Your hernia care
Understand your hernia, prepare for your consultation with Nic Fischer, and know what to expect if surgery becomes the right option for you.
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Welcome
This guide will help you understand your hernia, prepare for your consultation with Nic Fischer, consider whether surgery is right for you, and know what to expect if you choose to have a hernia repair.
Not every hernia needs an operation. The purpose of this guide is to help you understand the choices so that your consultation can focus on your symptoms, your priorities and the option that best fits you.
This guide provides useful background information. Nic will assess your individual hernia and discuss what the different options mean for you.
How to use this guide
This short video shows you how to move through the guide, use Quick Actions and save anything you would like to Discuss with Nic. Watch it now, or come back to it whenever you need it.
Nic Fischer
General Surgeon · DunedinNic provides specialist private general surgical care in Dunedin and performs both open and laparoscopic hernia repair.
At your consultation he will examine your hernia, talk with you about the symptoms it is causing and understand how it affects your work, exercise and everyday life.
If surgery is worth considering, the discussion is not simply about whether an operation can be done. It is about whether repair is likely to provide enough benefit for you to justify the operation, its risks and the recovery afterwards.
What would you like to know?
Read from the beginning, or go directly to the part that is most useful to you now.
Your hernia journey
For most people, the pathway is straightforward. Knowing what happens next can make each stage easier to prepare for.
Referral or enquiry
Your GP may refer you, or you may contact Fischer Surgery directly.
Prepare
Read about hernias and save anything you would like to discuss.
Meet Nic
Nic examines the hernia and discusses how it affects your life.
Decide together
Observation or surgery may be appropriate, depending on your circumstances.
Prepare for surgery
If you proceed, you receive your booking, fasting and medication instructions.
Hernia repair
Nic performs the repair using the approach agreed with you.
Recover at home
Gradually return to walking, work, driving and normal activity.
Follow-up
Review your recovery with Nic where appropriate.
Understanding your hernia
First, understand what a hernia is, why it can cause symptoms and when it may need attention.
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Understanding your hernia
A hernia is a weakness in the abdominal wall that allows tissue from inside the abdomen to push through. Understanding what type of hernia you have is the first step in deciding whether anything needs to be done.
Some remain small and cause very few symptoms. Others gradually enlarge or become uncomfortable. The important thing is understanding the type of hernia, how it affects you and whether there are any warning signs.
What is a hernia?
A hernia occurs when tissue from inside the abdomen pushes through a weak area in the muscles or connective tissue of the abdominal wall.
This may produce a lump or bulge that is more noticeable when you stand, cough, lift or exercise. The lump may become smaller or disappear when you lie down.
Some hernias remain small and cause very few symptoms. Others gradually enlarge or become uncomfortable.
What type of hernia do I have?
Hernias are usually named according to where the weakness occurs. The location and type of hernia can influence the symptoms you experience and the treatment options available.
An inguinal hernia occurs in the groin. You may notice a lump, aching or discomfort, particularly when standing, lifting, coughing or exercising.
A femoral hernia sits slightly lower in the groin. These are less common but can carry a greater risk of tissue becoming trapped.
These develop around the belly button or higher up in the middle of the abdominal wall.
An incisional hernia develops through a weakness in the abdominal wall at or close to the site of a previous operation.
What symptoms can a hernia cause?
Hernias affect people differently. Some cause very little trouble, while others cause symptoms that interfere with work, exercise or everyday activities.
What does “reducible” mean?
A reducible hernia is one where the contents of the hernia can move back through the opening in the abdominal wall, either by themselves or with gentle pressure.
A hernia may therefore be obvious when you are standing and much less noticeable when you lie down.
How is a hernia diagnosed?
Many groin and abdominal wall hernias can be diagnosed from your symptoms and examination.
Nic may examine the area while you are standing and may ask you to cough or strain gently so the hernia becomes easier to assess.
A scan is sometimes useful when the diagnosis is uncertain or when more information about the abdominal wall is needed, but not every hernia requires imaging.
What will Nic want to understand?
What changes should I take seriously?
A hernia that suddenly becomes very painful, firm, increasingly swollen or no longer goes back in needs prompt medical assessment, particularly if you also develop vomiting, worsening abdominal pain or feel unwell.
Nic will assess the type of hernia you have and, importantly, how much it is affecting you. This helps guide the decision about whether treatment is likely to be worthwhile.
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Is surgery right for me?
Finding a hernia does not automatically mean you need an operation. The important question is whether repairing it is likely to improve things that matter to you enough to justify surgery and the recovery afterwards.
For some people, continuing to observe a hernia is perfectly reasonable. For others, symptoms or limitations make repair increasingly worthwhile.
Does every hernia need surgery?
No. A hernia may be present for some time without causing enough trouble to justify an operation.
The decision depends less on the fact that a hernia exists and more on the type of hernia, the symptoms it causes, how it is changing and how much it affects your everyday life.
Continue to observe
This may be reasonable when the hernia causes little or no discomfort, is not significantly limiting your activities, and there is no particular reason that repair needs to happen now.
Consider repair
Surgery becomes more worth considering when the hernia is painful, increasing in size, interfering with work or activity, or creating enough concern or inconvenience to affect your quality of life.
What influences the decision?
Nic will look at the hernia itself, but he will also want to understand how it fits into the rest of your life.
Weighing benefit against downside
The purpose of the consultation is to compare what you may gain from repair with the downsides of having an operation.
- Reduce pain or discomfort
- Return to activities more comfortably
- Address an enlarging hernia
- Reduce the inconvenience or worry it causes
- The risks of an operation
- Pain and limitations during recovery
- Time away from work or usual activity
- The possibility of persistent symptoms afterwards
When might surgery become more worthwhile?
What happens if I wait?
For some people, observation is a reasonable choice. This does not mean ignoring the hernia. It means continuing normal life while noticing whether the hernia becomes more painful, larger or more limiting.
If your symptoms change, you can review the decision. Choosing not to have surgery now does not necessarily mean you cannot choose surgery later.
Nic will help you work through this balance. The aim is not simply to decide whether a hernia can be repaired, but whether repairing it is likely to be worthwhile for you.
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Choosing the right repair
If you decide to have surgery, the next step is choosing an approach that fits the type of hernia you have, your previous operations, your health and what matters to you during recovery.
The operation should be matched to the hernia and the person having it. Nic will explain why one approach may make more sense for you than another.
How can a hernia be repaired?
Most hernia repairs involve closing or reinforcing the weak area in the abdominal wall. The operation can usually be performed through an incision over the hernia or using a keyhole approach through several smaller incisions.
Open repair
Nic reaches the hernia through an incision directly over or close to it. This gives direct access to the weak area and may be particularly suitable for some straightforward hernias or where the anatomy favours an open approach.
Keyhole repair
Keyhole surgery uses several small incisions to reach the hernia from inside the abdominal wall. It may be useful for certain groin hernias, hernias on both sides, recurrent hernias, or where the pattern of recovery is an advantage.
What determines the approach?
Will mesh be used?
Mesh is a surgical material used to reinforce an area of weakness. It allows the repair to spread tension across a broader area rather than relying only on stitches in the surrounding tissue.
Mesh is commonly used in adult hernia surgery, but its role depends on the type and circumstances of the repair. Nic will explain whether he recommends mesh in your case and why.
Why might one approach suit me better?
A keyhole approach may allow both groins to be assessed and repaired during the same operation.
Nic may favour approaching the hernia through a different tissue plane from the one used previously.
Size, location and previous abdominal surgery may make planning more individual and occasionally require additional imaging.
Anaesthetic risk, medications and other medical conditions can influence both the operation and the timing.
The recommendation follows the examination
Online information can explain the options, but it cannot tell you which repair is best for your particular hernia. Nic will examine you, review any relevant imaging or previous operations, and then explain the approach he recommends.
Nic will explain not only which operation he recommends, but the reasoning behind it. If more than one option is reasonable, you can discuss the differences and decide which approach best fits your circumstances.
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Understanding the risks
Hernia surgery is commonly performed, but no operation is completely free of risk. Understanding the important possibilities helps you decide whether the expected benefit of repair is worthwhile for you.
The type of hernia, the operation being considered and your own health all influence what matters most. Nic will focus on the risks that are particularly relevant to you.
Some changes after surgery are expected
It helps to separate normal features of recovery from a true complication. Tenderness and swelling around the operation do not necessarily mean something has gone wrong.
Things you may notice
These commonly settle as the tissues heal.
Problems that can occur early
Most people recover without a major complication. These are some of the issues Nic will consider when discussing surgery with you.
Bruising is common. Occasionally a larger collection of blood, called a haematoma, develops around the operation.
A pocket of clear fluid, called a seroma, can form where the hernia used to be. Many settle without treatment.
A wound infection can occur after any operation. Infection involving surgical mesh is less common but can be more difficult to treat.
Some people temporarily have difficulty emptying their bladder after an anaesthetic or groin hernia repair.
Two longer-term risks are particularly worth understanding
These outcomes are important when weighing the benefit of an elective hernia repair against continuing to live with the hernia.
Most postoperative discomfort improves as healing progresses. A smaller proportion of people develop pain, numbness or altered sensation that persists beyond the usual recovery period. Occasionally this can significantly affect daily life.
A repaired hernia can recur. The likelihood depends on the type of hernia, repair technique, tissue quality and other individual factors.
Some complications are uncommon but potentially serious
The exact risks differ according to the type and location of the hernia. Depending on the operation, these can include:
What can change my individual risk?
Smoking can affect wound healing and increase some surgical complications.
Your general health can influence healing, infection risk and anaesthetic planning.
Previous operations can alter the anatomy and sometimes make a repair more complex.
Size, location, recurrence and the tissues around the hernia all influence the operation and its risks.
Nic will put these risks into context for the particular repair being considered. If there is a complication you are especially concerned about, bring it up during your consultation.
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Preparing for surgery
Once you have decided to proceed, good preparation makes the day itself more straightforward. Most of the important steps are practical: knowing when to stop eating and drinking, checking your medications and arranging how you will get home.
Your final fasting, medication and arrival instructions are specific to your operation. If anything in this guide differs from the instructions you receive from the hospital or surgical team, follow the instructions sent directly to you.
What happens next?
Once the date is confirmed, you will receive information about where to go, when to arrive and how to prepare. There may also be questions about your health, medications and previous anaesthetics.
Things worth organising early
Arrange for someone to collect you after surgery. You should not plan to drive yourself home after an anaesthetic.
It is helpful to have another adult available after you get home, particularly during the first evening.
Make arrangements for work, childcare, heavy lifting and other commitments that may be difficult immediately after surgery.
Make sure the team knows everything you take, including prescription medicines, injections and over-the-counter products.
Fasting
You will be told when to stop eating and when to stop drinking before your operation. These instructions are important for the safety of your anaesthetic.
Do not assume that the fasting times from a previous operation will be the same for this one.
Do any of my medicines need to change?
Some medicines need special planning around surgery. Do not stop important medication on your own unless you have been told to do so.
Arrange someone to take you home
If you are having a general anaesthetic or sedation, you should not drive yourself home afterwards.
Arrange for a responsible adult to collect you and, where possible, be available during your first evening at home.
What should I bring?
Hernia surgery with Fischer Surgery is usually performed at Mercy Hospital in Dunedin. Your booking information will confirm the location for your operation.
Arriving for your operation
Your booking information will tell you exactly where to report and what time to arrive. Check these details before leaving home, rather than relying on information from a previous hospital visit.
Before you leave home
A few simple checks can make arriving at hospital much easier.
A final check
What happens when I arrive?
The hospital team will confirm your details, medications, fasting and arrangements for going home.
A nurse will prepare you for theatre and complete the final checks needed before your operation.
You will meet the anaesthetist and can discuss the anaesthetic, pain relief and any relevant health concerns.
There is an opportunity to confirm the planned operation and deal with any final questions before surgery.
Ready for surgery?
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What if something changes?
Contact the team if you become unwell before surgery, develop a significant new health problem, start an important new medication or are unsure whether you should still attend.
It is better to check than to arrive with an unanswered concern.
Nic will see you before the operation. You do not need to arrive remembering every detail from this guide. The hospital team will take you through the important checks again, and there is still time to ask questions.
Anything you still want to ask?
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Recovery at home
Recovery is usually gradual rather than dramatic. The aim is to keep comfortable enough to move, steadily increase what you are doing and recognise the difference between normal healing and a problem that needs attention.
You do not need to stay still because you have had a hernia repair. Walking and normal light activity can usually begin early, then build up according to comfort and the instructions you receive after your operation.
The first few days
You are likely to feel sore around the operation, particularly when getting out of bed, coughing or changing position. This should gradually become easier rather than progressively worse.
Focus on the basics
The early part of recovery is mainly about comfort, movement and giving yourself time to recover from the operation and anaesthetic.
Short, regular walks around the house and outside as you feel able are better than spending long periods in bed.
Take the medication provided or recommended to you. Being reasonably comfortable helps you move and breathe normally.
Build back toward your usual diet as your appetite returns and keep well hydrated.
It is common to need more rest than usual for the first few days after an operation.
How recovery usually progresses
There is no single timetable that suits everyone. The type of repair, the size of the hernia and the kind of work or exercise you normally do all make a difference.
48 hours
Spend time resting, but get up regularly for short walks. Discomfort, stiffness and some swelling or bruising are expected.
week
Walking, dressing, showering and simple household activities should gradually become more comfortable.
weeks
Increase activity progressively. Return to work, exercise and heavier tasks depends on your repair and how physically demanding those activities are.
Pain relief
Some pain or aching is expected after surgery. Take the pain relief recommended on discharge rather than waiting until the discomfort has become difficult to control.
You should generally notice an improving trend over time.
Looking after the wound
Follow the wound and dressing instructions you receive from the hospital. These can vary according to the type of closure and dressing used.
Mild tenderness and bruising can be normal. Increasing redness, discharge or worsening swelling deserves review.
What can I do?
Use comfort as a guide for light everyday activity. For heavier work, lifting or structured exercise, follow the advice Nic gives you for the particular repair you have had.
Things that can look or feel different for a while
Some postoperative changes can be noticeable without representing a complication.
When should I ask for advice?
Contact Fischer Surgery or the hospital if recovery is not following the pattern you expected, particularly if you develop:
Seek urgent medical attention for a serious or rapidly worsening problem
Severe breathlessness, chest pain, collapse, major bleeding or another serious acute problem should not wait for a routine surgical callback. Call 111 or seek emergency medical care.
Nic may give you recovery advice that is more specific than the general information here. The type of hernia and the repair performed matter, so use your discharge instructions as the main guide after surgery.
Questions about your recovery?
Save anything you want to clarify about returning to normal activity.
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Follow-up and long-term recovery
The early recovery period is only part of the story. Over the following weeks, the aim is to return to normal activity, allow the repair to settle and make sure there are no problems that need further attention.
Some tenderness, firmness or altered sensation can take time to settle. What matters is the overall trend. If something is persistently worsening or simply does not seem right, it is reasonable to have it reviewed.
What is follow-up for?
Follow-up is an opportunity to check how the wound and repair are settling, review any symptoms that remain and discuss your return to normal work, exercise and other activities.
Things worth reviewing
Depending on your operation and recovery, follow-up may include:
What can take time to settle?
The skin may look healed before the deeper tissues feel completely normal. Some sensations around a repair can take longer to improve.
The tissues around the repair can feel firmer or thicker for a period while healing and scar tissue mature.
Numbness, tingling or a different sensation around the wound can gradually improve over time.
Some people remain aware of pulling, tightness or mild discomfort during certain movements while recovery continues.
It can take time to trust the repaired area again, particularly when returning to lifting or more demanding exercise.
Build back progressively
Recovery is usually better thought of as a progression rather than a single date when you suddenly become fully recovered.
Walking, household activity and normal daily movement.
Increase according to comfort and the physical demands involved.
Progress back to heavier lifting, sport or more demanding activity in a controlled way.
What if symptoms do not settle?
Recovery does not have to be completely symptom-free, but some problems deserve review rather than simply being tolerated.
What if I notice another lump?
A new lump does not automatically mean the hernia has returned. Healing tissue and postoperative swelling can sometimes feel different from the surrounding area.
If you later notice a new or enlarging bulge, particularly if it behaves like your original hernia, arrange a review rather than trying to diagnose it yourself.
Nic would rather you ask about a recovery concern than continue worrying about it. If something does not seem to be progressing as expected, contact Fischer Surgery for advice.
Anything you want to clarify?
Save a question for your follow-up or next conversation with Nic.
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