Hernia: Do You Actually Need Surgery? Laparoscopic vs Open, Explained

What is a hernia?

A hernia occurs when tissue — typically part of the intestine or abdominal fat — pushes through a weak spot or gap in the surrounding muscle wall. The most common types are:

• Inguinal hernia — in the groin; far more frequent in men.
• Umbilical hernia — around the navel; common in adults and infants.
• Incisional hernia — through the scar of a previous abdominal operation.
• Femoral hernia — in the upper inner thigh; more common in women.

All types share the same fundamental fact: the gap in the muscle wall does not close by itself. A hernia belt or truss can contain a hernia, but it is not a cure.

Symptoms: what does a hernia feel like?

The most recognisable sign is a soft, reducible bulge — one that often flattens when you lie down and reappears when you stand, cough, or strain. Associated symptoms can include:

• A dragging ache or heaviness in the groin or abdomen, worse at the end of the day.
• Discomfort on physical exertion or prolonged standing.
• A sharp pain if the hernia is compressed.

Some hernias cause no symptoms at all — found incidentally on an ultrasound done for another reason. Others are painful from the start.

When is a hernia an emergency?

A hernia that becomes suddenly firm, intensely painful, and cannot be pushed back in needs immediate hospital attention. This may mean the tissue is trapped (incarcerated) or its blood supply is cut off (strangulated) — a condition that requires emergency surgery and should not be waited out.

Do you always need surgery?

The honest answer is: not always immediately, but usually eventually. The key distinctions are:

• Asymptomatic (no symptoms) hernias — particularly small inguinal hernias in older men — may be watched cautiously. Research suggests that a period of active observation is safe in this specific group, provided they understand the symptoms that require prompt attention.
• Symptomatic hernias — causing pain, affecting daily activity, or enlarging — are generally best repaired sooner rather than later. An untreated hernia is not without risk; the risk of emergency presentation is real, even if uncommon.
• Incisional hernias tend to enlarge over time and rarely remain symptom-free — repair is usually recommended unless there is a strong reason against surgery.

Dr. Khanna's approach is to give patients a genuine opinion: if surgery is not yet warranted, he will say so. If it is clearly needed, he will explain why, plainly and without pressure.

Laparoscopic (keyhole) hernia repair

Laparoscopic repair is now the standard technique for most inguinal, umbilical, and many incisional hernias. The surgeon works through two or three small incisions — typically less than a centimetre — using a camera and fine instruments to place a mesh that reinforces the weakened wall from behind (the TEP or TAPP approach for inguinal hernias; IPOM for incisional).

Advantages of laparoscopic repair

• Less post-operative pain compared to open repair for the same hernia.
• Shorter hospital stay — often one to two days; some patients go home the same day.
• Quicker return to light activity and desk work.
• Lower risk of wound complications such as wound infection.
• Better cosmesis — small scars rather than a longer incision.
• Particularly advantageous for bilateral (both-sides) inguinal hernias — both sides repaired through the same small incisions in a single operation.

When laparoscopic repair may not be the first choice

• Very large incisional hernias where the defect size or loss of domain makes laparoscopic mesh placement impractical.
• Recurrent hernias after a previous laparoscopic repair — where returning to the same space may carry higher risk than an open approach.
• Significant adhesions from multiple prior abdominal operations.
• Patients who cannot tolerate a general anaesthetic and CO₂ insufflation safely.

These are not arbitrary rules — they are judgement calls based on what is genuinely safer for the individual patient. With over 30 years of continuous practice at Shree Mahavir Hospital, Dr. Khanna makes these decisions from accumulated experience rather than a fixed protocol.

Open hernia repair

Open repair — a single, direct incision over the hernia — remains an entirely valid technique and is sometimes the better choice. The Lichtenstein tension-free mesh repair is the most widely used open technique for inguinal hernia. Open repair has a long track record and can be performed under local, regional, or general anaesthesia — an advantage in patients where general anaesthesia carries higher risk.

Recovery from open repair is generally a little longer than laparoscopic for the same hernia type, but outcomes in terms of recurrence and long-term function are broadly comparable when the correct technique is applied by an experienced surgeon.

What about mesh — is it safe?

Surgical mesh is used in the vast majority of hernia repairs today because repairs without it (primary closure) have higher recurrence rates for most hernia types. Modern hernia mesh — particularly lightweight, partially absorbable varieties — has been refined considerably over the decades. Mesh complications do occur, but they are uncommon when the mesh is appropriately selected and correctly placed. If you have concerns about mesh, raise them at the consultation; Dr. Khanna will discuss the options honestly.

Recurrent hernias: when a previous repair has failed

A hernia that comes back after repair is called a recurrent hernia — one of the more challenging problems in general surgery. Scar tissue from the first operation alters the anatomy; the approach for the second repair must be planned differently, often favouring the opposite route (laparoscopic if the first was open, or open if the first was laparoscopic). This is a particular area of focus at Dr. Khanna's practice. For more, see the dedicated page on revision and complex GI surgery.

Recovery: what to realistically expect

Recovery timelines vary with hernia size, technique, and each patient's own fitness. As a general guide for a routine laparoscopic repair:

• Day 0–1: Discharge home; walking encouraged.
• Week 1–2: Light activity, desk work; avoid driving if on pain medication.
• Week 3–4: Return to most daily activities; no heavy lifting yet.
• 6 weeks+: Gradual return to physical labour and strenuous exercise, as cleared at review.

Open repair typically adds one to two weeks to each phase. Every patient receives individual guidance at discharge and at the follow-up appointment.

When to see Dr. Khanna

A consultation at the OPD is the right step if you have a bulge you are not sure about, pain that has started recently around an old hernia, or if you have already had one hernia repair and are worried it may have failed. For a referral to the service page, see hernia surgery in Surat. To book, call the OPD or find directions here.