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When a hernia occurs a part of the bowel or abdominal fat, normally within the abdomen, protrudes out through a weakened part. An inguinal hernia is the commonest type and occurs in the groin. There is a small gap deep in the wall of muscle in the abdomen, just above the ligament in the groin, through which the veins and arteries course to reach the testicle. If the gap or the tissues around it stretch or weaken then part of the peritoneum (lining of the abdomen) can protrude through. This protrusion can occur, with fat or bowel bulging out, on vigorous activity, coughing or standing.

The bulging hernia area can cause discomfort, with the contents of the hernia sac usually going back into the abdomen on lying down, although sometimes they need to be pushed back gently. Sometimes a small hernia can cause aching without an obvious bulge and the hernia is then only found during examination by a doctor. If a hernia has been present for a long time then it can become very large, and in a man it can even fill the scrotum. When this happens, it may stay out most of the time, and prove very difficult to push back.

Inguinal hernias occur less frequently in females than males but femoral hernias, a different type, occur more frequently in females and can mostly be found on examination by a specialist. Femoral hernias are more likely to need to be repaired.

Hernias are usually troublesome only because they cause a bulge and aching whilst the most serious risk of a hernia is strangulation which means the bowel which becomes completely trapped and its blood supply may become cut off. The produces sudden severe pain and requires an urgent operation when the affected piece of bowel may need to be removed. Strangulation is not very common and many people have hernias for years without them ever becoming strangulated. Obstruction of the bowel can also occur it the bowel becomes trapped and this demands an operation even if the blood supply has not been cut off.

An operation is the only permanent cure for a hernia and can prevent the long term presence or increase in size of the hernia. Hernias can cause discomfort and strangulation can occur but is not common. An operation is not mandatory if the hernia is not causing any trouble and patients should discuss this with their surgeons. A symptomatic hernia can be held in place by a truss which needs to be put on before the patient gets up and makes the hernia bulge. A symptomatic hernia is mostly much better treated by an operation. Having medical problems or being older should not stop hernia repair due to the safe use of local and general anaesthetics.

A groin incision about 12 centimetres in length is used for the repair of a hernia, with an opening of a layer of muscle and then the careful separation of the bulging hernia sac from the veins, arteries and tube to the testicle. The protruding fat or bowel from the abdomen is compressed back in and the sac is then stitched back into the abdominal cavity or tied off at its narrow neck area.

The weakened area is then repaired and strengthened and the hole for the veins and arteries to the testicle is recreated back to its usual size. The hernia will be likely to return if it is not repaired, with surgeons typically using a plastic mesh which they stitch over the herniated area. Stitches can also be used without employing the mesh and this is more likely in femoral hernias. Good long term results have been shown with both techniques and the typical chance of hernia reoccurrence is 2%.

Some surgeons do the operation laparoscopically, under general anaesthetic. The telescope is inserted just below the tummy button and gas is introduced through the telescope to open up the space between the muscles in the lower part of the abdomen and groin. Two tiny 5mm incisions are made in the lower abdomen for further instruments to be inserted which are used to place a sheet of plastic mesh to repair the hernia.