A hernia occurs when an internal organ or fatty tissue pushes through a weak spot in the surrounding muscle or connective tissue wall, most commonly in the abdomen or groin area. This creates a noticeable bulge and can cause discomfort or pain. While not all hernias require immediate intervention, surgery is the only definitive treatment to repair the weakened barrier and prevent serious complications like tissue strangulation.
The Primary Role of the General Surgeon
The general surgeon handles the vast majority of adult hernia repairs. Their extensive training in abdominal procedures makes them the expert for common types, including inguinal (groin), umbilical (belly button), and incisional hernias (occurring at a previous surgical site). Inguinal hernia repair is one of the most frequently performed operations by general surgeons in the United States.
These surgeons employ several techniques to return the protruding tissue to its proper place and reinforce the muscle wall, often using a surgical mesh. The traditional approach is open surgery, which involves a single incision near the hernia site.
Minimally invasive methods, such as laparoscopic and robotic-assisted surgery, use several smaller incisions. Laparoscopic repair utilizes a laparoscope, a thin tube with a camera, to guide the surgeon’s instruments. Robotic-assisted surgery is a refined version of this, offering the surgeon enhanced dexterity and a magnified, three-dimensional view of the surgical field. For most uncomplicated cases, the general surgeon performs the procedure in either an outpatient surgical center or a hospital setting.
Specialized Surgical Requirements
While the general surgeon is the first choice, certain complexities or anatomical locations necessitate a more specialized approach. Recurrent hernias, which reappear after a previous repair, or very large, complex hernias often require a surgeon with advanced training in abdominal wall reconstruction. This training focuses on restoring the function and integrity of the abdominal wall, which may involve techniques beyond standard mesh placement.
Pediatric hernias require the care of a pediatric surgeon who specializes in the surgical needs of younger patients. Hernias in specific anatomical locations may also involve different surgical specialists.
A hiatal hernia, where the upper part of the stomach pushes into the chest through an opening in the diaphragm, may involve a gastrointestinal or thoracic surgeon, depending on the complexity of the repair and the surgical approach. These specialists have focused experience with the unique challenges presented by organs and tissues outside the standard abdominal wall.
Navigating Diagnosis and Referral
The patient’s journey typically begins with a primary care physician (PCP) or family doctor. They are the first point of contact when a patient notices a bulge or experiences symptoms like pain.
The PCP will perform a physical examination and may order diagnostic imaging, such as an ultrasound, CT scan, or MRI, to confirm the presence, size, and location of the hernia. Radiologists specialize in interpreting these imaging tests, confirming the diagnosis.
Once the diagnosis is confirmed, the PCP facilitates the referral to the appropriate surgical specialist, usually a general surgeon. However, if a hernia becomes incarcerated or strangulated—meaning the tissue is trapped and losing blood supply—it becomes a medical emergency.
In such acute situations, the patient presents to an emergency room. The emergency physician stabilizes the patient and immediately consults with an on-call general surgeon for urgent repair.