What Is a Hernia and How Is It Repaired?

You probably notice it doing something ordinary — coughing, lifting a bag, standing up after sitting a while. A soft bulge appears where there wasn't one before, maybe with a dull ache, and then it fades when you lie down and relax. That coming-and-going lump is the classic calling card of a hernia, and the short video embedded at the top of this page shows one being repaired: a right-sided inguinal hernia in the groin, fixed in just under four minutes of operating footage using a prosthetic reinforcing device.

So what exactly has pushed through?

Think of the abdominal wall as a layered jacket that keeps everything inside in place. A hernia happens when an inner layer — sometimes fat, sometimes a loop of intestine — pokes through a weak spot or a natural opening in that jacket and sits under the skin as a bulge. Nothing has burst. The contents have simply found a gap and slipped part-way through it, which is why the bulge often slides back when you lie flat and the pressure inside your abdomen drops, then reappears the moment you stand, strain, or cough.

Where do hernias tend to show up?

The groin is the most familiar location. Inguinal hernias, like the one in the video, pass through the inguinal canal in the groin — they're called direct when they push straight through a weak area of the wall, and indirect when they follow the canal itself. Other common spots include the belly button (umbilical), the upper thigh just below the groin (femoral), and the site of an earlier abdominal operation, where a scar can leave the wall a little weaker than the tissue around it (incisional). The pattern is the same in each place; only the address changes.

Can't it just be pushed back and left alone?

Sometimes a clinician can gently ease a bulge back in during an examination, and small hernias that cause no symptoms are occasionally simply watched, with a plan to review. But pushing contents back doesn't close the gap — the weak spot stays weak, and hernias tend to enlarge slowly over time rather than heal. The situation doctors worry about is a bulge that becomes stuck and cannot go back, or worse, one whose blood supply gets squeezed off by the tight edges of the gap. That is why a bulge that suddenly becomes painful, firm, and impossible to push back, especially with nausea or vomiting, should be assessed urgently rather than waited out at home.

What does the repair itself involve?

A repair does two things: it returns whatever has slipped through to where it belongs, and it closes or reinforces the weak spot so it can't slip through again. In the video on this page, the surgeon repairs a right indirect inguinal hernia using a prosthetic device — a soft mesh-type reinforcement placed so the weakened area is supported rather than simply pulled shut under tension. That reinforcing idea is common to many modern repairs, whether the mesh is placed through an open operation or a laparoscopic one. If you'd like to watch the open approach at a slower pace, this direct inguinal hernia repair follows a groin operation step by step over nearly fourteen minutes. The same return-and-reinforce logic, incidentally, is what makes hernia repair a close cousin of other abdominal wall and abdominal operations on this site — our guide to gallbladder removal shows the laparoscopic side of abdominal surgery, where the camera view does the guiding.

Open or laparoscopic — what's actually different?

Honestly, less than the names suggest. In an open repair the surgeon works directly through an incision over the hernia; in a laparoscopic repair the work is done through a few small openings with a camera, viewing the area from inside. Both aim at the same finished job — contents back in place, weak spot reinforced — and both are usually done with some form of anaesthesia, which may be general or, for some open groin repairs, regional or local. Which route suits you depends on the hernia's type and size, whether it's on one side or both, any previous surgery in the area, and your surgeon's judgement after examining you. There isn't a universal winner, and a good consultation will explain the reasoning for your particular case rather than selling you a technique.

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician and researcher.

Frequently Asked Questions

Do hernias go away on their own?

In adults, no — the weak spot in the wall doesn't close by itself, and hernias generally stay the same or slowly get bigger. That doesn't mean every hernia needs an operation straight away; some symptom-free hernias are watched. It does mean "wait and it will heal" isn't a realistic plan, so a diagnosis is worth having even if you and your doctor decide simply to monitor it.

What is the mesh used in hernia repair?

Mesh is a soft, flexible prosthetic material placed over or within the weak area to reinforce it, a bit like a patch reinforcing worn fabric. In the video on this page the repair uses a prosthetic device of this kind. Not every repair uses mesh — some are done with stitches alone — and your surgeon can explain which approach they're recommending and why.

Can a hernia come back after repair?

It can, though repair is intended to be lasting. A recurrence means tissue has pushed through again at or near the repaired spot. Heavy strain during early healing doesn't help, which is why your team will give you activity guidance for the first weeks — follow theirs rather than a generic timetable, because it will be based on your operation.

How do I know if a hernia is an emergency?

Warning signs are a bulge that becomes suddenly painful, tense, or discoloured, that you cannot gently push back when it normally goes back, or pain accompanied by nausea, vomiting, or being unable to pass wind or stool. Those can signal that tissue is trapped, and they warrant urgent medical assessment the same day.

Educational only — this article is general information about hernias and their repair, not medical advice. A new groin or abdominal bulge should be examined by your own doctor, and a painful bulge that won't go back in, especially with vomiting, needs urgent same-day assessment.