Can a hernia go away without surgery?

No. A hernia is a defect in the abdominal wall, and it does not close on its own. A support belt and exercises may ease discomfort but do not treat the hernia.

Is mesh always necessary?

For most inguinal hernias, umbilical hernias of 1 cm or more and incisional hernias — yes: mesh markedly lowers the risk of recurrence compared with suturing the tissues. Small umbilical hernias under 1 cm can be closed with sutures.

Laparoscopic or open?

Both are effective. Laparoscopy is convenient for bilateral inguinal hernias and recurrence after open repair and for some incisional hernias; the open approach suits large hernias and some other medical conditions. The approach is chosen after examination.

How can I recognize strangulation?

Sudden severe pain at the hernia, a bulge that has become firm and cannot be pushed back, and possibly nausea and vomiting. This is an emergency — immediate assessment by a surgeon is needed, and often surgery the same day.

When can I return to sport after surgery?

After inguinal or umbilical repair, normal activity is possible as you feel able, usually within 1–2 weeks, and full exertion gradually, as you feel able. After large abdominal wall repairs, heavy exertion is limited for several weeks.

Hernias: inguinal, umbilical, incisional and hiatal

A hernia is the protrusion of organs or fatty tissue through a weak spot in the abdominal wall or the diaphragm. It does not go away on its own and usually grows over time. Most hernias are treated electively with modern mesh repair, which greatly reduces the risk of recurrence; some operations are performed laparoscopically. The emergency situation is strangulation: severe pain and a hernia that cannot be pushed back require urgent assessment by a surgeon and often surgery the same day.

Kateryna Valikhnovska, MD, surgical oncologist, during a laparoscopic operation — The laparoscopic stage of an operation: the lights in the operating room are dimmed because the surgeon works from the camera image on the monitor.

Types of hernias

Inguinal and femoral — inguinal hernias are the most common, mainly in men; femoral hernias are rarer, more frequent in women and strangulate more often.
Umbilical and epigastric — small defects in the midline of the abdomen.
Incisional — at the site of a previous surgical incision.
Parastomal — next to a stoma.
Diastasis recti — separation of the abdominal muscles, often after pregnancy; not a hernia in itself, but often combined with one.
Hiatal hernia — displacement of part of the stomach into the chest; it often causes no symptoms or shows up as heartburn and reflux.

Excess weight, smoking, chronic cough, constipation, heavy physical work and poor wound healing after surgery increase the risk.

Are there symptoms

Most often there is a bulge that appears when coughing, straining or standing and disappears when lying down, with discomfort or a dragging pain. A hiatal hernia causes heartburn, regurgitation, chest pain and difficulty swallowing.

Signs of strangulation are sudden severe pain at the hernia, a bulge that becomes firm and cannot be pushed back, and sometimes nausea, vomiting and inability to pass gas. This is a reason to seek help immediately.

Examinations needed

Examination by a surgeon — enough for most inguinal and umbilical hernias.
Ultrasound — for small or uncertain hernias.
CT of the abdominal wall — for large incisional and parastomal hernias, to plan surgery.
For a hiatal hernia — upper endoscopy, a contrast X-ray study and, when indicated, esophageal manometry and pH monitoring.
Standard tests and assessment of the heart and lungs before surgery.

When surgery is needed

Surgery is recommended for hernias that cause complaints. An asymptomatic or minimally symptomatic inguinal hernia in men can be watched, but over time most such hernias still need surgery; in women, inguinal and femoral hernias are repaired because of the higher risk of strangulation. Umbilical, incisional and parastomal hernias are repaired if they cause complaints, grow or are at risk of strangulation.

A hiatal hernia is operated on for persistent reflux that responds poorly to medication, or for a paraesophageal hernia that causes symptoms. Diastasis without a hernia is first treated with exercises; surgery is considered when it is combined with a hernia or causes marked complaints.

If surgery is not possible now

If surgery is postponed, it is important to lose weight, stop smoking and control diabetes — this lowers the risk of complications and recurrence, and before large incisional hernia repair it is part of the preparation. A support belt may ease discomfort but does not treat the hernia. For heartburn from a hiatal hernia, acid-reducing medication is prescribed.

How the operation is performed

Inguinal hernias are repaired with a mesh implant — open or laparoscopically, when the patient’s condition and the hernia’s features allow; laparoscopy is especially convenient for bilateral hernias and for recurrence after open repair. Umbilical and epigastric hernias of 1 cm or more are also closed with mesh. Large incisional hernias are repaired with mesh placed between the muscle layers, sometimes with component separation of the abdominal wall; some are done laparoscopically.

For a hiatal hernia, the opening in the diaphragm is narrowed laparoscopically and a wrap is formed from the stomach around the esophagus — a fundoplication, which reduces reflux.

A hernia will not go away on its own. Elective surgery is usually simpler and safer than an emergency operation for strangulation.

Kateryna Valikhnovska, MD, surgical oncologist

Recovery after surgery

Care follows the enhanced recovery after surgery (ERAS) protocol. After inguinal or umbilical repair, patients usually go home the same day or the next; walking is possible straight away, and normal activity resumes as you feel able, usually within 1–2 weeks. After large abdominal wall repairs, recovery takes longer and heavy exertion is limited for several weeks.

After a fundoplication, soft food in small portions is eaten for the first few weeks while swelling settles.

Follow-up

No long-term follow-up is needed after an elective repair. See a doctor if a bulge or pain reappears at the operation site. After hiatal hernia surgery, it is checked whether heartburn and difficulty swallowing have resolved.

What to bring to the consultation

ultrasound reports or CT discs, if performed;
reports of previous operations — especially for incisional and recurrent hernias;
for a hiatal hernia — the endoscopy and X-ray reports;
a list of other conditions and medications, including anticoagulants.

If some materials are missing, that is no reason to postpone the consultation: some examinations can be done on site.

The consultation is free of charge. How it goes and how long it takes is described on the page “Oncologist Consultation”.