A hernia occurs when an internal organ or tissue pushes through a weak spot in the muscle or connective tissue that normally contains it. This typically presents as a noticeable bulge or lump, and while it may start small, it will not heal on its own in adults. Because a hernia can lead to serious complications like tissue strangulation, medical intervention is almost always necessary to fix the problem permanently. The path to repair starts with a routine medical visit, but the definitive treatment is performed by a surgical specialist.
Initial Diagnosis and Referral
The first medical professional a patient sees for a suspected hernia is usually their Primary Care Provider (PCP), such as a family physician or internist. The PCP’s initial role involves a physical examination, which often confirms the presence of an abdominal wall hernia, especially in the groin area where a cough or strain can make the bulge more prominent. The physician may also order diagnostic imaging, like an ultrasound or a CT scan, to confirm the location, size, and contents of the protruding sac.
Based on the physical exam and imaging results, the PCP determines the urgency of the situation and coordinates the patient’s care. If the hernia is painful, rapidly growing, or shows signs of incarceration—where the tissue is trapped and cannot be pushed back—a prompt referral to a surgical specialist is made. This initial assessment is crucial for ensuring timely treatment and preventing potentially life-threatening complications.
The General Surgeon
The medical professional who fixes the vast majority of common hernias is the General Surgeon. These specialists are the primary choice for repairing inguinal (groin), umbilical, incisional, and femoral hernias. General Surgeons are proficient in a range of techniques, which they select based on the hernia type, size, and the patient’s overall health.
One common approach is open repair, where a single incision is made directly over the hernia site. In most cases, the weakened area is reinforced with a synthetic surgical mesh, which acts as a scaffold to support the newly repaired muscle wall, reducing the likelihood of recurrence.
Alternatively, many General Surgeons utilize minimally invasive methods, such as laparoscopic or robotic surgery. These procedures involve making several small incisions to fix the defect from the inside of the abdominal wall, often leading to less postoperative pain and a faster recovery time. The choice of technique and the use of mesh is tailored by the General Surgeon to each patient’s anatomical needs.
Specialized Surgical Requirements
While General Surgeons manage most routine cases, hernias that are unusually complex, recurrent, or located in specific areas may require the expertise of sub-specialists. Pediatric Surgeons, for instance, are the correct choice for hernias in infants and children, as they have specialized knowledge of pediatric anatomy and growth considerations.
For very large incisional hernias or those that have failed previous repairs, a Complex Abdominal Wall Surgeon is often necessary. These specialists perform advanced abdominal wall reconstruction, sometimes mobilizing abdominal muscles or using biologic mesh to restore the core’s strength. Hiatal hernias, which involve the stomach pushing through the diaphragm into the chest cavity, are typically managed by specialized Gastrointestinal or Cardiothoracic Surgeons.
Management Options Before Surgery
For certain patients, particularly those with small, asymptomatic hernias or those with other medical conditions that increase surgical risk, a non-operative approach may be considered first. This strategy is referred to as “watchful waiting” or active surveillance, where the hernia is closely monitored without immediate surgical intervention. This approach is primarily used for minimally symptomatic inguinal hernias in men.
The patient and physician may also discuss supportive devices, such as a hernia truss or abdominal binder. These external devices apply pressure over the bulge to help keep the protruding tissue in place and can sometimes alleviate discomfort. However, it is important to understand that a truss is a temporary measure for symptom management only and does not fix the underlying anatomical defect.