Hernia
By The Treatment Registry editors
Protrusion of an organ or tissue through a weakness in surrounding muscle or fascia. The most common varieties are inguinal, umbilical, incisional, and hiatal. Treatment selection depends on hernia type, size, symptoms, and the patient's surgical risk profile. Watchful waiting is appropriate for small asymptomatic inguinal hernias in older patients; surgical repair (open or laparoscopic, with or without mesh) is the definitive treatment for symptomatic hernias.
Treatment ladder
Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.
Conservative
- Watchful waiting (small asymptomatic)
Reasonable for small, asymptomatic inguinal hernias particularly in older patients with comorbidity. Crossover to surgical repair occurs in a minority of patients over time as symptoms develop.
- Truss or supportive garment
Symptomatic relief only; does not reduce the hernia or prevent progression. Of limited modern role.
Procedural
- Manual reduction (incarcerated hernia, emergency)
Manual reduction of an incarcerated hernia by trained clinician, deferring surgery to elective scheduling. Only appropriate when reduction can be achieved without force and without signs of strangulation.
Surgical
- Open hernia repair · View procedure page
Single-incision repair, typically with synthetic mesh reinforcement (Lichtenstein technique for inguinal). Shorter operating time than laparoscopic; suitable under local or general anaesthesia.
- Laparoscopic hernia repair
Minimally invasive transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach with mesh placement from inside the abdominal wall. Faster return to normal activity than open repair; preferred for bilateral and recurrent inguinal hernias per NICE TA160.
- Component-separation repair (large incisional)
Reserved for large or complex incisional hernias. Releases of the abdominal wall layers permit tension-free closure of large defects, often with biological or large-pore synthetic mesh.