A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

Hernias don't go away by themselves. Surgery is the only way to repair a hernia. A hernia repair returns the organ or structure to its proper place and fixes the weakened area of muscle or tissue. Most of the time, having a surgery is a big decision. It can be tempting to put it off. Here are some points to consider and discuss with your surgeon who can help you make the right decision.

How is the hernia affecting you?

The first thing to consider is if you are experiencing any symptom. Not everyone has symptoms with a hernia, especially small ones. When symptoms occur, the most common one is pain. Others can include a feeling of heaviness or fullness in the belly or groin.

A hernia can interfere with your leisure activities and your work whether you have symptoms or not. So you also need to recognise if you are taking time off from work or interests due to your hernia.

Delaying surgery may mean you spend more time away from work and fun instead of returning to activities after recovery. If you have symptoms, especially pain, your surgeon is likely to recommend surgery.

But what if you don't have symptoms or they are minimal? In this case, you may be recommended for watchful waiting. Before you agree to watchful waiting, be sure your doctor knows the whole story. Be honest about any limitations your hernia puts on your time and activities.

What are the risks of waiting?

1. Hernias can become incarcerated. One potentially serious risk of not fixing a hernia is that it can become trapped outside the abdominal wall — or incarcerated. This can cut off the blood supply to the hernia and obstruct the bowel, resulting in a strangulated hernia. This requires urgent surgical repair.

Of course not all hernias progress to this point, but it is a risk nonetheless. Avoiding an emergency situation that you can't control is one reason to consider not delaying surgery.

2. Hernias grow. A more likely scenario is that your hernia will continue to grow and weaken with time. This is likely to increase your symptoms, including pain, and cause more changes to your lifestyle.

Surgeons know that smaller hernias are easier to repair than larger hernias. Going ahead with surgery instead of delaying can prevent your symptoms from getting worse.

3. Hernias require surgery eventually. Even if you are not having symptoms, you may still want to consider having surgery sooner rather than later. Surgery for a hernia is somewhat inevitable in most cases. Keep in mind that delaying surgery until your hernia is larger and the muscles are weaker may make surgery and recovery more difficult.

4. Your overall health may change. Your age may determine whether waiting is a risk for you. Putting off surgery for years down the road may mean you are not in as good overall health or physical shape. This will also affect your surgery and recovery. So having surgery at a younger age can be beneficial.

However, if you are elderly (older than about 75 years of age), not very active, and your hernia is not causing problems, it may be left as it is. The risks of surgery may outweigh the benefit of repair.

Making the decision

Surgery is never convenient and life is always busy. Being in control of when you have surgery is a huge benefit of not delaying your hernia repair. You can schedule your surgery at your convenience.

If you are a candidate for laparoscopic hernia surgery, you will be back to your life and work quicker. Surgery should be easier on and recovery will likely be smoother at a younger age and with a smaller hernia.

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The write-up is compiled by Prof Dr Anisur Rahman, Consultant General and Laparoscopic Surgery, United Hospital Limited, Dhaka, Bangladesh.

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