Hernias don’t always hurt, but they can still be a pain. Often creating a bulge on the body, hernias happen when an organ pokes through the abdominal wall or other tissues that are supposed to be holding that organ in.

For some people, the bulge is inconvenient but not necessarily unsafe. But for most people—particularly those over five years old—doctors like Seth Kipnis, M.D., often recommend surgery to repair the hernia.

“With the exception of some pediatric hernias, a hernia will never go away on its own,” says Dr. Kipnis, medical director of bariatric and robotic surgery at Hackensack Meridian Jersey Shore University Medical Center. “Once you have one, it's a permanent hole and it will stay there until it's repaired. Usually, the longer you wait, the bigger it gets and the harder it is to repair.”

“On occasion, unrepaired hernias may be at risk of getting stuck or strangulated, a potentially life-threatening complication that happens when bulging tissue loses blood flow and dies,” says Thomas Bauer, M.D., chair of surgery at Jersey Shore University Medical Center. “These cases can involve nausea, vomiting and extreme pain. So if you or a loved one have a hernia, it’s a good idea to talk to a surgeon sooner than later to see if surgery makes sense for you.”

Here’s what you should know:

About the Surgery

Who Is and Isn’t a Candidate for Surgery?

Almost everyone can undergo hernia surgery repair. In general, if you have a hernia and you’re not too sick or too old to undergo surgery, you’re likely a candidate. Still, there may be some cases where surgery may not be recommended.

Among them: children under five. 

“Belly button (umbilical) hernias can close on their own in kids this young, but if they persist after five years old, they usually don’t close and may eventually need repair,” says Dr. Kipnis.

Others who may not benefit from surgery are those who’ve experienced several procedures and surgeries in the abdominal area to repair previous hernias. “At some point after multiple attempts to repair a hernia, some hernias may not be fixable anymore,” says Dr. Kipnis. “That may be a situation where someone might have to live with their hernia.”

What Are the Risks of Hernia Surgery?

Repairs for small hernias generally use minimal and monitored sedation, like what you might get for a colonoscopy. Larger or more complex hernias may require general anesthesia. All sedation can involve risks, however low. Other risks can involve structural damage—such as nerve damage, numbness, loss of function, bowel perforation or ongoing pain. 

During the repair, surgeons typically use a mesh material to strengthen the tissue. While this is a common practice, it has also been associated with complications such as infection. But surgeons are increasingly using bioabsorbable mesh materials that are better tolerated by the human body, helping to minimize this risk.

What If I’m Pregnant?

The body undergoes extremes during pregnancy, especially around the abdomen. As a result, hernias can happen when you’re pregnant—typically in the belly or groin. But you might not need surgery right away.

“We usually wait to fix the hernia until mom is done with her childbearing years,” says Dr. Kipnis. “If you have a small belly button hernia after having a child, for instance, but you’re still wanting more kids, you likely will want to wait because your abdominal wall will get pushed out multiple times and it’s better to repair the hernia just once.”

Still, tell your doctor right away if you think you might have a hernia while pregnant so that they can watch out for complications or pain associated with the injury. 

What If My Child Has a Hernia?

When children get hernias, they’re typically “congenital”—meaning it’s something kids are born with, not the result of a physical strain or movement. Generally, pediatric hernias like these require surgery quickly, unless it’s a belly button hernia. Those can sometimes fix themselves, but if they don’t by your child’s fifth birthday, surgery may be necessary for them, too.

Before the Surgery

What Should I Expect Before the Surgery?

Before the surgery, your doctor’s office will send pre-op instructions that can depend on the anesthesia offered. Read these instructions closely; you may need to follow certain restrictions for food, drinks and medications. Always refer to those instructions and ask your care team if you have questions leading up to the procedure.

Additionally, plan on having someone drive you to and from your surgery.

What If I Have a Special Health Condition?

Always check with your doctor to see how unique health factors might affect your care plan. For example, Dr. Kipnis recommends that all his smoking patients quit before the procedure and continue withholding throughout recovery.

“Smoker’s cough after hernia repair can strain the abdominal area, which can potentially jeopardize the success of surgery,” he says. “Smokers also don’t heal as well and have a higher risk of infection.”

Similarly, people who struggle to pass hard stools will need to manage their constipation before and after surgery, since straining during bowel movements can worsen hernias. Dr. Kipnis also suggests that patients who are obese aim to lose weight before surgery for the best chances of hernia repair success and reduced risk of recurrence.

During the Surgery

What Happens During Hernia Repair?

When doctors fix hernias, they’re stitching the abdominal wall or other containing tissue to keep it closed, and potentially adding a mesh to reinforce that tissue. This helps ensure that no organs can poke out again in the future.

Historically, surgeons have done that process incisionally—meaning they’d cut a hole into the body and sew the hernia closed from the outside. But with noninvasive techniques like laparoscopic and robotic surgery, patients have more options than ever.

“We can now repair hernias from the inside, which doesn’t require cutting through any muscle layers,” says Dr. Kipnis. “There’s less tissue trauma when you do a hernia laparoscopically, so the recovery is usually much quicker.”

How Long Does Surgery Take?

For small hernias performed laparoscopically, expect about an hour of procedure time. If your case is more complex, such as for a recurrent or larger hernia, or a repair where you’ve previously had another surgery, expect a little longer. 

After the Surgery

What is the Recovery Process Like?

Most small hernia repairs are done in an outpatient setting, which involves a same-day procedure without an overnight stay. In general, patients can go home as soon as they’ve woken up from the anesthesia and are cleared for discharge.

Afterward, expect some discomfort around the incision. But don’t let that stop you: No matter what type of surgery you had—laparoscopic or not—doctors will likely recommend that you start moving gently right away.

“We want patients walking and taking the stairs the same day after any type of hernia repair,” says Dr. Kipnis. “This is essential to recovery.”

The care team may write you a prescription for some pain medication. But within a couple of days, you might not need it anymore, especially for laparoscopic procedures. However, you’ll still want to watch for signs of infection such as excessive pain, fever, swelling or skin that feels hot. Tell your doctor right away if you’re concerned about infection.

When Can I Resume Daily Activities?

Gentle movements like walking are good for your recovery. But hold off on anything more strenuous, Dr. Kipnis warns.

“Don’t do heavy lifting or vigorous exercise at least for a couple of weeks after the procedure, and longer if you had an open surgery that wasn’t laparoscopically performed,” he says. “A lot of that will depend on the size of the hernia and the extent of its repair, so follow your doctor’s instructions.”

Can the Hernia Come Back?

Small hernias rarely come back. For bigger hernias or those performed incisionally, recurrence can happen more often. 

“Usually, if a hernia returns, it will take a long time to develop,” says Dr. Kipnis. “If you do have a hernia recurrence, we recommend repairing it again. Occasionally, large hernias can require several repairs over several years before they’re completely fixed.”

Next Steps & Resources:

• Our sources: Seth Kipnis, M.D. & Thomas Bauer, M.D.

• Make an appointment with a surgeon near you.

• Learn more about surgical services at Hackensack Meridian Health

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.