Hernias occur when tissue pushes through a weak spot in the muscle wall, most commonly in the abdomen or groin. Since hernias do not heal on their own and can lead to serious complications, surgery is often required for repair. Understanding which medical professionals are trained to perform these repairs is an important first step for patients seeking treatment. Hernia repair primarily involves general surgeons for routine cases and several specialists for more complex patient needs.
The Central Role of the General Surgeon
General surgeons are the primary specialists performing the vast majority of all hernia repairs. Their extensive training, which typically includes a five-year surgical residency, provides them with comprehensive expertise in a wide range of abdominal procedures. Hernias like inguinal (groin), femoral, umbilical (navel), and incisional (at a previous surgical site) fall squarely within their scope of practice.
These surgeons are proficient in various surgical approaches, including traditional open repair, which uses a single, larger incision. They also routinely perform minimally invasive techniques such as laparoscopic and robotic-assisted surgery. The choice between open and minimally invasive repair depends on factors like the hernia’s size, location, and the patient’s overall health, but the general surgeon is qualified to execute either technique.
The goal of the repair is to push the protruding tissue back into place and then reinforce the weakened abdominal wall, often using a synthetic mesh to prevent recurrence. The Lichtenstein tension-free mesh repair is a standard technique for inguinal hernias that general surgeons commonly employ. Their high volume of experience with standard hernia types results in excellent outcomes for most adult patients.
Specialized Surgeons and Unique Patient Needs
While general surgeons handle most cases, certain patient populations or complex hernias require the specialized knowledge of other doctors. Pediatric surgeons focus exclusively on the surgical needs of infants, children, and adolescents, often treating congenital hernias that present differently than those in adults. In children, inguinal hernia repair typically involves closing a natural tunnel that failed to seal after birth, often without the need for mesh used in adult repairs.
For adults with particularly challenging cases, such as those with massive, recurrent, or previously failed repairs, a subspecialist in abdominal wall reconstruction (AWR) may be needed. These AWR specialists are general surgeons who have completed advanced fellowship training focused entirely on complex hernias. They utilize sophisticated techniques like “component separation,” which involves strategically cutting and repositioning muscle layers to close large defects without undue tension.
Other specialists may be involved depending on the hernia’s location, such as a thoracic surgeon for diaphragmatic hernias or a bariatric surgeon for patients whose obesity complicates the hernia. The multidisciplinary approach for complex hernias can also involve plastic surgeons, who assist with tissue reconstruction, and gastrointestinal surgeons for cases involving associated digestive tract issues.
Navigating the Diagnosis and Referral Process
The patient journey toward surgical repair typically begins with a non-surgical healthcare professional, usually a primary care physician (PCP) or an emergency room doctor. The PCP performs a physical examination to confirm the presence of a hernia, which is sufficient for diagnosis in many cases. Imaging tests like ultrasound may be used if the diagnosis is uncertain or if the patient is female.
Once a hernia is diagnosed, the PCP initiates a referral to a surgical specialist for definitive evaluation and treatment planning. Timely referral is important if the hernia is symptomatic, painful, or cannot be pushed back in, as these signs suggest a risk of incarceration or strangulation. During the surgical consultation, the specialist will determine the appropriate course of action, which may range from watchful waiting for asymptomatic hernias to urgent surgical intervention for complicated ones.
During the surgical consultation, the patient and surgeon discuss the specific procedure, including whether an open, laparoscopic, or robotic approach is best suited for their condition. The specialist coordinates any necessary pre-operative preparations, ensuring the patient is medically optimized before scheduling the repair. This initial diagnostic and referral phase connects the patient to the appropriate surgical care.