A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac.
This is the most common type of abdominal hernia; it affects about 27% of men and 3% of women over lifetime. It can occur at any age from infancy to old age.
Femoral hernia surgery is a procedure that repairs a weak area in the abdominal wall near the groin, the femoral canal, through which abdominal tissue or intestine have bulged out.
This condition can happen in both infants and adults and may require surgical correction if it persists or causes symptoms.
This condition can happen in both children and adults and requires surgical correction if it has narrow neck or causes symptoms.
Abdominal wall hernias are typically classified by location or aetiology. We evaluate and offer care for all types of abdominal wall hernia in the clinic. The nature of the repair depends upon the size and location of the hernia.
There are many things to consider when deciding if you should have inguinal hernia repair surgery, such as whether your hernia is incarcerated or strangulated and whether you have other conditions that need to be addressed before hernia repair surgery is appropriate.
Surgical repair is recommended for most inguinal hernias that are causing pain or present with history or symptoms suggestive of incarcerated or strangulated hernia. Hernias do not go away on their own and get larger with time. Hernias can worsen the comorbidities of the patient as it comes in the way of routine physical activity and health. Surgery is always recommended for inguinal hernias in children.
Single Key Hole Laparoscopic hernia repair is offered along with Laparoscopic and open surgery for hernia repair. It may be the preferred option for people who need to return quickly to work or other activities and for those who have hernias on both sides.
Laparoscopic hernia repair usually is not done on children as the surgery in children with hernia is known as herniotomy. This is different from the surgery in adults. It involves ligation of the patent processus vaginalis which is a peritoneal communication with the outer layers of the testis. It does not involve repairing the posterior wall of hernia and reinforcing it with a mesh. But a laparoscope may be used during open hernia repairs in children to explore the opposite groin for a hernia. This can be done by inserting the laparoscope into the side that is being operated on and looking at the opposite side. If a hernia is present, the surgeon can repair both sides during the same operation.
One Key Hole Laparoscopic Hernia surgery has the following advantages over open hernia repair:
Doctors and researchers of laparoscopic hernia repair say that laparoscopy has not yet been proved to offer long-term advantages over open surgery. They stress the need for more studies on laparoscopic safety and effectiveness in hernia repair. Laparoscopic hernia repair is different from open surgery in the following ways:
Laparoscopic repair of a hernia is more expensive than open surgery because of the increased costs associated with slightly longer operating room time and the cost of laparoscopic technology.
What happens if the operation cannot be performed or completed by the laparoscopic method?
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include irreducibility of hernia prior to surgery on OT table, morbid obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.
When an incisional hernia occurs, it usually arises in the abdominal wall where a previous surgical incision was made. In this area the abdominal muscles have weakened; this results in a bulge or a tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a balloon-like sac. This can allow a loop of intestines or other abdominal contents to push into the sac. If the abdominal contents get stuck within the sac, they can become trapped or “incarcerated.” This could lead to potentially serious problems that might require emergency surgery.
Other sites that ventral hernias can develop are the belly button (umbilicus) or any other area of the abdominal wall. A hernia does not get better over time, nor will it go away by itself.
Results may vary depending on the type of procedure and each patient’s overall condition. Common advantages may include:
The use of an abdominal wall binder is occasionally prescribed but often ineffective. Incisional hernias do not go away on their own and may enlarge with time. Surgery is the preferred treatment and is done in one of two ways.
The laparoscope and TV camera allow the surgeon to view the hernia from the inside. Other small incisions will be required for other small cannulas for placement of other instruments to remove any scar tissue and to insert a surgical mesh into the abdomen. This mesh, or screen, is fixed under the hernia defect to the strong tissues of the abdominal wall. It is held in place with special surgical tacks and in many instances, sutures. Usually, three or four 1/4 inch to 1/2 inch incisions are necessary. The sutures, which go through the entire thickness of the abdominal wall, are placed through smaller incisions around the circumference of the mesh. This operation is usually performed under general anaesthesia.
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.
Senior Consultant Single Keyhole Laparoscopic Surgeon
MBBS, M.S (Gen Surg – KEMH, Bombay), FAMS
Over 30 years of clinical experience in gastrointestinal and metabolic surgery
His clinical focus includes:
Dr. Ravi routinely performs laparoscopic (keyhole) and endoscopic procedures, which are associated with smaller incisions and faster recovery times compared to traditional open surgery.
(Based on standard clinical outcomes for minimally invasive techniques.)
He holds a university academic appointment and is actively involved in teaching medical students and surgical trainees in Singapore, reflecting his commitment to medical education and continuous learning.
Dr. Ravi is affiliated with various international and local professional bodies including:
Our friendly team is looking forward to serving you. For urgent enquiries and appointment requests, please call the clinic directly.
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When an inguinal hernia starts causing discomfort, pain or increases in size, hernia repair surgery is usually advised to prevent complications. Understanding the process—from preparation to recovery—can help you make a confident and informed decision.
Hernias are abnormal protrusion of an organ or tissue through an opening that should not be there. For inguinal hernias, the defect is through a weak spot in the lower abdominal wall, typically in the groin. Inguinal hernia can be direct(through a weak point) or indirect (through the inguinal canal – running parallel to cord structures in males)
Inguinal hernia surgery is a procedure that repairs a weak area in the abdominal wall near the groin, through which abdominal tissue or intestine may bulge. This is the most common type of abdominal hernia; it affects about 27% of men and 3% of women over lifetime. It can occur at any age from infancy to old age.
The goal of this surgery is to return the protruding tissue to its proper place and close the defect in the abdominal wall. Surgeons may use sutures alone or reinforce the area with a surgical mesh, depending on the size of the hernia and the patient’s risk factors. In adults when the surgery is done as single incision laparoscopic surgery (one key hole) or laparoscopic surgery (3-4 key hole) using an anatomical mesh by the TEP method, the mesh covers the area of indirect inguinal hernia, direct inguinal hernia and the femoral hernia defect areas on the particular side. This minimises the risk of future occurrence of hernia in all the three sites. This is a significant benefit of TEP laparoscopic Mesh repair.
SILS – One key hole laparoscopic surgery incision
SILS incision opened up
SILS port inserted through one key hole
Demonstration of technique of SILS surgery, with camera in one channel and two operating instruments through the other two operating channels.
Dissection of inguinal cord structures for indirect inguinal hernia repair (SILS-TEP)
Indirect sac dissected, clipped proximally before dividing distal sac with diathermy
Area being prepared for mesh placement
SILS TEP repair with anatomical mesh to cover inguinal hernia orifice and femoral hernia orifice
Your surgeon will conduct a pre-surgery evaluation, which typically includes a physical examination, blood tests, ECG etc to assess fitness for surgery and any imaging studies as needed.
You’ll receive detailed instructions, including:
Your care team will monitor your vital signs, manage any discomfort, and ensure that you’re stable before discharge. Most adult patients stay overnight in the hospital for comfort of recovery.
The team will also guide you on how to care for your wound at home and help you resume daily activities gradually with safe movements. Most people return to light work within a week, but full recovery may take two to four weeks, depending on the surgical method and your overall health.
An inguinal hernia may recur after surgery if you:
Yes, Inguinal hernias almost always need surgery as they do not heal on their own. In adults, surgery is generally advised with mesh repair as hernias won’t heal on their own and can worsen. In asymptomatic inguinal hernia, about 50 to 75% come up for surgery over 5 to 7 years due to discomfort, pain or increasing size. Incidence of serious complications needing emergency is usually less than 5% over similar period of time, though the risk can be variable based on the type of hernia at presentation and associated risk factors. These issues can be discussed with your surgeon at consultation.
Most people recover within 4 to 6 weeks. You can typically resume light activities and exercise after a couple of weeks, as advised by your doctor
When a femoral hernia starts causing discomfort, pain or increases in size, hernia repair surgery is usually advised to prevent complications. Understanding the process—from preparation to recovery—can help you make a confident and informed decision.
Hernias are abnormal protrusion of an organ or tissue through an opening that should not be there. For femoral hernias, the defect is through a weak spot in the lower abdominal wall, typically in the groin. It protrudes through the femoral canal, a narrow passage at the upper end of thigh. Femoral hernias are less common than inguinal hernias and occur more often in women, especially older adults.
Femoral hernia surgery is a procedure that repairs a weak area in the abdominal wall near the groin, the femoral canal, through which abdominal tissue or intestine have bulged out.
The goal of this surgery is to return the protruding tissue to its proper place and close the defect in the abdominal wall. Surgeons may use sutures alone or reinforce the area with a surgical mesh, depending on the size of the hernia and the patient’s risk factors. In adults when the surgery is done as single incision laparoscopic surgery (one key hole) or laparoscopic surgery (3-4 key hole) using an anatomical mesh by the TEP method, the mesh covers the area of indirect inguinal hernia, direct inguinal hernia and the femoral hernia defect areas on the particular side. This technique of repair minimises the risk of future occurrence of hernia in all the three sites. This is a significant benefit of TEP laparoscopic Mesh repair using anatomical mesh.
The surgeon performing laparoscopic surgery makes one small incision through which a camera and surgical instruments are inserted using a special port device. This technique enables them to repair the femoral hernia from the inside using a mesh, resulting in least post-surgery pain, small scar(Usually within umbilicus hence not obviously visible) , and a quicker recovery.
SILS – One key hole laparoscopic surgery incision
SILS incision opened up
SILS port inserted through one key hole
Demonstration of technique of SILS surgery, with camera in one channel and two operating instruments through the other two operating channels.
Spermatic cord structures dissected for SILS TEP repair
Femoral hernia contents being reduced from behind the cord structures
Femoral hernia contents reduced, small indirect inguinal hernia sac being reduced and brought down at the same time
Paritex anatomical mesh placed to cover the orifices of femoral hernia and inguinal hernia(direct and indirect) for SILS-one key hole laparoscopic hernia repair(TEP)
Your surgeon will conduct a pre-surgery evaluation, which typically includes a physical examination, blood tests, ECG etc to assess fitness for surgery and any imaging studies as needed.
You’ll receive detailed instructions, including:
Your care team will monitor your vital signs, manage any discomfort, and ensure that you’re stable before discharge. Most adult patients stay overnight in the hospital for comfort of recovery.
The team will also guide you on how to care for your wound at home and help you resume daily activities gradually with safe movements. Most people return to light work within a week, but full recovery may take two to four weeks, depending on the surgical method and your overall health.
Most people recover within 4 to 6 weeks. You can typically resume light activities and exercise after a couple of weeks, as advised by your doctor.
Hernias are abnormal protrusion of an organ or tissue through an opening that should not be there. For umbilical hernias, the defect is through an opening for the umbilical cord that did fuse completely after birth. ( In the true sense hernias in adults are paraumbilical hernias and in children are truly umbilical hernia, wherein the opening for umbilical cord fails to fuse after birth). { For sake of convenience here we continue to call hernias in adults at the belly button as umbilical hernias}
Umbilical hernia surgery is a procedure that repairs a weak area in the abdominal wall near the belly button, through which abdominal tissue or intestine may bulge. This condition can happen in both infants and adults and may require surgical correction if it persists or causes symptoms.
The goal of this surgery is to return the protruding tissue to its proper place and close the defect in the abdominal wall. Surgeons may use sutures alone or reinforce the area with a surgical mesh, depending on the size of the hernia and the patient’s risk factors.
2Cms Pfannensteil incision within the bikini line and also appearance of final scar
SILS port inserted through Pfannensteil incision
Laparoscopic view of Umbilical Hernia after reducing contents from inside (SILS – one key hole surgery)
Suture closure of laparoscopic umbilical hernia (SILS – one key hole surgery)
Sutured defect area covered with composite dual layer mesh and absorbatack (SILS – one key hole surgery)
In infants, many umbilical hernias close on their own before the 3rd or 4th birthday. Surgery is only recommended if the hernia persists beyond that age, grows larger, or causes symptoms.
In adults, hernias rarely close without surgery and carry a greater risk of complications. Elective surgery is usually advised to prevent issues like incarceration or strangulation. The incidence of incarceration or strangulation happens in about 4% of patients over a waiting time of 5 years
Your surgeon will conduct a pre-surgery evaluation, which typically includes a physical examination, blood tests, ECG etc to assess fitness for surgery and any imaging studies as needed.
You’ll receive detailed instructions, including:
Your care team will monitor your vital signs, manage any discomfort, and ensure that you’re stable before discharge. Most adult patients stay overnight in the hospital for comfort of recovery.
The team will also guide you on how to care for your wound at home and help you resume daily activities gradually with safe movements. Most people return to light work within a week, but full recovery may take two to four weeks, depending on the surgical method and your overall health.
Not always. In infants, many hernias close naturally by age 3–4. In adults, surgery is generally advised as hernias won’t heal on their own and can worsen. In asymptomatic umbilical hernia, about 4% of patients develop incarceration or intestinal obstruction needing surgery over a 5 year follow up from studies published in literature.
Complications are rare but can include infection, bleeding, or recurrence. Full details will be discussed at the time of consenting for surgery.
Most people recover within 4 to 6 weeks. You can typically resume light activities and exercise after a couple of weeks, as advised by your doctor.
Yes, although recurrence is uncommon when the mesh is used and post-operative instructions are followed.
You may return to office work within a few days. Driving is usually safe after a week once the pain is minimal. Avoid heavy lifting or strenuous exercise for 6 to 8 weeks or until your surgeon clears you.
Contact your surgeon if you notice:
An incisional hernia is a bulge caused by abdominal organs or tissue pushing through a weak spot in the abdominal wall at the site of a previous surgical incision. Symptoms include a visible bulge, pain, and discomfort, particularly when straining. Risk factors include poor wound healing, obesity, and increased abdominal pressure from chronic coughing, constipation, difficulty in passing urine or heavy lifting. Treatment is surgery to reposition the tissue and close the defect, often with a surgical mesh, and can be performed by Single Incision ( One Key hole) Laparoscopic Surgery, , laparoscopic surgery (3-4 key holes), or open surgery methods.
Incisional hernia surgery is a procedure that repairs a weak area in the abdominal wall at the weakness of previous surgery, through which abdominal tissue or intestine have bulged. This condition can happen in both children and adults and requires surgical correction if it has narrow neck or causes symptoms.
The goal of this surgery is to return the protruding tissue to its proper place and close the defect in the abdominal wall. Surgeons may use sutures alone or reinforce the area with a surgical mesh, depending on the size of the hernia and the patient’s risk factors.
The surgeon performing laparoscopic surgery makes one small incision through which a camera and surgical instruments are inserted using a special port device. This technique enables them to repair the Incisional Hernia from the inside using a mesh, resulting in least post-surgery pain, small scar(Usually within bikini line hence not obviously visible) , and a quicker recovery.
2Cms Pfannensteil incision within the bikini line and also appearance of final scar
SILS port inserted through Pfannensteil incision
Laparoscopic view of Incisional Hernia after partial reducing contents from inside with omentum still attached (SILS – one key hole surgery) {Multiple defect pockets}
Laparoscopic view of Incisional Hernia after reducing contents from inside (SILS – one key hole surgery)
Laparoscopic Suture closure of Incisional hernia (SILS – one key hole surgery)
Dual layer composite Paritex mesh in place with sutures (SILS – one key hole surgery)
Dual layer composite Paritex mesh in place lifted with sutures and stitched to muscle layer (SILS – one key hole surgery)
Sutured defect area covered with composite dual layer mesh and reinforced with absorbatack (SILS – one key hole surgery)
Your surgeon will conduct a pre-surgery evaluation, which typically includes a physical examination, blood tests, ECG etc to assess fitness for surgery and any imaging studies as needed.
You’ll receive detailed instructions, including:
Your care team will monitor your vital signs, manage any discomfort, and ensure that you’re stable before discharge. Most adult patients stay overnight in the hospital for comfort of recovery.
The team will also guide you on how to care for your wound at home and help you resume daily activities gradually with safe movements. Most people return to light work within a week, but full recovery may take four to six weeks, depending on the surgical method and your overall health.
Several factors can contribute to the development of an incisional hernia
Post-surgical complications at previous surgery: Wound infection or bleeding after surgery can hinder proper healing.
Increased abdominal pressure following previous surgery: Activities such as heavy lifting, chronic coughing, and straining during constipation can put stress on the incision.
Patient factors: Being overweight, pregnancy, diabetes, liver cirrhosis and older age are also risk factors.
Multiple surgeries: Having several operations on the same surgical site can increase weakness of tissues leading to incisional hernia
You may return to office work within a week or two. Driving is usually safe after a fortnight once the pain is minimal. Avoid heavy lifting or strenuous exercise for 6 to 8 weeks or until your surgeon clears you.
Contact your surgeon if you notice:
A hernia is an abnormal protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it. Abdominal wall hernias are typically classified by location or aetiology. We evaluate and offer care for all types of abdominal wall hernia in the clinic. The nature of the repair depends upon the size and location of the hernia.
In my clinic we offer the following types of surgical repairs when clinically indicated.
| Single Incision Laparoscopic Surgery | Conventional ( 3 or 4 ) Key hole laparoscopic surgery | Open surgery |
|---|---|---|
|
Least pain from one cut in Umbilicus or Suprapubic region |
Minimal pain from 3 or 4 cuts with 1 cut being 2 cms and the rest 1 cms long |
Open surgical cut based on the size of the hernia. About 10 cms in groin and rest of areas larger than the size of hernia |
|
Minimal risk of mesh infection. Wound infection risk limited to 1 incision site( Least) |
Minimal risk of mesh infection. Wound infection risk limited to 3 or 4 incision sites |
Higher risk of mesh infection and wound infection |
|
Minimal risk of mesh infection. Wound infection risk limited to 1 incision site( Least) |
Minimal risk of mesh infection. Wound infection risk limited to 3 or 4 incision sites |
Higher risk of incisional hernia due to the larger incision |
|
Risk of incisional hernia limited to 1 site |
Risk of incisional hernia sites corresponds to the number of cuts |
Higher risk of incisional hernia due to the larger incision |
|
Shortest recovery time |
Short recovery time |
Recovery time longer than laparoscopic surgery |
|
Scar hidden within belly button or within Bikini line(no obviously visible scars) |
Three or four small scars |
Obvious scar of long incision. |
|
Lower risk of recurrence of hernia |
Lower risk of recurrence of hernia |
Higher risk of recurrence if done without mesh (Primary repair) |
|
Cannot be done in cases of gangrenous bowel/omentum due to risk of mesh infection |
Cannot be done in cases of gangrenous bowel/omentum due to risk of mesh infection |
Can be done in cases of gangrenous bowel/omentum as a primary repair, which can be done without mesh. |
|
Slightly more expensive due to Additional cost of disposable instruments of 1 key hole laparoscopic surgery compared to 3 key hole offset by quicker recovery |
Slightly more expensive than open surgery offset by quicker recovery |
Less expensive but cost benefits lost in longer recovery and work hours lost. |
