Hernia Clinic

1/F, CUHKMC | CUHK Medical Clinic

Introduction

The CUHK Medical Centre Hernia Clinic is devoted to research, teaching and surgery of hernias (inguinal hernia, femoral hernia, umbilical hernia, ventral hernia, incisional hernia, hiatal hernia, diaphragmatic hernia, parastomal hernia and paediatric hernias). Led by professional practitioners, we aim to provide patients with quality care in hernia surgery. This would be achieved by a patient centered approach with a multi-disciplinary team comprised of surgeons, anaesthesiologist, pain specialists, specialty nurses and radiologist using cutting edge technology including robotic assisted surgery.

Our Services

The CUHK Medical Centre Hernia Clinic provides multi-disciplinary care to patients suffering from hernias or hernia related conditions (adult and children).
The types of hernia that are treated include inguinal hernia, femoral hernia, umbilical hernia, ventral hernia, incisional hernia, hiatal hernia, diaphragmatic hernia, parastomal hernia, paediatric hernias and other rarer hernias.
Dedicated Professorial and Resident surgeons offer both open and laparoscopic surgery to patients suffering from these types of conditions.
The clinic also has a special interest in managing chronic pain after hernia surgery in a dedicated pain clinic.
Professional team of radiologists in imaging the condition are also provided in the clinic.

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Pain Management After Hernia Surgery

Chronic groin pain after hernia surgery is a serious problem. The pain could be due to nerve injury during the operation, nerves being trapped, or reaction to mesh and scar. The pain can severely impair patient’s quality of life and are difficult for management.

The Hernia Clinic at CUHK Medical Centre has a special interest in managing this condition. We have a multi-disciplinary team including surgeons, pain specialist and radiologist dedicated to treating this condition. We support the use of light weight mesh and glue for fixation to reduce the occurrence of chronic pain. To manage the condition, non-operative measures are usually promoted, and in cases that are unresponsive to conservative measures, surgery may be required.

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Frequently Asked Questions

Do all hernias require surgery?

Not all hernias require operation. Small hernias that are not causing symptoms may be safely observed but the hernia will not go away without surgery. Most hernias will increase in size over time and may cause symptoms. Hernias that cause symptoms or affect activity should be repaired.

Are hernias dangerous?

Most hernias are not dangerous, but there is always a risk that abdominal contents may enter the hernia and become stuck. This can lead to pain, nausea, vomiting and constipation with intestinal blockage, and in rare cases, dead organs. While this is uncommon, early repair of at-risk and symptomatic hernias is recommended.

How are hernias repaired?

Hernias are repaired surgically by open or laparoscopic means. A mesh will need to be placed to help repair the hernia. Surgical options, their risks and benefits will be discussed with you at the time of your consultation.

What is the difference between laparoscopic and open hernia repair?

Both surgery will repair the hernia with the use of a mesh. Laparoscopic repair is a minimally invasive technique performed through three small incisions, the largest of which is 1 cm. With the open technique, a skin incision of around 6cm is required. Laparoscopic surgery requires general anaesthesia. Many studies have shown that laparoscopic hernia repair is associated with better outcomes including lower incidence of pain (acute and chronic), foreign body sensation and faster recovery. Recurrences after both kinds of surgery should be similar in experienced hands.

Can all types of hernia be repaired laparoscopically?

With inguinal hernias, if a patient has had a prior lower open abdominal operation (prostate surgery, cesarean section, colon surgery), the scarring may preclude laparoscopic repair. Large inguinal hernias extending to the scrotum may also be difficult to be repaired laparoscopically.

Can hernia be repaired without general anaesthesia?

Yes. Most inguinal, femoral and umbilical hernias can be repaired under local or regional anaesthesia with the open approach. For patients that prefer to avoid general anaesthesia and those that have medical comorbidities that make general anaesthesia higher risk, open surgery is preferred.

What is the typical recovery after inguinal hernia surgery?

Recovery after surgery depends on whether it is being done laparoscopically or open, but both are associated with rapid recovery. The length of stay in hospital and recovery times vary according to the extent of the operation and your general health, but in general, patients will be discharged the next day after operation in laparoscopic repair and are back to normal activity within one week. Those that received open repair may need to stay for 1 or 2 more days. Pain medications will be prescribed to you to help with your recovery. Walking, movement and routine activity are encouraged immediately after surgery. Strenuous exercises should be avoided for four weeks after surgery.

Will I be in pain after the operation?

For inguinal hernias, pain would be minimal after laparoscopic repair. Most patients would be able to walk to the toilet for urination the day after operation. For patients undergoing open repair or complex abdominal operations, pain would be more and these can be controlled with a mix of epidural anaesthesia, narcotics and ant-inflammatory medications.

When will I be able to return to work?

This depends on the patient and factors such as sensitivity to pain as well as the type of work you do. Typically, office workers whose jobs do not require much physical activity can usually return after a week. Those with jobs that involve a lot of physical activity may require two or three weeks before returning to work.

Videos

[Doctors' Insights] - Child Hernia
(Only available in Cantonese)

Dr MOU Wai Cheung

[Doctors' Insights] - Hernia patients sharing I
(Only available in Cantonese)

Professor TEOH Yuen Bun, Anthony

[Doctors' Insights] - Hernia patients sharing II
(Only available in Cantonese)

Professor TEOH Yuen Bun, Anthony

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Health Knowledge

HerniaHernias

What are Hernias

What can cause hernias? Hernias usually occur when there is a cause for increase abdominal pressure. This can happen in patients suffering from certain conditions including benign prostatic hyperplasia, constipation, chronic cough and obesity. Sometimes, they can occur with heavy lifting. Hernias can be present at birth, but the bulging may not be noticeable until later in life. Some patients may have a family history of hernias. How often do they occur? The frequency of patients suffering from hernia depends on the type of hernia. Hernias can occur in adults and children. Please refer the respective sections in other parts of the website for reference. What are the symptoms? The symptoms hernias can cause depends on the type of hernia. The most common abdominal wall hernias usually present as a bulge. There can also be discomfort or pain. The discomfort may be worse when you stand, strain or lift heavy objects. Occasionally, the hernias can present as an emergency condition. Signs and tests A doctor can confirm the presence of a hernia during a physical exam. The bulge can increase in size when coughing or straining. The bulge may not be obvious in children except when they are crying or coughing. Treatment Hernia is usually treated by surgery. The type of surgery will depend on the type of hernia. Small asymptomatic hernias can sometimes be observed. In some patients with multiple medical problems, surgery may not be suggested by your doctor. Please refer to other sections in the website for more information. Emergency surgery is sometimes needed. The organs in the hernia may become stuck and even die because it loses its blood supply. Surgery would be required to remove the dead organs and repair the hernia. Emergency hernia surgery greatly increases the risks of the operation and is usually performed by open surgery.

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Inguinal Hernia

Bilateral inguinal hernia Inguinal hernias are the most common type of abdominal wall hernia. It accounts for 75% of abdominal wall hernias and the chances of having a hernia is 27% in men and 3% in women. Surgery for inguinal hernia is one of the most common operations in Hong Kong. Inguinal hernias occur more frequently in men and may be confined to one side or be present on both (bilateral). Patients with bilateral hernias may have them appear together or there may be a gap of several years before the second one becomes apparent. Inguinal hernias usually present as a bulge in the groin. The bulge usually disappears when the patient lies flat and reappears after coughing or straining. Hernias usually occur when there is a cause of increase abdominal pressure. This can happen in patients suffering from certain conditions including benign prostatic hyperplasia, constipation, chronic cough and obesity. Sometimes, they can occur with heavy lifting. Diagnosis of the condition is usually made on examination by your doctor. Occasionally, radiological investigations may be required to help make the diagnosis Treatment While small, asymptomatic inguinal hernias can be safely observed. The natural progression however, typically involves enlargement of the hernia and development of symptoms over time. There are a number of possible ways to repair an inguinal hernia. This can be done by open and laparoscopic procedures. Studies have shown that laparoscopic repair is associated with better outcomes including lower risk of early and persistent pain after surgery, analgesic requirements and presence of foreign body sensation. Furthermore, it is the preferred approach in recurrent and bilateral hernias. However, laparoscopic repair needs to be done under general anaesthesia, so in patients that are at high risk for general anaesthesia, open repair may be preferred. The risk of recurrence in experienced hands is similar in both laparoscopic and open repair. Laparoscopic inguinal hernia repair Laparoscopic repair of an inguinal hernia is performed through three small incisions measuring 5mm to 1 cm in size. The operation involves locating the hernia and placing a mesh that helps to repair the defect that is causing the hernia. In the open hernia repair, an incision approximately 6cm long is made in the groin. The hernia is identified and its contents are pushed back into the abdomen. A mesh is also placed to repair the defect that is causing the hernia. The operation can be performed under general or local anaesthesia. Both operations are offered at the CUHK Medical Centre Hernia Clinic. You can discuss with your doctor on which surgery is better suited for you.

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Femoral Hernia

Femoral hernias are less common and occur more frequently in women. It can be difficult to tell between an inguinal and femoral hernia. They are usually smaller and extend toward the upper thigh. Because the defect through which the hernia has to pass is tight, there is a higher chance of organs being stuck. Therefore, early surgery is suggested. Treatment Like inguinal hernias, femoral hernias can be treated by laparoscopic or open hernia repair. For laparoscopic repair, it is performed through three small incisions measuring 5mm to 1 cm in size. The operation involves locating the hernia and placing a mesh that helps to repair the defect that is causing the hernia. The operation has to be performed under general anaesthesia. In open repair, an incision approximately 2 to 3 cm long is made in the groin. The hernia is identified and its contents are pushed back into the abdomen. A mesh is also placed to repair the defect that is causing the hernia. The operation can be performed under general or local anaesthesia.

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