When Dawn's routine hernia surgery turned into a devastating two-year cycle of recurrent infections, the Mass General Hernia Surgery team was there to help.
Locations & Contact Information
Mass General offers specialized care for hernias on our main Boston campus and at several leading hospitals west and north of the city:
Wang Ambulatory Care Center, 4th Floor
15 Parkman Street
Boston, MA 02114
2014 Washington Street
Newton, MA 02462
Mass General/North Shore Center for Outpatient Care
102 Endicott Street
Danvers, MA 01923
57 Highland Avenue
Salem, MA 01970
Your gift enables our team at the Hernia Center to pursue new treatment options for patients seeking hernia repairs.
Explore This Program
About the Program
Hernias are common and occur in 15 out of every 1,000 people in the United States. Each year, approximately 700,000 hernia repairs are carried out in the U.S.
At the Massachusetts General Hospital Hernia Center, our expert surgeons have performed thousands of successful simple and complex hernia procedures. We use a wide range of cutting-edge tools and techniques to ensure the best possible outcome for every patient.
Our care is centered around the patient and available at several convenient locations throughout the Greater Boston area, allowing for the best care close to home. Locations include:
- Mass General’s main Boston campus
- Newton-Wellesley Hospital
- Salem Hospital
- Mass General/North Shore Center for Outpatient Care (standard hernia repairs only)
Multidisciplinary Hernia Care
We recognize that patients with hernias may require an array of individualized interventions, beyond the hernia repair itself. Such needs include, but are not limited to:
- Weight loss surgery
- Nutritional interventions
- Plastic surgery
- Psychological support
- Rehabilitation medicine
- Wound care
Our hernia team will collaborate with specialists across the Mass General Brigham (MGB) system to ensure your treatment plan is tailored to your needs.
Expert Care, Close to Home
Patients who live north of Boston have the option to receive surgical care for hernias closer to home. Our community surgery team provides comprehensive, accessible surgical care to patients in Danvers and Salem, MA—two communities north of Boston.
A hernia is a weakness or a hole in the muscles of the abdominal wall that allows for fat or abdominal contents to push through the irregular opening. They usually occur due to an inherent weakness in the abdominal wall, injury, or from abrupt, excessive or repetitive strain, such as heavy lifting or weight gain.
Mass General researchers have studied why some people develop a hernia and others do not. Genetic factors—mostly related to collagen, one of the structural proteins of our muscles—and acquired factors—such as infection or obesity—play a role.
While some hernias do not cause symptoms, others cause pain, discomfort and limitations in daily activities. Beyond affecting quality of life, hernias may become dangerous. When a piece of intestine is strangulated inside a tight hernia, this piece may be cut off from an adequate blood supply and eventually die.
Types of Hernias
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.
Rectus Muscle Diastasis
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.
Other Types of Hernias
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 can be repaired by three surgical techniques:
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.
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.
Your care team will discuss surgical options with you and make a recommendation based on your history, condition and needs. The Mass General Hernia Center offers all these options as well as a strong commitment to your overall well-being and a timely recovery.
Recovery from Hernia Repair
Most hernias are repaired on an outpatient basis, without hospitalization required and with minimal down time. However, certain types of large hernias are complicated and require hospitalization in order to ensure the best possible recovery. Depending on the type and size of your hernia and your general condition, the care team may recommend a hospital stay following your surgery.
If the operation does not require a hospital stay (outpatient), you will likely spend the full day at Mass General—arriving a few hours before your operation and leaving at the conclusion of a short recovery period of a few hours. If the operation does require a hospital stay (inpatient), you should still arrive to the hospital a few hours before your operation and expect to spend a few days in the hospital after the operation. The exact number of days for your hospital stay will be communicated to you in advance by your care team.
Frequently Asked Questions
How Do I Know if I Have a Hernia?
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.
How is a Hernia Diagnosed?
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
Does a Hernia Always Need Surgery?
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.
Is Mesh Safe?
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.
Is My Life at Risk Because of the Hernia?
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.
How Do I Prepare for Surgery?
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.
What Can I Expect on the Day of Surgery?
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.
What is Recovery Like After Hernia Surgery?
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.
When Can I Return to Physical Activities?
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.
Can My Hernia Come Back After Surgery?
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.
What is the Required Follow-up After a Hernia Repair?
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.
Research & Clinical Trials
Our surgeons are accomplished researchers who are at the forefront of the latest surgical and medical innovations.
Publications from physicians in the Hernia Center include:
- Velmahos G, El Moheb M, et al. The Worst-Case Scenario: Bridging Repair with a Biologic Mesh in High-Risk Patients with Very Large Abdominal Wall Hernias. World J Surg. 2020 Oct. 13. doi: 10.1016/j.surg.2020.08.036
- Velmahos G, et al. WSES Guidelines for Emergency Repair of Complicated Abdominal Wall Hernias. World J Surg. 2013 Dec. 1. doi: 10.1186/1749-7922-8-50
- Velmahos G. Direct and Recurrent Inguinal Hernias Are Associated with Ventral Hernia Repair: A Database Study. World J Surg. 2012 Dec. 14. doi: 10.1007/s00268-012-1883-7
Our surgeons are board-certified, Harvard Medical School-affiliated physicians who specialize in repairing hernias.
Peter Fagenholz, MD
Dr. Fagenholz is a hernia repair expert with a special interest in complex abdominal wall reconstruction for patients with complicated or recurrent hernias. He has a rich experience in all types of hernias and helped regionally pioneer multiple techniques and innovative prosthetics. He believes in customizing the approach to hernia repair to each patient’s particular circumstances. A very active surgeon, he has contributed to over 130 publications, over 30 books/book chapters and lectured around the world.
Denise W. Gee, MD
General and Laparoscopic Surgeon, Mass General
Director, Mass General Minimally Invasive Bariatric and Advanced GI Surgery Fellowship
Dr. Gee is an associate professor of surgery at Harvard Medical School and the director of surgical simulation at the Mass General Department of Surgery. She has a busy advanced laparoscopic surgical practice and brings her expertise onto a national level serving in leadership roles in multiple prestigious societies.
Matthew Hutter, MD, MPH
Bariatric Surgeon, Mass General
Laparoscopic/Minimally Invasive Surgeon, Mass General
Gastrointestinal Surgeon, Mass General
Dr. Hutter is a hernia repair expert who cares for all patients with hernias, big and small. He received his fellowship training in minimally invasive surgical techniques and routinely performs advanced laparoscopic operations.
Keith Lillemoe, MD
Chief of the Department of Surgery, Mass General
General and Gastrointestinal Surgeon, Mass General
Dr. Lillemoe has 35 years of experience in performing traditional open inguinal hernia repair. He maintains an active clinical practice in general surgery.
Charudutt Paranjape, MD
Chief of General Surgery and Acute Care Surgery, Newton Wellesley Hospital
Dr. Paranjape offers advanced laparoscopic and robotic surgery for all types of hernias. Dr. Paranjape has been a faculty at national and international conferences and consistently recognized for his contribution in surgical education and by his peers as one of the top doctors in Boston.
Jaime Rivera, MD
Director of the Bariatric Surgery Center, MGB Salem Hospital
Dr. Rivera attended Stanford University and Harvard Medical School. He completed surgical training at Mass General and has been in practice for over 20 years. He specializes in minimally invasive surgery and performs robotic, laparoscopic and open hernia repairs.
Nari Sabeti, MD
General and Bariatric Surgeon, MGB Salem Hospital
Dr. Sabeti completed her training in minimally invasive and bariatric surgery at Tufts Medical Center. After eight years in private practice, she was recruited by Mass General to academic practice. She has a special interest in abdominal wall hernias and reconstruction. She has championed and expanded the utilization of robotic technology in hernia, complex surgical procedures and general surgery at MGB Salem Hospital.
Noelle Saillant, MD
Trauma and Acute Care Surgeon, Mass General
Director, Mass General Surgical Clerkship
Dr. Saillant completed her surgical residency at Beth Israel Deaconess Medical Center in 2013 after completing medical school at Boston University School of Medicine. In 2013, Dr. Saillant entered a two-year trauma and critical care fellowship at the University of Pennsylvania where she trained with William Schwab, MD, in damage control surgery, management of the open abdomen and the subsequent reconstruction of the abdominal wall. She practices trauma and emergency general surgery and is an ICU intensivist at Mass General. Her clinical interests include hernia, abdominal wall reconstruction and chest wall reconstruction.
George Velmahos, MD, PhD, MSEd
Director of Hernia Center, Mass General
Chief of the Mass General Division of Trauma, Emergency Surgery, and Surgical Critical Care
John F. Burke Professor of Surgery, Harvard Medical School
Dr. Velmahos is a hernia repair expert with a special interest in complex abdominal wall reconstruction for patients with complicated hernias. He is experienced in all types of hernias and pioneered the use of robotic techniques at Mass General. A very active surgeon, he has contributed to over 550 publications, over 60 books/book chapters and given numerous lectures around the world.
Elan Witkowski, MD, MS
Minimally Invasive and Gastrointestinal Surgeon, Mass General
Dr. Witkowski is a minimally invasive surgeon with interests including complex abdominal wall reconstruction/hernia repair and weight loss surgery. He performs robotic, laparoscopic and open surgery using a variety of techniques tailored to each patient’s anatomy and preferences. He is an assistant professor of surgery at Harvard Medical School and performs research related to health care delivery and the use of artificial intelligence in surgery.
Related News and Articles
- Patient Story
- Apr | 14 | 2022
Jen Lyons was 29 years old when the truck that she was in was hit by an intoxicated driver, causing her to be thrown through the window. With a shredded abdominal wall, Jen was quickly flown to Mass General for emergency surgery.