Hernia Center

About Groin Hernias

Typically referred to as inguinal or femoral hernias, they appear as a bulge in the groin area. More common in men than in women, groin hernias can become quite large, descend towards the testicles and distend the testicular sac (scrotum).

Sometimes these hernias can be resolved without an operation; however, surgery is often recommended. Most groin hernias are repaired by using a durable, tension-free mesh insert. However, non-mesh repairs are also an option and can be done under local or general anesthesia, depending on the patient's condition and preference. Open, laparoscopic (minimally invasive) and robotic (minimally invasive) surgical techniques are implemented according to the specific circumstances of each patient.

Treating and Preventing Groin Hernia Surgery Complications

We often treat patients who had recurrence or infection after a previous hernia repair. We also treat patients with persistent pain following a hernia operation performed elsewhere. Such pain is suspected to be related to the small nerves in the groin being injured by either sutures, mesh or scar tissue. Our expert surgeons are particularly alert to this potential complication and perform techniques to nearly eliminate the risk of persistent pain after a hernia operation.

Such interventions are performed via open or laparoscopic techniques and include multidisciplinary approaches in collaboration with pain specialists, nerve specialists and physiotherapists.

About Ventral Hernias

Ventral hernias occur at any location on your abdominal wall. They include:

• Umbilical hernias, which are bulges located at the belly button (umbilicus) area. They are typically the result of a natural defect that has existed there since birth. On occasion, this defect becomes bigger, allowing for internal organs or fat to protrude through it
• Epigastric hernias, which are bulges located at the midline between the umbilicus and the lower end of the breastbone (sternum)
• Incisional hernias, which are bulges that occur in areas of previous operations where there are sutured muscles. Depending on a variety of factors, this natural area of weakness can be further weakened or torn, resulting in a bulge. Although incisional hernias are typically associated with larger incisions from open surgery, they can also form on the sites of incisions after laparoscopic surgery
• Flank hernias, which are bulges that happen at the flanks and are most commonly related to either an injury (traumatic hernia) or a previous operation (incisional hernia)
• Spigelian hernias, which are bulges that appear to the left or right side of the abdomen, at the level of the umbilicus or slightly below it. This area represents a point of natural weakness of the abdominal wall

Repairs for Ventral Hernias

Repairs for ventral hernias can be performed by open, laparoscopic or robotic techniques. The majority require general anesthesia, often combined with epidural anesthesia, which is the same anesthesia offered to women during labor, or muscle block anesthesia, which is a special anesthesia that blocks pain related to the sutured muscles.

Ventral hernia repair falls into three main categories:

• Primary repair, in which the edges of healthy muscle around the hernia are sewn together, is a simple procedure and does not involve the use of mesh. It is typically offered for small defects with low likelihood of hernia recurrence, since primary repairs are usually not as durable as mesh repairs
• Mesh repair, in which a patch of material is used to add strength to the abdominal wall. Meshes can be made of materials that are permanent and synthetic (e.g., polypropylene or polyester), temporary and resorbable, biological (e.g., cadaveric or animal tissue) or a combination of different materials. The type of mesh used for your repair will be determined by your care team. Meshes can be placed under, over or in between muscle layers
• Component separation and repair, in which the different components of the healthy muscles surrounding the hernia are separated before repair. This allows flexibility and easier reapproximation of the muscles. It is typically combined with mesh placement. This is a complex procedure and typically reserved for larger, recurrent and/or high-risk hernias

About Traumatic Hernias

A traumatic injury, such as a motor vehicle crash, a fall from a height or interpersonal violence, can cause a tear through the abdominal muscles that allows internal organs to herniate. Oftentimes, traumatic hernias happen in areas where muscle attaches to bone, such as the hips and pelvis.

About Rectus Muscle Diastasis

Normally, the muscles of the left and the right side of the abdomen meet in the middle. As a result of age, weight gain/loss, pregnancy, etc., this middle area can stretch and bulge, giving the impression of a hernia, even if there is no true hole in the muscle. It is called rectus muscle diastasis and should be brought to the attention of your doctor.

About Internal Hernias

Internal hernias occur when the intestines slide inside the abdomen through natural gaps that have existed since birth or result from operations (e.g. weight loss surgery). They often require an urgent operation to both reduce the hernia and address any intestinal problems.

About Hiatal Hernias

Hiatal hernias form internally when the upper part of your stomach bulges through the diaphragm. They are not associated with any external bulge but may cause many other symptoms. Hiatal hernias are treated by providers in the Mass General Swallowing, Heartburn and Esophageal Disease (SHED) Center.

About Sports Hernias

Repetitive sports activities that target the abdomen and pelvis, such as sit-ups and squats, can sometimes result in groin pain, either indicating muscle strain and small tears or a true gap in the muscles (hernia). Discuss any sports-related groin pain with your doctor so they can determine if the pain is caused by a hernia and come up with a plan for alleviating acute or chronic pain.

Hernias can form in any part of the abdominal wall. Additional, less common types include:

• Obturator, a hernia that is located deep in the pelvis
• Perineal, a rare hernia located in the region under the genitals (perineum)
• Lumbar, a hernia of the back
• Richter, a hernia in which only a small part of the intestine is herniated

Hernias treated by open surgery are repaired through larger incisions in the skin. The size of the incision is variable and based on the specific hernia. Typically, this approach is reserved for large hernias.

For hernias treated by laparoscopic surgery, the surgeon inserts a camera and special instruments into the abdomen through small skin incisions to repair the hernia. This is a minimally invasive approach.

Learn more about laparoscopic surgery

Similar to the laparoscopic technique, hernias treated by robotic surgery are repaired by a minimally invasive approach through small incisions in the skin. The surgeon operates special instruments that are connected to robotic arms. Under specific indications, the robotic technique may allow better access and visualization of certain anatomical areas.

Learn more about robotic surgery

Most people with a hernia will feel or see a bulge in the belly or the groin. They may also feel discomfort or pressure in this area, such as a pulling or tugging sensation, especially when exercising or moving. If you have these symptoms, you should be evaluated for a hernia. On some occasions, a hernia is too small to produce a visible bulge, and further testing is required to diagnose it.

Most hernias can be diagnosed with just a physical exam. However, a CT scan or an MRI may be useful to detect the:

• Exact size of the hernia
• Presence of other smaller hernias
• Anatomy of the muscles around the hernia
• Relationship of the hernia with other organs

Not always. A hernia that is not causing any symptoms nor any compromise in the daily quality-of-life can be closely watched via regular follow-ups with a physician. If it grows in size or starts to create problems, it may require an operation. These decisions will be made through thoughtful discussion with your care team.

Yes. Hernia meshes are a commonly used treatment that achieves a strong, “tension-free” repair. Like any other treatment, there can be complications; however, overall, the benefits are much greater than the risks. There are numerous mesh choices that your hernia surgeon will discuss with you.

A hernia is not life-threatening unless it becomes strangulated. In a strangulated hernia, a piece of intestine is trapped within the hernia and becomes strangled. If left untreated, it can cause a hole in the intestine or a dead piece of intestine, which in turn may cause sepsis and shock.

Some hernias are more prone to strangulation than others, and your hernia surgeon can discuss the risks of your specific case with you. Hernia strangulation typically causes obvious symptoms, such as excruciating pain, nausea and vomiting. If you are experiencing these symptoms and they last for over two hours, you should immediately seek care from your doctor or go to an emergency room.

Surgery at the Mass General Hernia Center is a partnership between you and your doctor. Your surgeon will discuss openly with you your options and treatment plan. Patients are generally advised to maintain a healthy body weight and diet and abstain from smoking for a successful surgery.

Learn more

Prior to your surgery, you will receive detailed instructions from your surgeon's office about how to prepare for surgery. On the day of surgery, arrive two to three hours prior to your scheduled procedure. The team that will care for you will meet with you and administer intravenous medication. After the surgery, you will recover in the post-anesthesia care unit (PACU) until you are ready to go home. You are not allowed to drive following surgery, so you should arrange to be picked up by somebody else or we can help you book a car service. If you need to stay overnight, you will be transferred to your hospital room.

Recovery from minimally invasive surgery (laparoscopic or robotic) and open inguinal hernia surgery typically involves mild-to-moderate pain or discomfort for 2-14 days. We often prescribe patients over-the-counter pain medication and avoid opioid medications as much as possible, although some opioid pills may be needed.

Typically, patients can walk and use the stairs immediately following surgery. Patients will need to avoid heavy lifting, strenuous exercise and core-centric exercise for a few weeks following surgery.

For patients with larger abdominal hernias undergoing major reconstructive hernia surgery, recovery is typically longer and may require an inpatient hospital stay.

This depends on the size of the hernia, the type of operation and any comorbidities, among other factors. While simple activities (walking, driving, climbing stairs) will be possible immediately, more strenuous exercise should be avoided for some time. Your hernia surgeon will individualize your post-surgical activity instructions/plan.

It is possible, but we pride ourselves in achieving very low recurrence rates for our patients through pre-surgical optimization and using state-of-the-art surgical techniques.

For simple hernia repairs, you will have a follow-up with your surgeon 10 to 20 days after the surgery via an in-person or virtual visit. For complex hernias, you may need more than one follow-up appointment. For certain hernias, you will also have a follow-up one year after surgery and may even require a CT scan to examine the integrity of the hernia repair. Your hernia surgeon will discuss a follow-up plan with you.