Most hernias can be diagnosed with a physical exam. Some hernias may require tests such as a CT scan, an ultrasound, or even an MRI for diagnosis. Your surgical team will help guide you through the evaluation period and let you know which tests will be required to evaluate your hernia.

Surgery to Treat Hernias

Surgery is the only treatment that can permanently fix a hernia. Surgery may be more risky for patients who have serious medical problems. If the hernia is small and not causing any problems, you and your surgeon may decide to watch the hernia for several months or more to make sure it is not growing.

Usually, surgery is necessary when hernias:

  • Are getting larger
  • Are painful
  • Cannot be reduced (pushed back inside) without surgery
  • May involve a trapped piece of bowel

Surgery secures the weakened abdominal wall tissue and closes any holes. Today, most hernias are closed with mesh material to repair the hole and reinforce the weakened tissue surrounding the hernia.

Sometimes, emergency surgery is needed. If a hernia becomes stuck and can't be pushed back in, the blood supply to whatever is inside the hernia sac can be cut off. Left untreated, this portion of the intestine dies and patients can become very sick and even die.

In rare cases, inguinal hernia repair can damage structures involved in the function of a man’s testicles. Another risk of hernia surgery is nerve damage, which can lead to numbness in the groin area. Your surgeon can tell you more about the risks of hernia surgery, as well as the risks of deciding not to proceed with repair of your hernia.

Minimally Invasive Treatment for Inguinal Hernia Repair

Froedtert & MCW surgeons use the latest techniques to treat inguinal hernias, including totally extraperitoneal (TEP) or transabdominal pre-peritoneal (TAPP) laparoscopic repairs for primary (never before repaired), bilateral (occurring on both sides, in each groin) and recurrent hernias.

Abdominal (ventral) and incisional hernias are treated with traditional and minimally invasive methods, including laparoscopic component separation (a technique for repair of large and complicated hernias where the different layers of the abdominal wall are dissected away from each other and the hernia is then repaired layer by layer) and abdominal wall reconstruction. We choose from a variety of mesh materials when performing repairs and reconstructions, including the latest biologic grafts.

The type of treatment is decided by each patient’s quality of life and daily activity needs, and is based on the latest evidence-based data.

Whenever possible, we offer a minimally invasive hernia repair. While some types of hernias do not allow for this approach, a minimally invasive approach offers faster recovery, faster return to full function and work with less risk of complications, particularly wound infections.

Note: Many thousands of hernia repair operations occur each year with and without surgical mesh, and patients generally recover quickly and do well post-surgery. As with any surgical procedure, complications are possible. You should discuss all your options and their risks and benefits for your individual situation with your health care provider.

Hernia Treatment Outcomes With Surgery

The outcome for most hernias is usually good with treatment. It is rare for an inguinal hernia to come back (1 to 3 percent chance, depending on the type of hernia and many other factors). Incisional hernias are more likely to return. When a hernia comes back after being repaired, this is called a recurrence.

Hernia Recurrence Rates

Recurrence rates after incisional hernia repair depend on a lot of different factors related to the patient (obesity is a risk factor), the size of the hernia defect (larger hernias more likely to recur), whether the hernia has already been repaired (recurrent hernias are more likely to recur when repaired again), and other factors (surgical technique, the nature of a patient’s tissue, etc.).

The recurrence rate for groin hernias is 1 to 3 percent, while it’s 5 to 10 percent for abdominal (ventral) hernias, and 10 to 15 percent for stoma hernias. For the most complex hernias, the recurrence rate is 10 to 20 percent, depending on the nature of the hernia and other factors.

Hospital Stays for Hernia Surgery

Hospital stays are rare for inguinal hernias. Some incisional hernias are small and can be repaired without needing to be admitted to the hospital after surgery.

For larger incisional repairs, the patient can expect to spend one to four days in the hospital with a return to work and normal activities within two weeks or more depending on the nature of the repair. For the most complex hernias, the hospital stay depends on the extent of the problem

High Volume of Hernia Repair Means Optimal Outcomes

Froedtert & MCW hernia surgeons do a high volume of hernia repair. Research shows that surgeons who perform a high volume of a specific procedure are able to provide more optimal outcomes for their patients. Hernias are more likely to recur when repaired by surgeons who perform a low volume of hernia surgeries.

We are also active in research to develop advanced hernia treatments and help translate research into improved options for patients.

Risks of Hernias Left Untreated

Without treatment, the prognosis depends on the hernia. Smaller hernias that aren’t symptomatic may not need to be treated, especially if the patient may not be a good surgical candidate.

 You may not be a candidate for surgery if you have severe and significant medical problems that make surgery extremely risky. Most hernias are likely to get bigger. A hernia that is initially without symptoms when discovered can become painful or uncomfortable over time.

For hernias managed without surgery, there is a small risk of a “hernia emergency” which may make unplanned surgical repairs a necessity.

Hernia Surgery FAQ

These are some of the most common questions we hear about hernia treatment and what happens after hernia surgery.

  • Not all hernias need to be fixed. This is a decision each patient should make with his/her surgeon by weighing the risks and benefits of surgery.

  • Your specific restrictions will be discussed when you meet your surgeon. For large abdominal hernias, a typical restriction might be a 10 to 20 pound lifting restriction for six weeks after surgery.

  • Smoking decreases the chance that the hernia repair will be successful. The chemicals in cigarettes slow wound healing and increase the tendency to cough, which puts stress on the repair.

  • Some hernia repairs are done as an outpatient, meaning you will go home the same day you have surgery. For more extensive repairs, you may be in the hospital for a few days.

  • You must be able to urinate on your own, drink liquids on your own without nausea and/or vomiting, and your pain must be controlled with oral medications.

  • Depending on the kind of surgery you had, the type of dressings used on your wounds, the location of your incisions and a variety of other factors, you may be able to take a shower on the day after surgery. For more complicated abdominal wall reconstruction, instructions about exposing incisions to water will vary. Your surgical team will provide you with specific instructions at the time of your discharge from the hospital.

  • You should be alert for increased redness, tenderness, or warmth around your incisions, drainage, fever and chills. Wound infections are most common within about two weeks after surgery. If you notice any of these things, you should call the clinic immediately.

  • After surgery, it is common for fluid to collect in the space where the hernia was. This is called a seroma. Your body will reabsorb the extra fluid with time, but this may take up to three months to resolve completely.

  • It is important to drink enough fluid, especially water, while taking narcotics. It is also recommended to take a stool softener (may be purchased over-the-counter). Adding raw fruits and vegetables to your diet can also help to prevent constipation.

  • Alternatives that may be used for pain control instead of narcotics include acetaminophen or ibuprofen (as long as there aren’t other reasons you may not take these medications). You may also apply a cold pack to the area of pain to ease discomfort. You may do this a few times a day for about 20 minutes at a time.

  • The answer depends on the type of work you do, as well as what type of surgery you had. If your job requires lifting, you may not be able to return until your restrictions have expired. Some patients return to a desk job after about a week, but this will also depend upon how well you feel.

  • Walking after surgery is highly encouraged. Climbing stairs is also OK. We will ask you to avoid strenuous activities for a few weeks, but after about four weeks, it is OK to add in more moderate physical activity, such as using an elliptical machine or riding a stationary bike. This will be discussed at your first post-operative visit in the clinic.

  • You are more at risk for recurrence if you’ve had other hernias in the past. Heavy lifting also increases this risk as does smoking.

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