Frequently Asked Questions

Do I need a referral from my GP?

No, but it is often useful for the surgeon to have your medical history and medications when examining you. Also some insurance companies require you to have a GP referral.

Will my Insurance cover hernia repair?

The Hernia Clinic are a Southern Cross Affiliated Provider, they will apply for prior approval for you. Or if you are insured with another insurance company, The Hernia Clinic will supply you with all the information you need to apply for this yourself.

What are the symptoms?

The most common symptom of a hernia is a lump in the groin. Sometimes the lump is painful, but a small hernia may not even be noticed and may only be found as part of a routine examination. Each hernia is different, and the symptoms of a hernia can appear gradually or suddenly. Different people feel varying degrees of pain. Some people even feel that something has ruptured or given way. Other symptoms may include:

  • Feelings of weakness, pressure, burning or pain in the abdomen, groin or scrotum
  • A bulge or lump in the abdomen, groin or scrotum that is easier to see when you cough and disappears when you lie down, and may not be obvious after a night’s sleep
  • Pain when straining, lifting or coughing

However, a hernia can be dangerous if it gets trapped and twisted in the weak spot in the abdominal wall and becomes tender. This is known as a strangulated hernia. If the intestinal loop is damaged, its contents can leak out. Gangrene and peritonitis, which can be life-threatening, may occur as a result. Strangulation is an emergency requiring urgent surgery.

What causes hernias?

Many hernias begin as a congenital defect, a weakness in the abdominal wall that a person is born with. If you have a weak point in a muscle wall, pressure from extra body weight, coughing, heavy lifting, or from straining during bowel movements can force the muscle apart, allowing part of an internal organ (or another part of the body) to push through. Once that happens, the defect (hernia) will continue to enlarge until it is repaired.

Are hernias hereditary?

You may inherit a tendency to have weak abdominal muscles from one of your parents, but hernias themselves are either acquired or congenital. Acquired hernias are caused by the wear and tear of living, such as childbirth, weight gain, and other muscle strain. Congenital hernias are present when you are born with points of weakness in the abdominal wall. Children’s hernias are almost always congenital. Many adult hernias are also congenital but may have been too small to detect at an earlier age.

How does smoking affect a hernia?

Chronic coughing from the lung irritation caused by smoking can put you at risk for a hernia. It can also cause a hernia to recur. Heavy smokers also tend to develop abdominal hernias at a higher rate than non-smokers, as exposure to nicotine can help weaken the abdominal wall.

Why are men more prone to inguinal hernias than women?

Men are more prone to inguinal hernias than women because of the basic differences in anatomy. The area where hernias occur most often has a very different function in men than in women. The internal inguinal ring through which a man’s testicles descend before birth, can be a natural weak spot of the anatomy that is at risk.

How is it diagnosed?

A hernia is usually diagnosed through a simple physical examination. Sometimes your family doctor or specialist will arrange an ultrasound examination of the groin in conjunction with this physical examination.

Can I prevent hernias?

There is really no guaranteed way to prevent getting a hernia or to prevent recurrence of a hernia. Some hernias are due to a congenital condition. The best thing you can do is stay healthy by eating well, maintaining a healthy weight, and exercising regularly.

A good diet will help you avoid constipation which can lead to straining, and help to keep your  muscles healthy. If you are overweight, losing some weight will ease the pressure on your abdominal muscles. Regular, gentle exercises will tone and strengthen your abdominal muscles. Use proper lifting techniques and avoid lifting weights that are too heavy for you. If you smoke, try to quit. Chronic coughing from lung irritation can put you at increased risk for a hernia. It can also cause a hernia to recur.

Why surgery?

It is necessary and important to have a hernia repaired through surgery.  A hernia will not go away on its own. However your surgeon may not always recommend it, depending on your medical history.

The majority of hernias require surgical repair to alleviate symptoms and to prevent possible strangulation of the intestine. The most common form of repair is to insert an artificial mesh in the defect, sometimes under local anaesthetic. General anaesthetic is more commonly used but may be precluded by a patient’s pre-existing medical problems. Trusses should only be seen as a temporary measure whilst awaiting surgical repair.

What kind of surgery is used?

The operation for a groin hernia is one of the commonest surgical procedures.

The standard (open) operation involves a 10cm incision in the groin (or both groins if there are hernias present on both sides), finding the hernia and patching the defect with polypropylene mesh.

In endoscopic or keyhole surgery a 1.5cm (3/4 inch) incision is made just below the umbilicus (bellybutton) and two further tiny incisions are placed between the umbilicus and the pubic bone. The operation is performed with long instruments inserted through these incisions. A camera inserted through one of the small incisions lets the surgeon watch the operation on a TV screen linked to the camera inside the patient.

No further incisions are required even if there are hernias in both groins. The hernia is identified and the defect repaired with mesh as in the open (non-keyhole) operation. For further information, please see our information sheets.

What is mesh?

There are many types of mesh products available, but surgeons typically use a sterile, woven material made from a synthetic plastic-like material, such as polypropylene. The mesh can be in the form of a patch that goes under or over the weakness, or it can be in the form of a plug that goes inside the hole. Mesh is very sturdy and strong, yet extremely thin. It is also soft and flexible to allow it to easily conform to your body’s movement, position, and size.

Mesh is generally available in various sizes and can often be cut to fit. Depending on the repair technique used, the mesh is placed either under or over the defect in the abdominal wall and held in place by sutures. Mesh acts as support for the new growth of a patient’s own tissue, which eventually incorporates the mesh into the surrounding area.

Mesh devices are generally not used in patients with the potential for growth or tissue expansion (such as infants or children) as the mesh will not stretch significantly as the patient grows.

Please see Information sheet, Advisory statement from New Zealand Association of General Surgeons.

How much will it cost?

Charges incurred are for the surgery (plus consultation prior to your operation), an anaesthetist, the hospital and items used during your hospital stay. You are welcome to ask for an estimate of the costs for your treatment.

The Hernia Clinic are a Southern Cross Affiliated Provider, they will apply for prior approval for you. Or if you are insured with another insurance company, The Hernia Clinic will supply you with all the information you need to apply for this yourself.

Please check your health insurance policy as to what it will provide for you and ensure that your insurance is up to date.
Occasionally patients require additional medical care and may incur charges for pathology, radiology and other specialists.

If your hernia has occurred as the result of an accident, ACC will fully fund the operation, depending on the circumstances. Feel free to ask if you qualify.

Major credit cards are accepted for both hospital and surgical costs.

What do ACC pay for?

If you have an accepted ACC claim you will only be charged a small surcharge for your initial consultation and any x-rays or ultrasounds you may require. There is no charge to the patient for the operation or post op care.

Do I have a choice of hospital?

Yes, you can choose to go to Southern Cross Hospital or St George’s Hospital in Christchurch.

Should I have laparoscopic or open surgery?

There are three main advantages of keyhole surgery:

  • The small incisions result in less pain and earlier return to work, especially when hernias are present on both sides.
  • The positioning of the mesh on the inside of the defect is mechanically better than when placed on the outside as in the non-keyhole operation.
  • By positioning the mesh on the inside of the defect, the very sensitive nerves in the inguinal canal are not damaged or irritated by the mesh as can occur in the non-keyhole operation.

For recurrent hernias, keyhole surgery is also useful. A surgeon using the open technique has to dissect through tissue that is very scarred from the first operation.

This is much more difficult than a first-time operation and can lead to increased risks of complications. If the operation is done with the keyhole technique, the hernia is approached from the inside, where the tissue has not been affected by the first operation. This makes it much easier for the surgeon, and less painful for the patient.

Possible disadvantages of keyhole surgery:

  • The operation can sometimes take longer. With experienced surgeons however there is very little difference in time taken between the keyhole and non-keyhole operation.
  • In the exceptionally rare situation of a complication of the mesh, such as infection or mesh rejection, the mesh is more difficult to remove than when it is on the outside of the muscles as with the non-keyhole operation.
  • Cost: Because the surgeon uses some disposable instruments during keyhole surgery, the cost is higher than open surgery.

Should everyone have keyhole surgery?

No. There are a number of reasons why an individual may be better off with the non-keyhole operation:

  • Very large hernias may not be suitable for keyhole repair.
  • Patients with previous lower abdominal surgery may not be suitable.
  • Patients unable to tolerate a general anaesthetic may not be suitable.
  • Patients who do not have a need for quick recovery may prefer the non-keyhole operation.

What are the risks of hernia surgery?

As with any surgery, infection and/or bleeding are possible. The risk of complications increase if the patient smokes, is a heavy drinker, is very young or old, or has other medical conditions. In addition, there is a slight chance that the intestines, bladder, blood vessels, or nerves may be injured during the procedure, or that extended scarring may occur.
All surgical procedures are associated with some risk. Talk to your surgeon prior to surgery about possible risks and complications. Please see our Information sheet General Risks of Surgery.

What type of anaesthesia will be used during surgery?

The type of anaesthesia you receive depends on your general health, the type of hernia repair being done, and the facility where you have surgery. Most laparoscopic repairs require a general anaesthetic. Open repairs can be done with general, local, spinal, or other types of anaesthesia.

Can the hernia come back?

Recurrence rates for modern hernia repairs (keyhole or non-keyhole) are very low, around 1-2%. The keyhole operation for inguinal hernia also prevents the future development of a femoral hernia. There is no evidence linking recurrence of a mesh hernia repair with physical activity either immediately after the operation or later.

What happens after the operation?

Please see our post op information sheets for different types of surgery.

When will I be back to normal?

After Keyhole Surgery – From the time you awake from the anaesthetic the repaired hernia is already stronger than a normal groin! Naturally you will be a little tender for the first few days but after a week or two there is no need to limit your activities, other than common sense regarding any discomfort from the tiny wounds.
 
After Open Surgery – Like the keyhole option, the repaired hernia is already stronger than a normal groin, but you will find it takes longer to return to normal activities and will need to take it easy for at least 2 to 3 weeks.

When can I return to work?

This will depend on the kind of work you do. Full recovery from hernia surgery may take from one to six weeks. If you have a very strenuous job that requires heavy lifting, it may be several weeks before you can get back to work. If you have a desk job, you may return in as little as three days. Ask your surgeon for advice on when to return to work and resume your normal daily activities.

When can I drive again?

Driving is generally not recommended for at least 48 hours following surgery because the effects of anaesthesia are still present in the body. Driving also puts a strain on the incision site. In addition, if you are taking pain medication, you may not be able to drive or operate machinery. Ask your surgeon when it is safe for you to resume driving.

When can I resume sporting activities?

Depending on the type of sport, you may be able to return to low-impact, non contact sports (such as swimming) in just a few days. It may take several weeks to return to sports that require greater exertion. You may be able to resume competitive and contact sports as early as three weeks after surgery. It is important to ask your surgeon when you should return to sports.

Can I drink alcohol prior to the procedure?

For your own health, don’t drink in excess but you should not drink alcohol for two days prior to an anaesthetic. The effects of other drug use on anaesthesia are complicated and it is best, if possible, to avoid using them around the time of the anaesthetic. It is vital your anaesthetist knows about any drug and alcohol history.

Can I take my diabetic medication?

You must discuss this with your surgeon as changes will be necessary. Please see Information Sheet Insulin Dependent Diabetics Undergoing Surgery.

Should I stop taking blood thinning medication?

In most situations you will need to cease blood thinning medication a few days prior, but it will depend on what medication you are taking, and the reason you are taking it. We need to be informed about any blood thinning medication you are taking well in advance prior to the operation. These medications include WARFARIN, CLOPIDIGREL, DABIGATRAN, DIPYRIDAMOLE, ASPIRIN. In some situations it is safe to continue, in others it is safer to discontinue. And in some situations the procedure may need to be deferred, or alternate medication given. Please inform us of this medication at the earliest opportunity.

Can I take herbal medications as usual?

Although these products are labelled as ‘natural’ products, they may have side effects either with sedation or anaesthetic. Generally it is safer to discontinue herbal medication a week before the procedure. Please see Information Sheet Taking Herbal Medications Before Surgery.

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