Hernia Surgery in Delhi, India

Hernia repair surgery, also known as herniorrhaphy or hernioplasty (depending on whether mesh in placed or not), is a surgical procedure aimed at correcting a hernia - a condition where an organ or tissue protrudes through a weakness in the muscular wall that normally contains it. Hernias most commonly occur in the abdomen or groin.

Here are the primary benefits of hernia repair surgery:

• Reduction of the herniated tissue: The surgeon gently manipulates the bulging tissue back into its proper position within the body cavity.
• Reinforcement of the weakened wall: To prevent future herniation, the surgeon repairs the weakened area using various techniques, often involving sutures and/or surgical mesh, a strong synthetic material that provides additional support.
• Alleviates symptoms: By addressing the anatomical defect, the surgery aims to relieve associated symptoms like pain, discomfort, and pressure.
• Prevents complications: Left untreated, hernias can lead to serious complications like incarceration (tissue trapped outside the wall) and strangulation (loss of blood flow to the trapped tissue). Prompt Surgery aims to prevent such risks.

There are three main types of hernia surgery:

1. Open Repair: This traditional approach involves a single incision, typically larger than 5 cm, made directly over the hernia site. The surgeon then accesses the hernia, gently pushes the protruding tissue back into its proper position, and reinforces the weakened wall using sutures and/or mesh. While open repair offers direct visualisation and potentially faster surgery time, it may lead to more pain, longer recovery, and a visible scar.
2. Laparoscopic Repair: This minimally invasive technique utilises several small incisions (usually 0.5-1 cm) through which the surgeon inserts a laparoscope (a thin tube with a camera) and specialised instruments. The camera projects magnified images onto a screen, allowing the surgeon to visualise and repair the hernia with enhanced precision. Laparoscopic repair often results in less pain, quicker recovery, and minimal scars compared to open repair.
3. Robotic Surgery: This is a variation of laparoscopic surgery where a robotic system assists the surgeon with more precise movements and control. The surgeon operates using a console, manipulating robotic arms that hold the surgical instruments. Robotic surgery offers potential advantages like improved dexterity, better ergonomics for the surgeon, and potentially shorter operating times compared to standard laparoscopy. However, it may be more expensive and not widely available at all healthcare facilities.

If an individual's hernia becomes painful or interferes with their daily activities, the doctor may recommend surgery. And sometimes, surgery might be considered even in the absence of pain, to prevent potential complications. 

Additionally, the sudden onset of intense hernia pain or tenderness serves as a warning sign indicating a potentially stuck or strangulated hernia. This condition is potentially life-threatening, necessitating emergency surgery.

Other indicators that emergency hernia surgery may be required include:

• Fever
• Bloating
• Nausea or vomiting
• Sudden enlargement of the bulge
• Redness at the site of the hernia
• A bulge that fails to retract back into the abdomen as previously observed

There are three phases of hernia: Preoperative, Intraoperative, and Postoperative 

Preoperative Phase

• Diagnosis and Consultation

The process begins with a thorough diagnosis of the hernia through physical examination, imaging tests, and medical history. Consultation with a surgeon follows to discuss the type of hernia, available treatment options, and potential risks.

• Medical Evaluation

Patients undergo preoperative medical evaluations to assess overall health and identify any potential complications. Blood tests, ECG, and other diagnostic tests may be conducted.

• Patient Education

Detailed discussion with the patient about the surgery, including the chosen surgical technique, expected outcomes, and potential risks. Preoperative instructions, including dietary restrictions, medication adjustments, and lifestyle recommendations, are provided.

• Anesthesia Evaluation

If general anaesthesia is planned, an anaesthesia evaluation is conducted to ensure the patient is fit for anaesthesia.

• Preoperative Fasting

Patients are typically instructed to fast for a certain period before surgery to minimise the risk of complications.

Intraoperative (During Surgery) Phase

• Anesthesia Administration

Anaesthesia is administered to induce unconsciousness for the duration of the surgery. General anaesthesia is common, but local or regional anaesthesia may be used in some cases.

• Incision and Access

For open hernia repair, a single incision is made over the hernia site. In laparoscopic and robotic surgeries, multiple small punctures are made, and a high definition camera is used for visualisation.

• Hernia Reduction

The surgeon carefully pushes the protruding organ or tissue back into its proper position.

• Repair Technique

For open repair, the weakened muscle or tissue is stitched together. In laparoscopic and robotic surgeries, mesh is used to reinforce the repair.

• Closure of Incisions

After completing the repair, incisions are closed using sutures or surgical staples.

Postoperative Phase

• Recovery Room

Patients are moved to a recovery area where they are monitored as they wake up from anaesthesia.

• Postoperative Pain Management

Pain management strategies are implemented to ensure the patient's comfort during the initial recovery period.

• Postoperative Instructions

Detailed instructions regarding postoperative care, activity restrictions, and any necessary follow-up appointments are provided.

• Hospital Stay or Discharge

Depending on the surgical approach and individual circumstances, patients may be discharged on the same day or stay in the hospital for observation.

• Rehabilitation and Return to Normal Activities

Gradual resumption of normal activities based on the surgeon's recommendations.

• Follow-up Appointments

Scheduled follow-up appointments to monitor the healing process and address any concerns.

It's important for patients to closely follow the preoperative and postoperative instructions provided by their healthcare team to ensure a smooth recovery and optimal outcomes.

While hernia repair surgery is generally safe and effective, it carries some potential risks and complications, like any medical procedure. It's essential to be aware of these before making a decision about surgery. Here's a breakdown of the most common risks and complications.

General Risks

• Anaesthesia complications: Reactions to anaesthesia, although rare, can occur. Discuss your medical history and any concerns with your doctor beforehand.
• Bleeding: Bleeding during or after surgery, while manageable, is a possibility. Your surgeon will take utmost care to minimise this risk.
• Infection: Wound infections can occur after surgery. Following proper incision care instructions is crucial to prevent this.
• Pain: You will experience some pain or discomfort after surgery, but your doctor will provide pain management medication.

Specific Risks

• Recurrence: The hernia may recur in some cases, depending on factors like the repair technique, type of hernia, and individual healing.
• Mesh complications: Surgical mesh used in some repairs can, in rare instances, cause discomfort, infection, or rejection.
• Injury to nearby structures: During surgery, there's a slight risk of injury to nerves, blood vessels, or other organs near the hernia site.
• Chronic pain: While uncommon, some patients experience chronic pain after surgery.

Long-term Complications

• Testicular atrophy: In inguinal hernia repairs, there's a theoretical, though minimal risk of testicular issues.
• Chronic urinary problems: Difficulty urinating or urinary retention can occur, especially in older adults after groin hernia repairs, especially if they suffer from prostatic issues.

• Choosing the right surgeon: Opt for an experienced and qualified surgeon with a good track record of performing hernia repairs. 
• Maintaining a healthy weight: Being overweight or obese increases the risk of complications and recurrences.
• Quitting smoking: Smoking can impede healing and increase recurrence risk.
• Following pre-operative instructions: Carefully follow your doctor's instructions before surgery, including dietary restrictions and medication adjustments.
• Proper post-operative care: Meticulously adhere to wound care instructions and attend follow-up appointments to monitor healing and address any concerns.

What are the different types of hernias treated by surgery?

The following types of hernias can be treated by surgery:

• Incisional hernia
• Inguinal hernia
• Sports hernia and core muscle injuries
• Umbilical hernia
• Lumbar and flank hernias

How long does hernia surgery take?

The duration of hernia surgery varies based on factors like the type of hernia and the chosen surgical technique. Generally, it can take anywhere from 30 minutes to 1 hour.

How painful is hernia repair surgery?

Pain levels can vary from person to person, but most individuals experience manageable discomfort. Pain management strategies are employed to ensure a more comfortable recovery.

What are the differences between Hernioplasty and Herniorrhaphy?

Hernioplasty involves using mesh to reinforce the weakened area, while herniorrhaphy involves stitching the muscle or tissue directly without the use of a mesh. Surgeons choose the approach based on the specific needs of the patient and the nature of the hernia.

What happens if a hernia is left untreated?

Untreated hernias can lead to complications such as increased size, pain, and the potential for incarceration or strangulation, which can be life-threatening. Prompt medical attention is advised.

Is hernia surgery life-threatening?

Hernia surgery is generally considered safe. However, as with any surgery, there are inherent risks. Complications are rare, and the benefits of addressing the hernia significantly outweigh the risks. 

How long does it take to heal after hernia surgery?

The healing time varies depending on factors like the type of surgery and individual health. Most people can resume normal activities within a week, but full internal healing may take several weeks.

Are there non-surgical options to treat hernia?

While surgery is the most common treatment for hernias, lifestyle modifications and the use of supportive garments may help minimise symptoms. However, these do not provide a permanent cure for the hernia.

Is life normal after hernia surgery?

In most cases, individuals can return to normal activities after hernia surgery, following the recommended recovery period and any guidelines provided by the healthcare team.

How much does a hernia surgery cost?

The cost of hernia surgery varies based on factors such as geographical location, type of surgery, and hospital fees. Health insurance coverage can significantly impact out-of-pocket expenses.

Can I walk right after hernia surgery?

Walking is generally encouraged after hernia surgery to promote circulation and prevent complications. However, the intensity and duration of physical activity should align with postoperative guidelines provided by the healthcare team.

Reviewed By Dr. Abhimanyu Dewan, Consultant - Department of MAMBS, Robotic Surgery, Laparoscopic / Minimal Access Surgery on 13 May 2024.