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Hernia (Open, MIS — Laparoscopic & Robotic)

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Hernia Surgery (Open, Laparoscopic & Robotic) — Abdominal Wall Hernias (Melbourne)

A hernia happens when tissue (often fat or bowel) pushes through a weak area in the abdominal wall or groin. Some hernias present as a lump and cause some discomfort, while others can become an emergency if the contents become trapped (incarcerated/non reducible) or lose blood supply (strangulated).

In our practice, we prioritise minimally invasive hernia repair (keyhole laparoscopic and robotic) when it’s safe and suitable, especially for groin hernias (inguinal/femoral) and many ventral/incisional hernias, because it can offer smaller incisions, less wound infection, and faster return to activity for the right patient.

Quick guide: hernia types we treat (abdominal wall)

Groin hernias

  • Inguinal hernia (most common): bulge in the groin; may extend into the scrotum.
  • Femoral hernia (less common, important): lower groin/upper thigh; higher risk of incarceration/strangulation.

Midline/abdominal wall hernias

  • Umbilical hernia: at/around the belly button.
  • Epigastric hernia: above the belly button (midline), often small but painful.
  • Ventral hernia: a general term for hernias of the abdominal wall (includes umbilical/epigastric and others).
  • Incisional hernia: occurs through a previous surgical scar.

Common symptoms (what patients notice)

  • Bulge that appears with standing, coughing, lifting, or straining
  • Aching, heaviness, dragging, or sharp discomfort (especially later in the day)
  • Pain with activity, coughing, or bowel motions
  • In larger hernias: difficulty exercising, work limitations, clothing discomfort

Red flags / when to seek urgent help (Emergency Department / call 000)

  • Hernia becomes firm, very painful, and cannot be pushed back
  • Red/purple skin over the hernia
  • Severe abdominal pain, vomiting, bloating, inability to pass gas or stool
  • Fever or rapidly worsening pain


These can be signs of incarceration/strangulation or bowel obstruction.

Assessment & work-up (clinic to theatre-ready)

1) History + examination

  • Location, size, reducibility, cough impulse
  • Triggers (lifting, constipation, chronic cough, prostate/urinary straining)
  • Previous repairs and abdominal operations
  • Work demands, sport, and personal goals
  • Past medical history , co-morbidities and medications in particular blood thinning medications and drug allergies.

2) Imaging (when needed)

  • Ultrasound: helpful for many groin and small abdominal wall hernias (operator dependent).
  • CT scan: best for incisional/complex ventral hernias, occult/rare hernias, surgical planning (defect size, muscle quality, bowel involvement).
  • MRI: occasionally for complex groin pain or unclear cases. It could assist to role out other pathology that mimic hernia symptoms ( Hip joints and musculoskeletal pathology) 

3) Pre-operative optimisation (reduces complications and recurrence)

  • Stop smoking/vaping (ideally weeks before surgery)
  • Weight optimisation where possible (especially for ventral/incisional hernias)
  • Control diabetes, treat chronic cough, address constipation
  • Review blood thinners/anti-platelets (individualised plan)

When is surgery recommended vs watchful waiting?

Not every hernia needs immediate repair, but many do.

Often reasonable to consider watchful waiting (in selected patients)

  • Minimally symptomatic inguinal hernia (especially in men), after discussion of risks/benefits and lifestyle needs

Usually recommended to repair (or repair sooner)

  • Femoral hernia (higher risk of strangulation)
  • Symptomatic hernias: pain, activity limitation, progressive size
  • Hernias that are difficult to reduce or have concerning features
  • Many incisional/ventral hernias once optimised, because they tend to enlarge and become more complex over time

Treatment options: Open vs Laparoscopic vs Robotic

A) Open hernia repair

How it’s done

  • Repair through an incision directly over the hernia.
  • Often includes mesh reinforcement (depending on type and size).

Common reasons to choose open

  • Some very large or complex hernias
  • Certain recurrent hernias (depending on the original approach)
  • Patients not suitable for general anaesthetic (some groin repairs can be done with local + sedation)

Pros

  • Good option in the right setting; can be efficient for certain hernias

Cons

  • Larger incision and potentially more wound discomfort
  • Higher wound complication risk in some abdominal wall repairs compared with keyhole techniques

B) Laparoscopic (keyhole) hernia repair

For groin hernias, the two main techniques are:

1) TEP (Totally Extraperitoneal — sometimes written as “TEPP”)

  • Repair is done without entering the abdominal cavity.
  • Mesh is placed in the preperitoneal space.

2) TAPP (TransAbdominal PrePeritoneal)

  • We enter the abdomen, create a preperitoneal pocket, place mesh, and close the peritoneum.

Why many patients like keyhole for groin hernias

  • Often less early pain, smaller scars
  • Useful for bilateral hernias (both sides) in one operation
  • Useful for recurrent hernia after a previous open repair (common strategy)

Key points to consider

  • Requires general anaesthetic
  • Small risks related to entering/working near the abdomen and pelvis (discussed below)

C) Robotic hernia repair (often Robotic TAPP for groin)

Robotic repair uses keyhole access like laparoscopy but with:

  • 3D vision, stable camera
  • Wristed instruments for precise suturing and dissection

Where robotic surgery can add value

  • Groin hernias needing meticulous dissection (selected cases)
  • Ventral/incisional hernias requiring more advanced reconstruction (e.g., retromuscular/abdominal wall techniques in appropriate patients)

Key points to consider

  • May involve longer operating time and higher system/hospital costs (varies by hospital and complexity)
  • Not necessary for every hernia, best used selectively

Mesh: what patients should know (simple and balanced)

  • Mesh reinforcement is commonly used because it generally reduces recurrence, especially for most adult groin and many ventral/incisional hernias.
  • Mesh comes in different materials/weights and is positioned in different anatomical planes depending on the technique.
  • Mesh complications are uncommon, but can include infection, chronic pain, fluid collection (seroma), or rarely erosion/migration (risk depends on technique, location, and patient factors).
  • The goal is a durable repair with the lowest risk of chronic pain and recurrence.

Risks & complications (all approaches)

Every operation has risks; your personal risk depends on hernia type, size, previous surgery, weight, smoking, diabetes, and occupation.

General surgical / anaesthetic risks

  • Bleeding, infection, clots (DVT/PE), anaesthetic complications

Hernia-specific risks

  • Recurrence (comes back)
  • Seroma/haematoma (fluid or blood collection)
  • Chronic pain (groin pain is a key topic in inguinal repairs)
  • Nerve irritation or injury (sensory changes; rarely more significant issues)
  • Mesh-related complications (uncommon)
  • Bowel or bladder injury (rare; risk varies by approach and complexity)
  • Testicular complications (groin repairs): swelling, cord vessel injury; testicular atrophy is rare
  • Urinary retention (temporary difficulty passing urine, more common in men after groin repairs)

We will discuss the specific risk profile for your hernia and approach during the consent process.

What to expect: day surgery, recovery, and return to work

Before surgery

  • Fasting instructions will be received from our team and the hospital will contact you
  • Medication review (especially anticoagulants/antiplatelets)
  • Arrange a responsible adult to take you home and stay the first night

After surgery (typical pattern)

  • Most patients may stay overnight in hospital but in selective patients a day procedure could be consider
  • Walking is encouraged early
  • Wound care instructions provided; showering timing depends on dressings
  • Expect some bruising/swelling (especially groin/scrotum in inguinal repairs)

Activity and lifting

  • Many people return to desk duties in 1 to 2 weeks (varies/ light duties)
  • Heavy lifting and strenuous work is usually restricted for longer (individualised guidance based on repair type, size, and job demands) usually between 4 to 6 weeks

Summary

  • Groin hernias (inguinal/femoral): minimally invasive TEP/TAPP (laparoscopic or robotic TAPP) is often ideal for bilateral hernias and many recurrences after open repair.
  • Umbilical/ventral/incisional hernias: approach is tailored, keyhole can reduce wound complications , robotic surgery can assist with selected cases.
  • Femoral hernias: commonly recommended for repair because of higher strangulation risk.
  • The “best” repair is the one that matches your anatomy, symptoms, goals, and risk profile, with a plan that minimises chronic pain, recurrence, and wound complications.

FOR PATIENTS

1) Inguinal Hernia / Common questions

  1. What is an inguinal hernia?
    A weakness in the groin where fat or bowel can protrude, causing a lump and discomfort, often worse with lifting or coughing.
  1. Do all inguinal hernias need surgery?
    Not always. If symptoms are minimal and the hernia is reducible, watchful waitingcan be reasonable in selected patients, but many choose repair due to symptoms or progression.
  1. What happens if I ignore it?
    Many slowly enlarge over time. A small number can become trapped (incarcerated) or strangulated, risk varies.
  1. How do you confirm the diagnosis?
    Often by examination. Ultrasound can help if it’s small or difficult to feel.
  1. What’s the difference between open and keyhole repair?
    Open uses one incision in the groin; keyhole (TEP/TAPP) uses small incisions and repairs from behind the weak area with mesh.
  1. Why might you recommend laparoscopic/robotic for me?
    Common reasons include bilateral hernias, recurrent hernia after open repair, desire for smaller scars, and faster early recovery (case dependent).
  1. Will I need mesh?
    Mesh is commonly used in adult inguinal repairs to reduce recurrence; we’ll discuss the best option for you.
  1. Will it affect my testicle or fertility?
    Temporary swelling or discomfort can occur. Serious complications affecting the testicle or fertility are rare, but we still discuss them.
  1. How much pain should I expect?
    Most pain improves significantly over days to weeks. A small minority can develop chronic groin pain, technique and nerve handling matter.
  1. When can I return to work/gym?
    Light activity and walking immediately; desk work (light duties) often within 1–2 weeks. Heavy lifting and gym timelines vary, follow your personalised plan.

2) Femoral Hernia / Common questions

  1. What is a femoral hernia?
    A hernia lower in the groin/upper thigh, passing through the femoral canal.
  1. Why is femoral hernia considered more serious?
    It has a higher risk of incarceration/strangulation than many inguinal hernias, so repair is often recommended once diagnosed.
  1. How does it feel?
    It may be a small lump or ache in the upper thigh/groin; sometimes it’s subtle until it causes trouble.
  1. How is it diagnosed?
    Exam plus ultrasound or CT can help, especially if the lump is small or unclear.
  1. What is the best repair approach?
    Many are well-suited to preperitoneal mesh repair (laparoscopic or robotic), but the best approach depends on anatomy and urgency.
  1. Can it be repaired as day surgery?
    Often yes if elective and uncomplicated. Emergency presentations may require admission.
  1. Does femoral hernia always contain bowel?
    Not always, but it can and that’s why strangulation risk matters.
  1. What are warning signs of strangulation?
    Sudden severe pain, vomiting, abdominal distension, and an irreducible tender lump, seek urgent care.
  1. Is recurrence common?
    Most repairs are durable, but recurrence risk depends on technique, tissue quality, and patient factors.
  1. What’s the recovery like?
    Similar to other groin repairs, walking early, gradual return to work and lifting with guided restrictions.

3) Umbilical Hernia / Common questions

  1. What is an umbilical hernia?
    A weakness at the belly button where fat or bowel can bulge out.
  1. Is it dangerous?
    Many are not urgent, but pain, enlargement, or episodes of trapping warrant review. Any irreducible painful lump needs urgent assessment.
  1. Do I always need mesh?
    Not always. Very small defects may be suitable for suture repair, but mesh is often recommended as size increases to reduce recurrence.
  1. What causes it?
    Prior pregnancy, weight changes, heavy lifting, chronic cough, constipation/straining, and natural tissue weakness.
  1. Do I need imaging?
    Often an Ultrasound or CT may be used if the diagnosis is uncertain or the hernia is complex.
  1. Can it be repaired laparoscopically/robotically?
    Yes, especially for larger defects, recurrent hernias, multiple defects, or when we want to reduce wound issues (patient dependent).
  1. Will my belly button look the same?
    Usually yes, but shape can change slightly depending on size and technique. We aim for a neat cosmetic outcome.
  1. What about diastasis recti (“ab separation”)?
    Diastasis isn’t a hernia, but it can influence repair planning and recurrence risk. We’ll assess this in clinic and discuss your management.
  1. How long until I can lift my kids or return to gym?
    It depends on repair size and method. We’ll give personalised lifting guidance.
  1. Can it come back?
    Any hernia can recur. Recurrence risk rises with smoking, obesity, poorly controlled diabetes, heavy lifting too early, and wound infection.

4) Ventral Hernia (Primary abdominal wall: epigastric, spigelian, etc.) / Common questions

  1. What does “ventral hernia” mean?
    A hernia of the abdominal wall (not groin), including epigastric, umbilical, spigelian, and other primary defects.
  1. Why do some ventral hernias hurt even when small?
    Small hernias can trap preperitoneal fat, causing sharp local pain, especially epigastric hernias.
  1. How do you decide between open vs keyhole?
    We consider defect size, location, body habitus, skin quality, risk of wound problems, and whether reconstruction is needed.
  1. Is laparoscopic/robotic always better?
    Not always. Keyhole can reduce wound issues, but open may be best for certain large/complex patterns or when skin work is required.
  1. What is “mesh plane” and why does it matter?
    Mesh can be placed in different layers (onlay, underlay, retromuscular, preperitoneal, etc.). The plane influences durability and complication profiles.
  1. Do I need a CT scan?
    For many small primary ventral hernias, no. For larger/complex cases or suspected rare hernias, CT helps plan the operation ( open vs minimal invasive surgery)
  1. What is a spigelian hernia?
    A hernia through the lateral abdominal wall that can be difficult to feel; imaging often helps confirm it.
  1. Can a ventral hernia cause bowel obstruction?
    It can, particularly if it becomes incarcerated. Obstruction symptoms (vomiting, bloating, no bowel motions/gas) need urgent review.
  1. How long is recovery?
    Varies widely, small repairs recover quickly; larger reconstructions take longer and may require a slower return to lifting.
  1. What can I do to lower recurrence risk?
    Optimise weight, stop smoking, control diabetes, treat cough/constipation, and follow lifting restrictions.

5) Incisional Hernia / Common questions

  1. What is an incisional hernia?
    A hernia that forms through a previous surgical scar where the abdominal wall closure has weakened.
  1. Why do incisional hernias keep getting bigger?
    The defect can widen with time and pressure, especially with heavy work, coughing, constipation, weight gain, or poor tissue quality.
  1. Do I need a CT scan?
    Often yes, CT helps assess defect size, muscle separation, bowel involvement, and plan the safest repair strategy.
  1. Can it be repaired laparoscopically or robotically?
    Many can, especially moderate defects. Robotic approaches can help with more advanced reconstruction in selected cases.
  1. What if my hernia is very large?
    Very large hernias may require formal abdominal wall reconstruction (sometimes open,  hybrid/robotic). Optimisation becomes even more important.
  1. Will you use mesh?
    In most incisional hernias, mesh is used to reduce recurrence, unless there are specific reasons not to (e.g., certain infection scenarios).
  1. What happens if I don’t repair it?
    Some remain stable, but many enlarge and become harder to repair. There’s also an ongoing risk of incarceration/obstruction.
  1. Is infection risk higher for incisional hernia repair?
    It can be, because prior scars, larger dissection, and patient factors (BMI, smoking, diabetes) increase risk. We minimise this with planning and optimisation.
  1. How long until I can return to manual work?
    Often longer than groin repairs. The timeline depends on defect size and repair method , your plan is individualised.
  1. What are the main causes of recurrence after incisional repair?
    Wound infection, smoking, high BMI, early heavy lifting, poor tissue quality, uncontrolled diabetes, and very complex hernia geometry.

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