Hernia Program
About the program
Hernias are common and occur in 15 out of every 1,000 people in the United States. Each year, approximately 700,000 hernia repairs are carried out in the U.S.
At the Mass General Brigham Hernia Program, our expert surgeons have performed thousands of successful simple and complex hernia procedures. We use a wide range of cutting-edge tools and techniques to ensure the best possible outcome for every patient.
Our care is centered around the patient and available at several convenient locations throughout the Greater Boston area, allowing for the best care close to home.
Multidisciplinary hernia care
We recognize that patients with hernias may require an array of individualized interventions, beyond the hernia repair itself. Such needs include, but are not limited to:
- Weight loss surgery
- Nutritional interventions
- Physiotherapy
- Plastic surgery
- Psychological support
- Rehabilitation medicine
- Wound care
Our hernia team will collaborate with specialists across Mass General Brigham to ensure your treatment plan is tailored to your needs.
About hernias
A hernia is a weakness or a hole in the muscles of the abdominal wall that allows for fat or abdominal contents to push through the irregular opening. They usually occur due to an inherent weakness in the abdominal wall, injury, or from abrupt, excessive or repetitive strain, such as heavy lifting or weight gain.
Mass General Brigham researchers have studied why some people develop a hernia and others do not. Genetic factors—mostly related to collagen, one of the structural proteins of our muscles—and acquired factors—such as infection or obesity—play a role.
While some hernias do not cause symptoms, others cause pain, discomfort and limitations in daily activities. Beyond affecting quality of life, hernias may become dangerous. When a piece of intestine is strangulated inside a tight hernia, this piece may be cut off from an adequate blood supply and eventually die.
Types of hernias
About groin hernias
Typically referred to as inguinal or femoral hernias, they appear as a bulge in the groin area. More common in men than in women, groin hernias can become quite large, descend towards the testicles and distend the testicular sac (scrotum).
Sometimes these hernias can be resolved without an operation; however, surgery is often recommended. Most groin hernias are repaired by using a durable, tension-free mesh insert. However, non-mesh repairs are also an option and can be done under local or general anesthesia, depending on the patient's condition and preference. Open, laparoscopic (minimally invasive) and robotic (minimally invasive) surgical techniques are implemented according to the specific circumstances of each patient.
Treating and preventing groin hernia surgery complications
We often treat patients who had recurrence or infection after a previous hernia repair. We also treat patients with persistent pain following a hernia operation performed elsewhere. Such pain is suspected to be related to the small nerves in the groin being injured by either sutures, mesh or scar tissue. Our expert surgeons are particularly alert to this potential complication and perform techniques to nearly eliminate the risk of persistent pain after a hernia operation.
Such interventions are performed via open or laparoscopic techniques and include multidisciplinary approaches in collaboration with pain specialists, nerve specialists and physiotherapists.
About ventral hernias
Ventral hernias occur at any location on your abdominal wall. They include:
- Umbilical hernias, which are bulges located at the belly button (umbilicus) area. They are typically the result of a natural defect that has existed there since birth. On occasion, this defect becomes bigger, allowing for internal organs or fat to protrude through it
- Epigastric hernias, which are bulges located at the midline between the umbilicus and the lower end of the breastbone (sternum)
- Incisional hernias, which are bulges that occur in areas of previous operations where there are sutured muscles. Depending on a variety of factors, this natural area of weakness can be further weakened or torn, resulting in a bulge. Although incisional hernias are typically associated with larger incisions from open surgery, they can also form on the sites of incisions after laparoscopic surgery
- Flank hernias, which are bulges that happen at the flanks and are most commonly related to either an injury (traumatic hernia) or a previous operation (incisional hernia)
- Spigelian hernias, which are bulges that appear to the left or right side of the abdomen, at the level of the umbilicus or slightly below it. This area represents a point of natural weakness of the abdominal wall
Repairs for ventral hernias
Repairs for ventral hernias can be performed by open, laparoscopic or robotic techniques. The majority require general anesthesia, often combined with epidural anesthesia, which is the same anesthesia offered to women during labor, or muscle block anesthesia, which is a special anesthesia that blocks pain related to the sutured muscles.
Ventral hernia repair falls into three main categories:
- Primary repair, in which the edges of healthy muscle around the hernia are sewn together, is a simple procedure and does not involve the use of mesh. It is typically offered for small defects with low likelihood of hernia recurrence, since primary repairs are usually not as durable as mesh repairs
- Mesh repair, in which a patch of material is used to add strength to the abdominal wall. Meshes can be made of materials that are permanent and synthetic (e.g., polypropylene or polyester), temporary and resorbable, biological (e.g., cadaveric or animal tissue) or a combination of different materials. The type of mesh used for your repair will be determined by your care team. Meshes can be placed under, over or in between muscle layers
- Component separation and repair, in which the different components of the healthy muscles surrounding the hernia are separated before repair. This allows flexibility and easier reapproximation of the muscles. It is typically combined with mesh placement. This is a complex procedure and typically reserved for larger, recurrent and/or high-risk hernias
About traumatic hernias
A traumatic injury, such as a motor vehicle crash, a fall from a height or interpersonal violence, can cause a tear through the abdominal muscles that allows internal organs to herniate. Oftentimes, traumatic hernias happen in areas where muscle attaches to bone, such as the hips and pelvis.
About rectus muscle diastasis
Normally, the muscles of the left and the right side of the abdomen meet in the middle. As a result of age, weight gain/loss, pregnancy, etc., this middle area can stretch and bulge, giving the impression of a hernia, even if there is no true hole in the muscle. It is called rectus muscle diastasis and should be brought to the attention of your doctor.
About internal hernias
Internal hernias occur when the intestines slide inside the abdomen through natural gaps that have existed since birth or result from operations (e.g. weight loss surgery). They often require an urgent operation to both reduce the hernia and address any intestinal problems.
About hiatal hernias
Hiatal hernias form internally when the upper part of your stomach bulges through the diaphragm. They are not associated with any external bulge but may cause many other symptoms.
About sports hernias
Repetitive sports activities that target the abdomen and pelvis, such as sit-ups and squats, can sometimes result in groin pain, either indicating muscle strain and small tears or a true gap in the muscles (hernia). Discuss any sports-related groin pain with your doctor so they can determine if the pain is caused by a hernia and come up with a plan for alleviating acute or chronic pain.
Hernias can form in any part of the abdominal wall. Additional, less common types include:
Obturator, a hernia that is located deep in the pelvis
Perineal, a rare hernia located in the region under the genitals (perineum)
Lumbar, a hernia of the back
Richter, a hernia in which only a small part of the intestine is herniated
Hernia procedures
Your care team will discuss surgical options with you and make a recommendation based on your history, condition and needs. The Mass General Brigham Hernia Program offers all these options as well as a strong commitment to your overall well-being and a timely recovery.
Recovery from hernia repair
Most hernias are repaired on an outpatient basis, without hospitalization required and with minimal down time. However, certain types of large hernias are complicated and require hospitalization in order to ensure the best possible recovery. Depending on the type and size of your hernia and your general condition, the care team may recommend a hospital stay following your surgery.
If the operation does not require a hospital stay (outpatient), you will likely spend the full day at Mass General Brigham—arriving a few hours before your operation and leaving at the conclusion of a short recovery period of a few hours. If the operation does require a hospital stay (inpatient), you should still arrive to the hospital a few hours before your operation and expect to spend a few days in the hospital after the operation. The exact number of days for your hospital stay will be communicated to you in advance by your care team.
Frequently asked questions
Most hernias can be diagnosed with just a physical exam. However, a CT scan or an MRI may be useful to detect the:
- Exact size of the hernia
- Presence of other smaller hernias
- Anatomy of the muscles around the hernia
- Relationship of the hernia with other organs
A hernia is not life-threatening unless it becomes strangulated. In a strangulated hernia, a piece of intestine is trapped within the hernia and becomes strangled. If left untreated, it can cause a hole in the intestine or a dead piece of intestine, which in turn may cause sepsis and shock.
Some hernias are more prone to strangulation than others, and your hernia surgeon can discuss the risks of your specific case with you. Hernia strangulation typically causes obvious symptoms, such as excruciating pain, nausea and vomiting. If you are experiencing these symptoms and they last for over two hours, you should immediately seek care from your doctor or go to an emergency room.
Recovery from minimally invasive surgery (laparoscopic or robotic) and open inguinal hernia surgery typically involves mild-to-moderate pain or discomfort for 2-14 days. We often prescribe patients over-the-counter pain medication and avoid opioid medications as much as possible, although some opioid pills may be needed.
Typically, patients can walk and use the stairs immediately following surgery. Patients will need to avoid heavy lifting, strenuous exercise and core-centric exercise for a few weeks following surgery.
For patients with larger abdominal hernias undergoing major reconstructive hernia surgery, recovery is typically longer and may require an inpatient hospital stay.
Related conditions and treatments
Contact the Hernia Program
Brigham and Women's Hospital
617-732-6802
Massachusetts General Hospital
617-724-0349