Hernia Repair Surgery Treatment Options: Which Procedure May Be Right for You?

If you have been told that your hernia needs surgery, you may be surprised to learn that there is no single operation called “hernia surgery.”

A small groin hernia, a hernia around the belly button, and a large hernia developing through an old abdominal scar may all require very different repairs. The main hernia repair surgery treatment options include open surgery, laparoscopic repair, robotic-assisted repair, mesh-based repair, non-mesh tissue repair, and more advanced abdominal wall reconstruction for selected complex hernias.

Hernia repair isn't one-size-fits-all — options vary by type and need.

Before Choosing Surgery, the Type of Hernia Matters

The word “hernia” describes tissue pushing through a weak area, but where that weakness develops makes a major difference to treatment.

Common abdominal wall hernias include:

• Inguinal hernia – develops in the groin
• Umbilical hernia – develops around the belly button
• Ventral hernia – develops through the front abdominal wall
• Incisional hernia – develops through or near the scar from a previous abdominal operation

The overall aim of hernia repair is to return the protruding tissue to its proper position and strengthen the weak area so that the hernia is less likely to return.

Option 1: Open Hernia Repair

Open hernia repair is one of the most established surgical approaches. The surgeon makes an incision over or near the hernia, moves the protruding tissue back into the abdomen, and repairs the weakened area. The repair may involve surgical mesh or, in selected cases, the patient’s own tissue.

When May Open Repair Be Considered?

Open surgery can be used for many different types of hernias and may be particularly useful for:

• Inguinal hernias
• Umbilical hernias
• Large ventral or incisional hernias
• Certain recurrent hernias
• Complex abdominal wall defects
• Patients for whom a minimally invasive approach may not be suitable

Option 2: Laparoscopic Hernia Repair

• TEP – Totally Extraperitoneal Repair
• TAPP – Transabdominal Preperitoneal Repair

Both approaches allow mesh to reinforce the weak groin area from behind the abdominal wall, although they reach that space differently.

Option 3: Robotic-Assisted Hernia Repair

Robotic techniques may be used for selected:

• Inguinal hernias
• Ventral hernias
• Incisional hernias
• More technically complex abdominal wall repairs

Robotic surgery can make certain reconstructive manoeuvres easier to perform through small incisions, but it is important not to assume that robotic surgery automatically produces a better result than laparoscopic or open surgery.

Option 4: Mesh Hernia Repair

For example, it may be positioned:

• Over the abdominal wall
• Between layers of the abdominal wall
• Behind the abdominal muscles
• In the preperitoneal space

Not every hernia operation requires mesh. During a non-mesh repair, the surgeon uses sutures and the patient’s own tissues to reconstruct and strengthen the weak area. For inguinal hernia surgery, one of the best-known tissue techniques is the Shouldice repair. Non-mesh repair may be considered for carefully selected patients, particularly when:

• The patient prefers to avoid mesh after an informed discussion
• The anatomy is suitable for a tissue repair
• There are specific concerns about using synthetic material
• A surgeon with appropriate non-mesh repair expertise is available

However, non-mesh repair is not automatically safer or better simply because no implant is used.

For adult inguinal hernias, mesh-based repair generally has a lower risk of recurrence than many traditional suture repairs. When non-mesh surgery is chosen, technique and surgeon experience become especially important.

What About Umbilical Hernia Repair?

Umbilical hernias can range from very small defects to much larger openings around the belly button. The surgical options may include:

• Open repair
• Open mesh repair
• Laparoscopic repair in selected cases

For many symptomatic adult umbilical hernias, mesh reinforcement is commonly used because it can reduce the likelihood of recurrence.

The size of the defect, body weight, wound risk, previous surgery, and other individual factors influence whether the operation is performed through an open or minimally invasive approach.

What About Incisional and Large Ventral Hernias?

Incisional hernias can be considerably more complicated than a small groin or umbilical hernia. A previous operation may have weakened a large section of the abdominal wall, and the surrounding muscles may have gradually moved apart.

For many incisional repairs, the surgeon aims not simply to cover the opening with mesh but to bring the abdominal wall tissues back together and reinforce the reconstruction. A common strategy involves positioning mesh in a deeper layer behind the abdominal muscles, often called a retromuscular repair.

Option 6: Abdominal Wall Reconstruction

Very large or complex ventral and incisional hernias may require an advanced operation known as abdominal wall reconstruction. Sometimes the abdominal muscles have moved so far apart that they cannot simply be stitched together without creating excessive tension.

In these situations, surgeons may use techniques known as component separation or other forms of myofascial release to allow the muscles and supporting tissues to come back toward the centre. Mesh is then commonly used to strengthen the reconstruction.

This type of surgery may be considered for:

• Large incisional hernias
• Recurrent abdominal wall hernias
• Multiple previous failed repairs
• Large defects where normal abdominal wall anatomy has been significantly disrupted

These procedures require considerably more planning than a straightforward small hernia repair.

What If the Hernia Has Already Been Repaired Once?

A hernia that returns after surgery is called a recurrent hernia. The second operation does not necessarily repeat the first technique. For example, if an inguinal hernia returns after an anterior open repair, the surgeon may consider approaching it from behind using a laparoscopic technique. 

Changing the surgical plane can help avoid operating repeatedly through scarred tissue. For recurrent ventral or incisional hernias, previous mesh placement, scar tissue, defect size, abdominal wall anatomy, and the reason the previous repair failed all need to be considered.

What Happens If the Hernia Becomes an Emergency?

Most planned hernia repairs are elective operations. The situation changes if tissue becomes trapped inside the hernia. An incarcerated hernia cannot be returned to its normal position. If the blood supply to the trapped intestine or tissue becomes compromised, the hernia becomes strangulated.

Emergency surgery may then be necessary. The surgeon needs to release the trapped tissue, assess whether it is still healthy, and repair the hernia. If a section of intestine has lost its blood supply and become severely damaged, bowel surgery may also be required. Sudden severe pain, vomiting, abdominal swelling, a painful lump that will not go back in, or redness around a hernia requires urgent medical assessment.

How Do Surgeons Choose the Best Hernia Repair?

Choosing the right approach involves weighing many personal health factors.

Can a Hernia Be Managed Without Surgery?

Sometimes, depending on the type of hernia and the person’s symptoms. For example, watchful waiting may be reasonable for some men with an asymptomatic or minimally symptomatic inguinal hernia.

However, a hernia generally does not repair the abdominal wall defect by itself, and symptoms can change over time. Women with groin hernias, people with significant symptoms, and anyone with possible incarceration or strangulation require a different level of assessment. The decision to observe or operate should therefore be made according to the specific hernia rather than applying one rule to everyone.

The Bottom Line

The right hernia repair procedure depends on the type, size, location, and complexity of the hernia, as well as your overall health and previous surgeries. Open, laparoscopic, and robotic approaches can all be effective, but each has different benefits and limitations. Your surgeon will consider these factors to choose the approach that offers the safest and most effective repair for your individual situation.