Hernia repair surgery is one of the most commonly performed operations worldwide. Most patients are able to go home the same day and can return to regular activities quickly. Hernia repair has been shown to have excellent long term outcomes. The purpose of the surgery is to return the bulging tissue to its proper place, and then repair the defect in the abdomen with stitches and/or a mesh patch to prevent the hernia returning.

At Harbour Surgery Centre, your surgeon will discuss the best suited option for you.

1. OPEN HERNIA REPAIR
Open hernia repair is where a cut is made in the groin for inguinal/ femoral hernias or directly over the bulge for other types of hernias (e.g. epigastric). The hernia “sac” containing the bulging intestine is identified and carefully dissected free from surrounding tissues. The surgeon then pushes the hernia back into the abdomen and strengthens the abdominal wall with stitches or mesh. Most patients are able to go home the same day and can build up to regular activities over the next fortnight to 6 weeks.

2. LAPAROSCOPIC HERNIA REPAIR
Laparoscopic hernia repair uses a thin camera that is inserted through a small incision at the umbilicus (belly button). The camera provides a view of the hernia space “from the inside.” The abdomen is inflated with a harmless gas, which creates space to allow your surgeon to dissect and reduce the hernia. Mesh is placed on the inside to cover the defects in the abdominal wall and strengthen the tissue. (See section on mesh below). The operation is usually done via 3 small incisions which are closed with dissolvable stitches.

The benefits of laparoscopic hernia surgery include three tiny scars rather than one larger incision, less pain after surgery, a quicker return to work and a shorter recovery time (days instead of weeks). The surgeons at Harbour Surgery Centre specialise in laparoscopic hernia repair and are able to offer this surgery to most patients with groin hernias. Laparoscopic or Robotic surgery (see below) is also offered to suitable patients with other types of hernias.

3. ROBOTIC HERNIA REPAIR
Robotic hernia repair is similar to laparoscopic surgery but differs in that the surgeon is seated at a console in the operating room and handles the surgical instruments from the console. The operation is still done completely by the surgeon but using robotic instruments. The robotic approach can be used for most hernia types. At Harbour Surgery Centre, robotic hernia repair is recommended when necessary and often favoured for incisional hernias.

The robot provides excellent three-dimensional images of the inside of the abdomen (vs. the two-dimensional images of laparoscopic surgery). Robotic surgery also allows the surgeon to easily use stitches to sew tissue and meshes inside the abdomen.

The use of mesh to repair hernias is both established and essential. However, in keeping with patient preferences, at Harbour Surgery Centre, a NZ-made biological mesh is used for inguinal hernia repairs.

NZ Association of General Surgeons Position Statement on Mesh

There has been much controversy in the media recently regarding transvaginal mesh prolapse repair and its potential associated risks of infection, erosion and chronic pain. Unfortunately, the media have portrayed the outcomes of this one gynaecological procedure to include all surgical use of mesh for hernia repair. It has caused unnecessary widespread patient stress and anxiety throughout New Zealand. The use of mesh in General Surgery to repair hernias of the groin or the abdominal wall is well established internationally and is considered the procedure of choice.

For ventral hernias with fascial defects greater than 2cm in diameter, mesh must be used to reinforce the tissue repair. If not, the hernia recurrence rate without mesh is unacceptably high. For groin hernia repair most surgeons worldwide use mesh for the repair. The use of mesh for abdominal and groin hernia repair is safe. Chronic pain may occur after hernia repair in less than 10% of patients. However, it is important to remember that chronic pain after groin hernia repair is higher for patients having non-mesh repair compared to mesh repair. Mesh infection after abdominal hernia repair is uncommon, less than 1 %. For laparoscopic inguinal hernia repair it is even lower. The use of surgical mesh is an important part of the curriculum for general surgical training and NZ general surgeons have extensive experience in the use of mesh for hernia repair. The good results of mesh hernia repair in general surgery should not be bought into disrepute by categorising all mesh repairs as the same.

Hernia repair is a routine operation with very few risks. But a small number of hernias can come back at some point after surgery.

Other potential complications of an inguinal hernia repair include:

• Temporary fluid building up in the space left by the hernia
• Temporary swelling and bruising
• Temporary altered sensation
• Small risk of damage to surrounding structures
• Small risk of infection (this usually gets better with antibiotics)

Your surgeon will discuss the specific risks of surgery and what to expect. After surgery, you will be able to reach the team at Harbour Surgery Centre 24/7, 365.

You will be able to reach the team at Harbour Surgery Centre 24/7, 365.

An adult must stay with you for the first 24 hours after your operation in case you experience any problems.

Your wound may still feel uncomfortable and you will be prescribed painkillers. Your nurse will give you instructions about caring for the wound, hygiene and bathing.

Over time, you can gradually return to your normal activities as soon as you’re able to do them without feeling any pain.

Most people are able to do light activities, such as shopping, within a few days to a week.

You should also be able to return to work after 1 or 2 weeks, although you may need more time off if your job involves manual labour.

Gentle exercise, such as walking, can help the healing process, but you should avoid heavy lifting and strenuous activities for about 4 to 6 weeks.

Driving is possible when you’re able to make an emergency stop without any discomfort. It is advisable to inform your car insurance company before resuming driving.