A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. It usually develops between your chest and hips. In many cases, it causes no or very few symptoms, although you may notice a swelling or lump in your tummy (abdomen) or groin.

The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.

Inguinal hernias occur when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh.

This is the most common type of hernia and it mainly affects men. It’s often associated with ageing and repeated strain on the abdomen.

Read More About the Diagnosis and Treatment of inguinal hernias here.

Femoral hernias also occur when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh. They’re much less common than inguinal hernias and tend to affect more women than men.

Like inguinal hernias, femoral hernias are also associated with ageing and repeated strain on the abdomen.

Read More About the Diagnosis and Treatment of femoral hernias here.

Umbilical hernias occur when fatty tissue or a part of your bowel pokes through your abdomen near your belly button (navel).

This type of hernia can occur in babies if the opening in the abdomen through which the umbilical cord passes doesn’t seal properly after birth. Adults can also be affected, possibly as a result of repeated strain on the abdomen.

Read More About the Diagnosis and Treatment of umbilical hernias here.

Hiatus hernias occur when part of the stomach pushes up into your chest by squeezing through an opening in the diaphragm (the thin sheet of muscle that separates the chest from the abdomen).

This type of hernia may not have any noticeable symptoms, although it can cause heartburn in some people.

It’s not exactly clear what causes hiatus hernias, but it may be the result of the diaphragm becoming weak with age or pressure on the abdomen.

Read More About the Diagnosis and Treatment of hiatus hernias here.

Other types of hernia that can affect the abdomen include:

  • incisional hernias – where tissue pokes through a surgical wound in your abdomen that hasn’t fully healed
  • epigastric hernias – where fatty tissue pokes through your abdomen, between your navel and the lower part of your breastbone (sternum)
  • spigelian hernias – where part of your bowel pokes through your abdomen at the side of your abdominal muscle, below your navel
  • diaphragmatic hernias – where organs in your abdomen move into your chest through an opening in the diaphragm; this can also affect babies if their diaphragm doesn’t develop properly in the womb
  • muscle hernias – where part of a muscle pokes through your abdomen; they also occur in leg muscles as the result of a sports injury

Your GP or consultant will usually be able to identify a hernia by examining the affected area.  A number of factors will then be considered when deciding whether surgery is appropriate, including:

  • the type of hernia – some types of hernia are more likely to become strangulated, or cause a bowel obstruction, than others
  • the content of your hernia – if the hernia contains a part of your bowel, muscle or other tissue, there may be a risk of strangulation or obstruction
  • your symptoms and the impact on your daily life – surgery may be recommended if your symptoms are severe or getting worse, or if the hernia is affecting your ability to carry out your normal activities
  • your general health – surgery may be too much of a risk if your general health is poor

There are two main ways surgery for hernias can be carried out:

  • open surgery – where one cut is made to allow the surgeon to push the lump back into the abdomen
  • keyhole (laparoscopic) surgery – this is a less invasive, but more difficult, technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia

Most people are able to go home the same day or the day after surgery and make a full recovery within a few weeks.

For more information on hernia repair surgery click here.

The Hernia Surge group are made of international hernia experts from every continent. These guidelines were published January 2018 with the aim of improving patient outcomes by reducing the risk of recurrence and the risk of chronic groin pain. The guidelines are extensive but these are some of what we think are the most important points:

  1. Factors associated with a higher risk of recurrence include poor surgical technique, low surgeon volume/experience and local anaesthetic approaches.
  2. It is recommended that all symptomatic hernias are repaired electively, as outcomes of emergency repair are poorer. Hernias in men which cause few or no symptoms can be safely managed without surgery but these patients eventually become symptomatic.
  3. A mesh repair is recommended over suture repairs. This is because the recurrence rate is lower with a mesh repair.
  4. Provided the surgeon has expertise in the technique, keyhole surgery for groin hernias has a faster recovery time, lower risk of chronic groin pain and is cost effective.
  5. In a keyhole operation, mesh fixation (with tacks) is only recommended for hernia with a large defect to reduce the risk of recurrence. Otherwise it is not necessary.
  6. Antibiotics at the time of surgery are not recommended for keyhole surgery, and only in high risk patients having open repairs.
  7. There is a learning curve in keyhole surgery and probably 100 repairs need to be carried out to be achieving the same outcomes as open surgery.

If you come to see us for a consultation, we will discuss these guidelines with you and explain the relevant sections for your particular case.

Read more at Hernia Surge here.

NICE issued guidance on the use of keyhole techniques in repair of groin hernias in 2004. At that time the techniques were relatively new and there was one study that seemed to present conflicting evidence. Most data suggested at that time that keyhole surgery resulted in a quicker return to normal activities, reduced numbness, reduced pain at 1 year, reduced complications and a similar risk of recurrent hernia (1.5-2.5%). Due to the resulting uncertainty, NICE recommended keyhole surgery for the repair of hernias on both sides simultaneously, as well as for recurrent hernias. NICE suggested that the choice of surgical approach for first time one-sided hernias can be left for discussion between surgeon and patient, taking available expertise and patient wishes into account.


  1. Lichtenstein Versus Total Extraperitoneal Patch Plasty Versus Transabdominal Patch Plasty Technique for Primary Unilateral Inguinal Hernia Repair. A large, registry based European study published in February 2019 directly compares these two approaches. Köckerling, Ferdinand, MD*; Bittner, Reinhard, MD†; Kofler, Michael‡; Mayer, Franz, MD; Adolf, Daniela, PhD; Kuthe, Andreas, MD; Weyhe, Dirk, MD. Annals of Surgery: February 2019 – Volume 269 – Issue 2 – p 351–357.


The above study was published in February 2019 and directly compares these two approaches, in over 55000 patients. The authors suggest that recovery times and pain scores are lower after keyhole surgery, supporting a role for the keyhole approach for all first-time groin hernias.


SPECIALIST UPPER GI SURGERY have expertise in both keyhole and open techniques to repair not only groin hernias, but other types of abdominal wall hernias. We can discuss this evidence and help you choose the most appropriate method of repair for your hernia.

One of the most important risks of groin hernia repair to consider is that of developing chronic groin discomfort after the surgery. At SPECIALIST UPPER GI SURGERY, we feel that one of the key technical factors that influences the risk of developing chronic discomfort relates to how the mesh used for the repair is fixed in place.

Meshes are fixed generally to avoid them moving out of position in the early post-operative period, thereby allowing a recurrent hernia to form. In the open technique, meshes are traditionally stitched in with permanent sutures. In keyhole repairs, meshes are usually held in place by tacks. These can be titanium or plastic and are permanent. Newer tacks are made of an absorbable material that disappears 6-12 months post-operatively.

However, all types of tack penetrate into the muscle and potentially can injure nerves.

At SPECIALIST UPPER GI SURGERY, we have switched to recommending the use of Pro-grip meshes, which have been available for over 5 years. These double sided meshes have a normal light weight mesh on one side, and what looks like “velcro-like” barbs on the other, again made of an absorbable material. There is a growing body of evidence (examples below) suggesting these meshes have low recurrence rates (0-1.5%) and are associated with less chronic pain that more traditional light weight meshes tacked in place.

  1. Surg Endosc. 2015 Sep;29(9):2690-6. doi: 10.1007/s00464-014-3991-y. Epub 2014 Dec 18. Progrip with no recurrence or chronic pain after 1 year. Use Carolinas Comfort Scale
  2. 2013 Jun;17(3):313-20. doi: 10.1007/s10029-013-1053-3. Epub 2013 Feb 15.. 220 patients with progrip, 1.4% recurrence, 1.2% severe pain, 3.6% mild pain at 2yrs.

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