Hernias are due to a weakness in the abdominal wall. Most (inguinal and femoral) occur in the groin where they appear as a bulge. Hernias do not go away on their own and tend to get bigger. Usually they are only uncomfortable but sometimes bowel gets caught in them. If the bowel is strangulated emergency surgery becomes necessary. The standard repair (Lichtenstein mesh repair) involves a cut in the groin through which a mesh is placed within the abdominal wall. Apart from some bruising recovery is swift and return to work is possible within days. Keyhole (laparoscopic) repair involves inserting a mesh behind the abdominal wall through a cut in the belly button. Instruments are inserted through two other puncture sites to fix the mesh. Scars are smaller, recovery is quicker, but recurrence of the hernia may be a little more common. The technique favoured by the The National Institute for Health and Clinical Excellence (NICE) is performed entirely without entering the abdominal cavity, using gas to create an artificial operating space within (extraperitoneal) the abdominal wall (TEP). Umbilical and epigastric hernias present as a bulge round the belly button or above it. Tension-free repair involves inserting a range of specifically designed meshes to close the defect. Incisional hernias occur when incisions from previous operations break down. Nowadays repair is often possible using keyhole surgery but this depends on individual circumstances.
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