Conditions · Hernia

Hernias and hernia repair

A hernia is a weakness or defect in the abdominal wall. If the defect is large enough, fat or bowel may protrude as a lump. Professor Tom Hugh assesses and repairs groin and abdominal wall hernias at Royal North Shore Hospital and North Shore Private Hospital.

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Open / keyhole

Both approaches used when appropriate

Day stay

Common for many groin and umbilical repairs

St Leonards

Consultations at the Tom Reeve Clinic

RNSH · NSP

Public and private operating hospitals

/ 01What they are

What is a hernia?

A hernia is a weakness or defect in the abdominal wall, present from birth or developing over time. Hernias commonly appear at the groin, umbilicus (belly button), or previous surgical incisions. Once present, a hernia usually stays the same size or enlarges.

Hernias are classified as primary or recurrent, and by anatomical site:

Inguinal
Femoral
Umbilical
Ventral (supra-umbilical or epigastric)
Incisional
Lateral (for example Spigelian or para-inguinal)
Perineal or pelvic (uncommon)
Internal (uncommon)

/ 02Symptoms

What symptoms should you notice?

Typical signs include a lump that appears with standing or straining, and local discomfort when lifting. Severe pain, a non-reducible lump, or vomiting needs urgent assessment because bowel can become trapped.

A lump or swelling in the groin or abdominal wall that is more obvious when standing or straining and may reduce when lying down
Pain at the site of the lump, especially when lifting
Swelling of the scrotum (in some groin hernias)
Severe pain if bowel or fat becomes trapped (strangulation)
Nausea, vomiting, or loss of appetite if intestinal obstruction occurs

/ 03Treatment

How is hernia repair performed?

Modern repair usually uses a prosthetic mesh to close the defect and reduce recurrence risk. Approaches include a smaller-incision open repair or a laparoscopic (keyhole) technique. Tom explains which option suits your hernia before you decide.

Approach	Typical use	Notes
Open (small incision)	Many groin and umbilical hernias; complex recurrence	Mesh placed in the anterior abdominal wall layers
Laparoscopic (keyhole)	Selected inguinal, femoral, and some abdominal wall hernias	Mesh placed behind the defect; several small incisions
Day surgery	Many inguinal, femoral, umbilical repairs	Incisional and complex repairs may need overnight stay

After surgery, written post-operative advice covers wound care, activity, diet and follow-up. Related evidence is on the hernia research hub.

/ 04Common questions

Not always. Small, asymptomatic hernias may be observed. Repair is usually recommended when a hernia causes symptoms, is enlarging, or is cosmetically troubling, provided surgery is safe for that patient.

Many inguinal, femoral and umbilical repairs can be day procedures. Larger incisional or complex hernias more often need an overnight stay. Tom will advise based on the hernia type and your health.

Both open and laparoscopic approaches are used. The choice depends on hernia type, prior surgery, and individual factors. Tom explains the benefits and risks of the preferred technique before you decide.

Seek urgent care for sudden severe pain, a lump that will not reduce, vomiting, or signs of bowel obstruction. These can indicate strangulation, which needs emergency assessment.