The evolving complexity of hernia surgery has prompted the growth of various centres of excellence for the treatment of more difficult hernias, and societies such as the American Hernia Society, the European Hernia Society, the German Hernia Society and the British Hernia Society have done much to share expertise and model the latest techniques and very best practice.
Though some informal certification has been introduced, selecting an experienced surgeon with a good track record in hernia surgery is still the most practical approach. While all surgeons are potentially capable of hernia repair, the recurrence rate (procedures that have to be repeated) is significantly higher for general surgeons who are non-specialists in hernia surgery.
The most common types of hernias treated by hernia specialists include:
- inguinal hernia: This category accounts for up to 75 per cent of all abdominal hernias, and occurs when the intestines burst through a weak area of the lower abdomen wall. The site of the condition is often the male inguinal canal – the part of the groin area where the spermatic cord passes through from the abdomen to the scrotum. Females also have an inguinal canal, but males are much more likely to suffer an inguinal hernia.
- hiatal hernia: A hiatal hernia happens when the upper part of the stomach squeezes up through the hiatus (a diaphragm opening which allows the oesophagus to pass through). The condition can present gastric problems – typically for adults over 50 years of age.
- femoral hernia: A condition that most commonly occurs in women, a femoral hernia happens when the intestine enters the canal conveying the femoral artery into the upper thigh. Women who are pregnant or obese are more at risk.
- umbilical hernia: An umbilical hernia usually affects young infants up to six months old, as well as obese women or those who have had many pregnancies. With this condition, part of the intestines slip through the wall of the abdomen in the umbilical area (bellybutton).
- incisional hernia: An incisional hernia may occur at or very near the location of previous abdominal surgery. The intestines may protrude through the scar tissue from the earlier surgical intervention.
In most cases, your hernia will require an early surgical repair. However, one of the following options may sometimes be considered:
- a ‘watch and wait’ strategy may be recommended for some hernias, perhaps where there are few symptoms, or where it would be wise to await any further developments
- a hernia support, such as a hernia belt or truss, may be used to temporarily secure a herniated area and ease discomfort, pending forthcoming surgery
Many hernias can be surgically repaired by carefully easing herniated tissues back inside the body, then strengthening and sealing the breached area. Sometimes an intervention can be performed using laparoscopic surgery, which is less invasive and leads to an earlier recovery.
Once a hernia occurs, it is most unlikely that it will go away without treatment. So while approaches involving any form of exercise, weight loss or medication may improve other aspects of your general health, they cannot repair a protruding hernia.
In some circumstances, a doctor may advise a ‘watch and wait’ strategy to assess the full extent of your condition and help you decide the best time to undergo a hernia repair. In addition, it may well be that your doctor suggests that some form of truss or hernia belt may help to hold any protruding tissue in place and thus ease your discomfort. These measures are always a temporary solution that should only be adopted on medical advice, because it is possible they will make your condition worse. The vast majority of hernias will require a surgical procedure to offer a permanent solution.
Though hernia specialisms among medical practitioners are still relatively informal, any surgeon must attend medical school – usually a four-year course in the US, for example – sit qualifying exams, and then spend another four years in a medical residency. There is then an opportunity to continue with a two-year fellowship to develop an area of specialism. For surgeons handling hernia repairs, the most relevant specialisms are likely to be urology or gastroenterology for the majority of hernias across the abdominal region.
Where surgeons have a special interest and above-average expertise in hernia procedures, this is likely to be reflected in their association with specialist hernia societies and/or specialist hernia centres. Some surgeons may also have some form of hernia certification, though the most important indicator of their work will be an excellent performance rating alongside clear evidence of high-level experience of hernia best practice, and a commitment to ongoing development of skills and knowledge.