At a glance
- What the surgery does
- Pushes the bulging tissue back and reinforces the weak spot in the abdominal wall, usually with mesh.
- Why people consider it
- A bulge that causes pain or limits activity, a femoral hernia, or a hernia that gets stuck. Hernias don't heal on their own.
- The main choices
- Whether to wait: watching a minimally symptomatic groin hernia is safe for many men, though most eventually have surgery.[1][2] Then mesh or stitches, and open, keyhole or robotic repair.
- What recovery involves
- Most people go home the same day and return to desk work within one to two weeks. Larger belly wall repairs take longer.
- What to ask your surgeon
- Whether waiting is safe for you, which approach and mesh they recommend and why, and their rates of recurrence and long-term groin pain.
The short version
- A groin (inguinal) hernia that causes few or no symptoms can often be watched safely in men. But most eventually need repair: in one long-term trial, about two thirds of men who started with watchful waiting had surgery within about 10 years, mostly because of pain.[1][2]
- Mesh repairs come back less often than stitch-only repairs for groin hernias.[4] Mesh also cut recurrences for small belly button hernias in a large trial.[7]
- Open and keyhole (laparoscopic) groin repairs both work well in experienced hands. Keyhole repair usually means less pain early and a faster return to normal activities.[5][6][10]
- Robotic repair cost more and took longer than standard keyhole repair, with no clear benefit for patients, in two US randomized trials.[8][9]
- A hernia that becomes suddenly painful, hard, and can't be pushed back in, especially with vomiting, is an emergency.[13]
What a hernia is
A hernia is a bulge where tissue, often fat or a loop of bowel, pushes through a weak spot in the muscle wall of the abdomen. It often shows up as a lump that gets bigger when you stand, cough or strain, and shrinks when you lie down.
- Inguinal hernias are in the groin, far more common in men, and make up most hernias.
- Femoral hernias are just below the groin crease, more common in women, and more likely to get stuck. Guidelines recommend repairing them fairly promptly.[6]
- Umbilical and epigastric hernias are at or above the belly button.[11]
- Incisional hernias develop through the scar of a previous abdominal operation.
Hernias don't heal on their own. A truss or support belt can ease symptoms for some people but doesn't fix the hernia.[13][14]
Watchful waiting: is it safe?
For men with a groin hernia that causes little or no discomfort, waiting is a reasonable option. The big trials looked at exactly this.
The research in detail: What the trials found
In a US trial of 720 men with minimally symptomatic groin hernias, watchful waiting was found to be an acceptable option over about two to four years, and the risk of the hernia getting acutely stuck was low.[1] With longer follow-up of the waiting group, an estimated 68% had crossed over to surgery by about 10 years, and nearly 8 in 10 men over 65 did. Pain was the most common reason.[2]
In a Scottish trial of men 55 and older with painless groin hernias, 72% of those assigned to observation had surgery by seven and a half years.[3] The authors recommended repair for medically fit men.
So waiting is safe for many men, but surgery usually comes eventually. Waiting makes the most sense if you have few symptoms, or if other health problems make surgery riskier right now.
If you choose to wait, know the warning signs of a stuck (incarcerated or strangulated) hernia: a bulge that becomes firm, tender and won't go back in, often with nausea or vomiting. That needs emergency care.
Mesh or stitches?
Most hernia repairs in the US now use mesh, a flexible sheet of medical-grade material that reinforces the weak area while your tissue grows into it.
The research in detail
For groin hernias, a Cochrane review of 25 trials with more than 6,000 people found mesh repair probably roughly halves the chance of the hernia coming back compared with stitch-only repair. Nerve and organ injuries were also less common with mesh. Fluid collections (seromas) were somewhat more common with mesh.[4]
For small belly button hernias (1 to 4 cm), a trial of 300 adults found hernias came back in about 4% after mesh repair versus about 11% after stitch repair at two years.[7]
Mesh isn't risk-free. In a Danish national study of more than 3,000 incisional hernia repairs, mesh lowered the chance of another operation for recurrence, but mesh-related complications needing surgery kept adding up over time, reaching about 4% to 6% at five years.[12] The FDA notes that the most common problems after hernia repair, such as pain, infection, recurrence, adhesions and bowel obstruction, happen with or without mesh.[15]
Ask which mesh your surgeon uses, why, and where it will sit.
Open, keyhole or robotic
| Approach | How it's done | What the evidence says |
|---|---|---|
| Open (for example Lichtenstein) | One incision over the hernia, mesh placed on top of the muscle layer. Can be done under local anesthetic. | Long track record and very low recurrence in experienced hands.[5] Often preferred for a first hernia on one side, or when general anesthesia is riskier.[6] |
| Laparoscopic (TEP or TAPP) | Small incisions and a camera. Mesh placed behind the muscle wall. Needs general anesthesia. | In the Dutch LEVEL trial of 660 patients, it meant less pain for the first six weeks and a faster return to work, with similar recurrence and chronic pain after about four years.[10] Often suggested for hernias on both sides, recurrences after open repair, and women.[6] |
| Robotic | Keyhole surgery done with a surgical robot. | For straightforward groin hernias, the RIVAL trial found no benefit over laparoscopic repair, with longer operations and higher cost.[8] For belly wall (ventral) hernias, a trial of 124 patients found no difference in hospital days, with longer operations and higher costs.[9] |
Experience matters a lot with keyhole repair. In a large US veterans trial, keyhole repair of first-time hernias came back more often than open repair (10% vs 4%), while keyhole repair had less early pain.[5] In a Swedish trial, one surgeon accounted for a third of the keyhole recurrences.[16] Ask how many of each type your surgeon does.
What happens on surgery day
Most planned hernia repairs are outpatient: you go home the same day. Open groin repair can be done under local anesthetic with sedation, spinal anesthesia or general anesthesia. Keyhole and robotic repairs use general anesthesia.
The operation usually takes about an hour, longer for large incisional hernias. Large or complex belly wall hernias may need a bigger reconstruction and a hospital stay.
Before a large ventral or incisional hernia repair, surgeons often ask patients to stop smoking and to get blood sugar under control, because both raise the risk of wound problems and recurrence.[6][11]
Recovery
- First daysSoreness and bruising around the incisions. Walking early is encouraged. Many people need only over-the-counter pain medicine after the first few days, especially after keyhole repair.[10]
- Weeks 1 to 2Most people with desk jobs return to work. Driving once you can brake hard without pain and you're off strong pain medicine.
- Weeks 2 to 6Gradual return to exercise and lifting. Many surgeons no longer give strict lifting limits after groin repair and advise letting comfort guide you.[6] Follow your own surgeon's plan, especially after a large incisional repair.
Risks and complications
- Long-lasting groin pain. This is the most important long-term problem after groin hernia repair. HerniaSurge guidelines estimate that about 10% to 12% of people have chronic pain that affects daily life to some degree.[6] Ask your surgeon how they try to protect the nerves in the groin.
- Recurrence. Low with modern mesh repairs, higher after stitch repair and incisional hernia repair.[4][12]
- Seroma or hematoma, a collection of fluid or blood under the skin, usually settles by itself.[4]
- Infection, including rarely an infected mesh that needs removal.[12][15]
- Trouble passing urine right after surgery, more common in older men.[4]
- Testicle problems after groin repair in men, such as swelling, which are uncommon.[4]
Questions to ask your surgeon
- What type of hernia do I have, and is it safe for me to wait?
Why we ask: Many men with a groin hernia that causes few symptoms can wait safely, though most eventually have surgery. Femoral hernias are different and are usually fixed sooner. Watchful waiting
- What symptoms mean I should come in urgently?
Why we ask: A bulge that becomes hard, painful and won't go back in, especially with vomiting, can mean the hernia is stuck. That's an emergency. Watchful waiting
- Do you recommend open, laparoscopic or robotic repair for me, and why?
Why we ask: Keyhole repair usually means less early pain. Robotic repair cost more without clear benefit in two trials. The right choice depends on your hernia and your surgeon. Open, keyhole or robotic
- How many of these repairs do you do each year, and what are your recurrence and chronic pain rates?
Why we ask: Experience matters, especially with keyhole repair. In one trial, a single surgeon accounted for a third of keyhole recurrences.
- Will you use mesh? Which type, and where will it sit?
Why we ask: Mesh roughly halves recurrence for groin hernias but has its own long-term risks. Where it's placed affects both. Mesh or stitches?
- How will you try to protect the nerves in my groin?
Why we ask: Long-lasting groin pain is the main long-term problem after groin repair, affecting roughly 1 in 10 people to some degree. Risks and complications
- When can I go back to work, drive and lift?
Why we ask: Many surgeons now let comfort guide activity after groin repair, but large incisional repairs often have firmer limits. Recovery
- Is there anything I should do before surgery, like stopping smoking or losing weight, to lower my risk?
Why we ask: Smoking and high blood sugar raise the risk of wound problems and recurrence, especially for belly wall hernias. Surgery day
Print this page or save it to your phone, and write down the answers during your visit.
Understanding your mesh and device options
The companies that make the implants and devices used in this surgery, compared side by side with FDA records and sources, plus recent research and FDA news explained for patients.
Recovery supplies
We list recovery supplies at every budget, from gel ice wraps to cold therapy machines, with what to look for in each.
- Comfort after belly surgery
- Support and swelling
- Bowel comfort
- Walking
Sources
- Fitzgibbons RJ Jr, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA. 2006;295:285-92. https://pubmed.ncbi.nlm.nih.gov/16418463/
- Fitzgibbons RJ Jr, et al. Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg. 2013;258:508-15. https://doi.org/10.1097/SLA.0b013e3182a19725
- Chung L, et al. Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial. Br J Surg. 2011;98:596-9. https://doi.org/10.1002/bjs.7355
- Lockhart K, et al. Mesh versus non-mesh for inguinal and femoral hernia repair. Cochrane Database Syst Rev. 2018;9:CD011517. https://doi.org/10.1002/14651858.CD011517.pub2
- Neumayer L, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350:1819-27. https://doi.org/10.1056/NEJMoa040093
- HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22:1-165. https://pubmed.ncbi.nlm.nih.gov/29330835/
- Kaufmann R, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet. 2018;391:860-9. https://doi.org/10.1016/S0140-6736(18)30298-8
- Prabhu AS, et al. Robotic inguinal vs transabdominal laparoscopic inguinal hernia repair: the RIVAL randomized clinical trial. JAMA Surg. 2020;155:380-7. https://doi.org/10.1001/jamasurg.2020.0034
- Olavarria OA, et al. Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial. BMJ. 2020;370:m2457. https://doi.org/10.1136/bmj.m2457
- Langeveld HR, et al. Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg. 2010;251:819-24. https://doi.org/10.1097/SLA.0b013e3181d96c32
- Henriksen NA, et al. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg. 2020;107:171-90. https://pubmed.ncbi.nlm.nih.gov/32342494/
- Kokotovic D, et al. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA. 2016;316:1575-82. https://doi.org/10.1001/jama.2016.15217
- MedlinePlus (US National Library of Medicine). Hernia. https://medlineplus.gov/hernia.html
- American College of Surgeons. Adult inguinal and femoral groin hernia repair (patient education). https://www.facs.org/for-patients/the-day-of-your-surgery/adult-inguinal-and-femoral-groin-hernia-repair/
- US Food and Drug Administration. Surgical mesh used for hernia repair. https://www.fda.gov/medical-devices/implants-and-prosthetics/surgical-mesh-used-hernia-repair
- Eklund AS, et al. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg. 2009;249:33-8. https://doi.org/10.1097/SLA.0b013e31819255d0
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