Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
Being told that your hernia will be repaired, but not yet, is easily heard as a refusal. It is usually the opposite.
A hernia repair is a piece of engineering installed into living tissue. Three or four measurable things decide how well that tissue will hold it. Where those things can be improved in a few weeks, improving them first is not caution. It is the part of the operation that happens before the operation.
None of this applies to an obstructed or strangulated hernia. That is operated now, in whatever condition the patient is in.
This is the strongest single factor you can change. Smoking narrows the small vessels that heal a wound. It impairs collagen. It raises the rate of wound infection. And it adds a cough that loads the repair hundreds of times a day.
Stopping four to six weeks before surgery measurably reduces wound complications. Stopping at all is worth doing. Stopping early is worth more.
Poorly controlled diabetes raises infection at the surgical site and slows healing. In a mesh repair an infection is a serious event.
HbA1c shows the last three months, and is the figure usually used. Where it is well above target, a few weeks of proper control changes the risk before it changes the number.
Extra weight raises the pressure inside the abdomen, and that pressure is the load the repair has to resist. It also makes the operation harder, because the wall is thicker.
For large ventral and incisional hernias, recurrence after repair is a good deal higher at high BMI. That is why weight loss is sometimes asked for before a big reconstruction. It is asked for on outcome grounds, not on principle.
A chronic cough is repeated maximal loading of a fresh repair. Sorting out inhalers, treating an infection and waiting out an acute chest episode are all worth the delay.
Easily fixed, and easily overlooked. Straining at stool generates high pressure inside the abdomen. Sort it before surgery, and keep it sorted afterwards.
Where straining is recent and unexplained, and above all over the age of 50, the cause deserves looking into in its own right.
Long term steroids slow healing. Blood thinners need a plan agreed with whoever prescribed them, and are never stopped on your own. Some diabetes medicines are held around surgery.
Bring the actual boxes to the clinic, not a remembered list.
A realistic pre-operative checklist
Ask for the target to be written down. An open ended delay with no endpoint is how patients drift out of follow-up, and come back years later with a larger hernia and the same problems.
What to fix before the date, and how long it takes
| What is being fixed | Roughly how long | Why it matters to the repair |
|---|---|---|
| Smoking | Four to six weeks | Small vessels heal the wound. Smoking narrows them, and the cough loads the repair all day. |
| Blood sugar | Six to twelve weeks to move a HbA1c | Poor control raises infection risk, and an infection around mesh is a serious event. |
| Constipation | Days to a couple of weeks | Straining at stool drives up abdominal pressure. That is the load the repair has to hold. |
| Cough or chest infection | Two to six weeks | A cough is repeated maximal loading of a fresh repair. |
| Weight, for a large repair | Months, with a written target | Recurrence after a big wall reconstruction is higher at high BMI. |
| Blood thinners and steroids | Planned with the prescriber | Steroids slow healing. Blood thinners are never stopped on your own. |
If your surgery has been deferred, ask for the target and the review date in writing.
A hernia awaiting repair should be known to you. If it becomes suddenly painful, will not go back in, changes colour, or comes with vomiting or no passage of wind, that is an emergency. The waiting is over. There is a separate page on those warning signs.
A truss or support belt may make a hernia more comfortable. It does not treat it. It does not stop it enlarging. It does not prevent obstruction.
Usually to improve something that affects how well the repair will hold or heal. Smoking, blood sugar, weight, a chronic cough, or a medicine that slows healing. It does not apply to an obstructed or strangulated hernia, which is operated at once.
Four to six weeks before gives a measurable reduction in wound complications. Stopping later still helps. Stopping for good also lowers the chance of the hernia coming back.
There is no single universal threshold, and the decision weighs the hernia against the diabetes. What matters is that poor control raises infection risk in a mesh repair. So it is measured and acted on, rather than ignored.
For small hernias, usually not. For large ventral and incisional hernias, recurrence is a good deal higher at high BMI, so weight loss is often asked for first. Ask for a specific target and a review date.
It may make the hernia more comfortable. It does not repair it, stop it enlarging, or prevent obstruction. It is not a substitute for surgery in someone fit for it.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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