What a hernia actually is
The abdominal wall is a layered sheet of muscle and tough fibrous tissue that holds the contents of the abdomen in place. A hernia is a gap in that sheet. Fat, or a loop of intestine, pushes through the gap and appears as a bulge under the skin — usually more obvious on standing, coughing or lifting, and often disappearing when you lie down.
The gap does not close by itself. Belts and binders can make a hernia more comfortable, and they are useful while you wait for surgery or if you are not fit for an operation, but they do not repair anything. Over months and years most hernias slowly enlarge, and a larger hernia is a harder hernia to repair well.
That said, a small, soft, easily reducible hernia that causes no symptoms is not an emergency. It is entirely reasonable to plan surgery around your work, your exams, your harvest or your daughter’s wedding. What is not reasonable is ignoring a hernia that has become painful, hard, or impossible to push back.
How the right repair is chosen
There is no single best hernia operation. There is a best operation for a particular hernia in a particular person, and choosing it is most of the skill. The decision turns on where the hernia is, how big the defect is, whether you have been operated on before, your weight, whether you smoke, whether your diabetes is controlled, and what you need to be able to do afterwards.
In broad terms:
- Laparoscopic (keyhole) repair — TEP or TAPP for groin hernias, IPOM or extraperitoneal techniques for ventral hernias. Three small cuts, less wound pain, faster return to work. Well suited to bilateral and recurrent groin hernias.
- Open tissue repair — no mesh. Reserved for specific situations: small defects in young patients, contaminated fields, and where mesh is unsafe or unwanted.
- Open mesh repair (Lichtenstein, retromuscular / Rives-Stoppa) — still the most reliable operation for many midline and incisional hernias, and the foundation of complex reconstruction.
- Component separation, including transversus abdominis release (TAR) — for large and recurrent abdominal wall defects where the muscle layers must be mobilised and rebuilt, not simply patched.
Complex, recurrent and giant hernias
Some hernias have already been operated on once, twice or more. Some sit alongside a stoma, or in an abdominal wall thinned by previous infection. Some are so large that the intestine has effectively lived outside the abdominal cavity for years — what surgeons call loss of domain, where simply pushing everything back in can make it hard to breathe.
These are a different problem from a routine hernia, and they are the reason abdominal wall reconstruction exists as a subspecialty. Preparation matters as much as the operation: optimising blood sugar, stopping smoking, weight reduction where it is needed, and in selected cases pre-operative botulinum toxin to relax and lengthen the lateral muscles before reconstruction.
If a previous repair has failed, that is not a reason to accept living with it. It is a reason to have the next repair planned more carefully than the last.
Mesh — the honest version
Mesh is a sheet of synthetic or biological material that reinforces the repair. Its use transformed hernia surgery: recurrence rates for most repairs fell substantially once mesh replaced pure suture techniques, and that is why it is standard worldwide.
Mesh is not, however, harmless or universal. A small proportion of patients develop chronic discomfort, and in a contaminated field synthetic mesh can become infected and need removal. The material, the weight, the position in which it is placed and how it is fixed all matter — and all of them are choices your surgeon makes on your behalf.
You are entitled to know which mesh is being used in your repair, where it will sit, and why that decision was made. Ask.
When to see a surgeon
Book a consultation if you notice any of the following:
- A bulge in the groin, navel or along an old surgical scar that appears on standing, coughing or straining
- A dragging ache or heaviness that worsens through the day and settles when you lie down
- A lump that used to disappear on lying down and now stays out
- A hernia that is visibly growing, or skin over it becoming thin, shiny or discoloured
- Discomfort that stops you lifting, exercising or doing your job
Go to an emergency department immediately if a hernia becomes suddenly painful, hard and tender and cannot be pushed back, especially with vomiting, abdominal distension or failure to pass wind or stool. This can mean the bowel is trapped and losing its blood supply, and it needs surgery within hours.
Recovery — what to expect
Timelines below are typical for an uncomplicated repair in a reasonably fit adult. Large or recurrent hernias and open reconstructions take longer, and your own plan will be discussed before surgery.
- Day 0–1Most laparoscopic and small open repairs are done as day-care or with one night in hospital. You will be walked within a few hours. Pain is controlled with simple oral medication in the majority of cases.
- First weekWalking freely at home, self-care, light desk work often possible from day three to five. Some bruising and swelling around the repair is normal and settles. Avoid straining and constipation.
- Weeks 2–4Back to office work, driving once you can perform an emergency stop without hesitating, and light household activity. Gradual increase in walking distance is encouraged rather than rest.
- Weeks 6–12Return to heavy lifting, gym and manual labour, staged rather than sudden. Complex abdominal wall reconstructions are given longer and are reviewed before clearance.
Common questions
Can a hernia go away on its own without surgery?
No. The gap in the abdominal wall does not close spontaneously in adults. Exercises, belts and medication can relieve symptoms but do not repair the defect. Umbilical hernias in infants are the one genuine exception — many of those do close on their own in the first few years of life.
Is laparoscopic surgery always better than open surgery?
Not always. Keyhole repair usually means less wound pain and a quicker return to work, and it is excellent for bilateral and recurrent groin hernias. But for very large, complex or previously operated abdominal walls, a well-planned open reconstruction gives a far more durable result. The technique should be chosen for the hernia, not for its marketing.
Do I definitely need mesh?
Most adult hernias are repaired more durably with mesh, and international guidelines reflect that. There are defined situations where mesh is avoided — very small defects, contaminated or infected fields, and some younger patients — and biological or absorbable materials exist for difficult cases. It is discussed with you before the operation, not decided silently.
How soon can I go back to work?
For a desk job after a keyhole repair, commonly within a week. For work involving lifting, loading or long hours on your feet, four to six weeks is more realistic. Manual labourers and gym users are given a staged plan rather than a single date.
Can a hernia come back after repair?
Yes, though modern mesh repairs have made it much less likely. Recurrence risk rises with smoking, uncontrolled diabetes, obesity, chronic cough, constipation and returning to heavy lifting too early — which is why those things are addressed as part of the treatment, not treated as unrelated.
I had a hernia operation elsewhere and it has failed. Is anything still possible?
Almost always, yes. Recurrent and multiply-operated hernias are a core part of abdominal wall reconstruction practice. It needs proper assessment — usually a CT scan of the abdominal wall — and a repair planned specifically around what was done before and why it did not hold.
Is hernia surgery safe if I am elderly, diabetic or on blood thinners?
Age alone is not a barrier, and a controlled hernia operation is considerably safer than an emergency one for an obstructed hernia. Diabetes is optimised before surgery, and blood thinners are managed in consultation with your cardiologist or physician. The assessment is individual.
What is loss of domain, and does it apply to me?
It describes a hernia so large that a substantial part of the abdominal contents has come to live outside the abdominal cavity. Returning everything at once can raise pressure inside the abdomen and make breathing difficult, so these cases need staged preparation — sometimes including botulinum toxin — before reconstruction. Your CT scan answers the question.
Who performs this
Prof. (Dr.) Ashvind Bawa, MS FACS — Director of Surgical Services, Bawa Hospital, Civil Lines, Ludhiana. Relevant to this page:
- AHS Gimbernat Award — Best International Presentation, USA 2022
- Nabeel Ibrahim Memorial Prize, 2024
- Top 10 Abstract, European Hernia Society Annual Meeting, Barcelona 2023
- ACS NSQIP International Scholar 2025 — Abdominal Wall Reconstruction programme, Cleveland Clinic & Mayo Clinic
- Laparoscopic colorectal & hernia training, AIIMS New Delhi; visit to Shouldice Hernia Hospital, Toronto
This page is general information about surgical conditions and their treatment. It is not a diagnosis and cannot replace an examination. Please seek a consultation for advice specific to you.