, wound infection, bleeding or haematoma, seroma (fluid collection), nerve injury causing numbness or chronic groin pain, injury to adjacent structures (rare), urinary retention (more common in older men, usually temporary), and hernia recurrence (uncommon with mesh repair, occurring in approximately 1 to 3% of cases over the long term).
All risks will be discussed in detail at your pre-operative consultation.

Hernia Surgery at Breast & Surgical Oncology at The Poche Centre

Our general surgical services including hernia repair are available to patients at our North Sydney practice. Surgery is performed at The Mater Hospital and North Shore Private Hospital for private patients, and through public hospital pathways where appropriate.

If you have been diagnosed with a hernia or have noticed a suspicious lump in the groin, navel, or at a previous surgical scar site, we welcome a consultation.