Managing complex hernias: Advanced surgery for high-risk patients

Hernia repair surgery is the definitive treatment for all hernias. Our specialist gastrointestinal team at St Thomas’ Hospital has extensive experience in treating all types of hernia in patients of all ages. Mr Husam Ebied, consultant general and abdominal wall surgeon at St Thomas’, explains more about treatment and management for complex hernias.

What makes a hernia complex?

Hernias are very common – it’s estimated that around 100,000 people in the UK have hernia repair surgery each year, of which 70,000 are inguinal hernia repairs. While there are several different types of hernia, inguinal hernias are the most common type overall. However, women have a higher proportion of femoral hernias, as well as a higher emergency risk than men. 

“When it comes to categorising hernia surgery as complex, it’s often due to patient-related factors with multiple comorbidities, immunosuppression, transplant status, or a high BMI,” explains Mr Ebied. “The patient then requires multi-team cooperation in order to have the repair operation safely.” 

Alternatively, hernia repair surgery can be deemed complex due to hernia-related factors. This includes the size, and hernias at rare sites such as Spigelian, obturator, lumbar, parastomal, or para-conduit hernias. In some cases, if a hernia has recurred following previous repair surgery, subsequent procedures are also considered complex. 

Cases with both patient-related and hernia-related complexities, which can occur together as well as independently, should be referred to our specialists at St Thomas’ Hospital to receive multidisciplinary support and access to HDU/ICU facilities.

Risk management of hernias 

Watchful waiting is considered safe for many asymptomatic inguinal hernias, particularly in men, as they have a lower emergency risk. However, femoral hernias and all symptomatic hernias should be repaired due to a higher risk of complications as the condition progresses. 

“We advise patients to have more complex hernias fixed because they come with a high risk of strangulation or obstruction,” says Mr Ebied. “Further to this, watchful waiting is not advised for women with groin hernias – instead, we recommend timely repair, preferably with laparoscopic surgery.”

Laparoscopic versus open hernia surgery 

Mr Ebied and our team of specialists offer hernia repair surgery both laparoscopically and with open surgery. Laparoscopic repair is recommended for bilateral and recurrent inguinal hernias, and for women with groin hernias. Unilateral primary inguinal hernias in men can be treated with either open or laparoscopic repair, the method depending on the size and location of the hernia. 

“Additionally, if the patient has had a previous hernia treated via open surgery, the second procedure should be laparoscopic, as it avoids scarred tissue planes and generally improves the outcome,” explains Mr Ebied. “In female patients, laparoscopic surgery is also recommended because it reduces the risk of missed femoral hernias and lowers the chance of chronic postoperative pain.” 

For small umbilical hernias, open mesh or suture repair via a short incision is usually preferred. However, laparoscopic repair can be considered for recurrent umbilical and ventral hernias. Most hernia operations are relatively short procedures, with most patients resuming their normal activities within a few days of their surgery.

Outstanding hernia expertise at St Thomas’ 

Mr Ebied runs a specialised hernia clinic at St Thomas’ Hospital which sees patients across the whole of southeast London, with high volume services extending beyond the catchment area and further across the southeast of England. 

“What sets us apart is that we have all the support from excellent multi-disciplinary teams, and outstanding intensive care on our high dependency and surgical wards,” explains Mr Ebied. “This ensures we’re well-equipped to see complex patients with extensive needs and multiple comorbidities.” Our specialists at St Thomas’ work closely with the hospital’s preoperative assessment teams to aid patients with both preparation and recovery. 

Mr Ebied offers his private patients direct contact with his secretary, should they have any queries, and several follow-up appointments to ensure they receive personalised care throughout their hernia surgery and recovery journey.

When to refer to us 

Patients with all types of hernias, including inguinal, femoral, umbilical, incisional, complex abdominal wall, parastomal and recurrent hernias, can be referred to our team of experts for specialist surgery. Private patients can usually be seen for surgery in the same week as their initial consultation, and we offer short-notice appointments with fast access to treatment. 

Patients who have previously been diagnosed with a hernia can also refer themselves to our team for private surgery, and our specialists will advise on the recommended treatment pathway.