When Do I Need Surgery for My Hernia?

By Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD — Compass Surgical, Auckland

One of the most common questions patients ask after being diagnosed with a hernia is, "Do I need surgery?"

The answer is not always straightforward.

While hernia repair is one of the most commonly performed operations worldwide, not every hernia requires immediate treatment. The decision depends on your symptoms, the type of hernia, your overall health, and how much the hernia is affecting your quality of life.

Do All Hernias Need Surgery?

No.

Many hernias can be safely monitored, particularly if they are small and causing minimal symptoms.

Some patients live with a hernia for years with little impact on their daily activities. Others find that discomfort gradually worsens over time, making exercise, work, or even simple day-to-day tasks increasingly difficult.

The key question is not simply whether a hernia exists, but whether it is causing symptoms or creating a significant risk of future problems.

When Is Surgery Usually Recommended?

Surgery is commonly recommended when a hernia:

Causes pain or discomfort
Interferes with work, sport, or daily activities
Continues to enlarge
Becomes increasingly difficult to push back in
Causes concern or anxiety for the patient
Has characteristics that increase the risk of complications

For many patients, surgery is chosen because symptoms are affecting their quality of life rather than because the hernia is dangerous.

What About Watchful Waiting?

For selected patients, a strategy known as "watchful waiting" may be appropriate.

This involves monitoring the hernia and reviewing symptoms over time rather than proceeding directly to surgery.

Research has shown that watchful waiting can be a safe option for some patients with minimally symptomatic inguinal hernias. However, many patients eventually choose surgery because symptoms gradually increase over the following years.

This is why treatment decisions should always be individualised rather than applying a one-size-fits-all approach.

Further patient information about hernias and hernia repair is available through the Royal Australasian College of Surgeons (RACS) and Healthify NZ.

Are There Situations Where Surgery Is More Urgent?

Yes.

Although most hernias are not emergencies, occasionally tissue or bowel can become trapped within the hernia.

Warning signs include:

Sudden worsening pain
A lump that becomes firm and cannot be pushed back in
Nausea or vomiting
Abdominal bloating
Redness over the hernia

These symptoms require urgent medical assessment. If you are seriously unwell or believe you may have a medical emergency, call 111.

Fortunately, most patients are diagnosed and treated long before such complications occur.

What Happens If I Choose Surgery?

Modern hernia surgery is highly effective and is usually performed as a day-stay procedure.

The goals of surgery are to:

Relieve symptoms
Prevent progression
Reduce the risk of future complications
Allow patients to return to normal activities with confidence

At Compass Surgical, we carefully assess each patient's symptoms, lifestyle, occupation and goals before recommending treatment. For some patients, surgery is clearly the best option. For others, observation may be entirely reasonable.

Making the Right Decision for You

There is no single answer that applies to every patient.

A young tradesperson with a symptomatic groin hernia may benefit from early repair. An older patient with a small, asymptomatic hernia may reasonably choose observation.

The most important thing is understanding your options and making an informed decision based on your individual circumstances.

Compass Surgical works closely with general practitioners and the wider multidisciplinary team, including physiotherapists, gastroenterologists, colorectal surgeons, upper gastrointestinal surgeons, dietitians and psychologists, ensuring every patient receives personalised care tailored to their needs.

If you would like to learn more about hernia treatment options or discuss whether surgery may be appropriate for you, contact Compass Surgical or arrange a consultation with one of our surgeons.

What Next?

If surgery is the right option for you, the next question is often, "What type of repair should I have?"

Modern hernia surgery can be performed using either traditional open techniques or minimally invasive laparoscopic approaches, each with its own advantages and considerations.

In the next article in this series, What Types of Hernia Repairs Are Available: Open or Laparoscopic?, we explain the differences between these techniques and how surgeons help determine the most appropriate approach for each patient.

About the author

Dr Tom Hanna is a consultant surgeon and founder of Compass Surgical. He provides expert care for patients with hernias, gallbladder disease and other general surgical conditions. He is committed to delivering personalised, evidence-based surgical care with integrity, compassion and a focus on achieving the best possible outcomes for every patient.

Compass Surgical — Doing what's right, always.

This article is part of the Compass Surgical patient education series, hosted by Loupa as an example of our patient education library.

Reviewed by Dr Thomas Hanna. Last reviewed: July 2026.

This article provides general information and education. It does not provide individual medical advice, diagnosis or treatment, and does not replace advice from your own healthcare professional. If you are seriously unwell, have severe or rapidly worsening symptoms, or believe you may have a medical emergency, call 111 or seek urgent medical care.