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
Most hernia pages describe one operation. This page is about the step before that. Which operation, or whether an operation is needed yet at all.
Patients often arrive having been told they need surgery, without being told why this repair and not another. That is the question worth answering first. Four routes exist: watching, open repair, keyhole repair and robotic repair. They suit different hernias and different people.
There is no single right operation for hernias as a group. There is usually a clearly better one for a particular hernia in a particular abdomen.
Not every hernia needs repairing the week it is found. Take a small groin hernia that goes back easily and causes no symptoms, in an older patient with serious heart or lung disease. The risk of the anaesthetic can be higher than the risk of the hernia. The same applies to a small umbilical hernia in someone about to start other treatment.
Watching is a plan, not neglect. It comes with conditions. You need to know the warning signs, and the hernia needs reviewing rather than forgetting.
Watching stops at once if the lump turns firm and will not go back, the pain changes or becomes constant, the skin over it changes colour, or vomiting starts. A hernia that will not go back and hurts is an emergency. Present the same day.
Watching is also the wrong plan in several settings. Where the hernia already causes symptoms. Where it is getting bigger. Where the neck of the defect is narrow. In most femoral hernias. And in any hernia that has obstructed once already.
Site does much of the deciding. Groin hernias are well served by all three routes. Hernias at the edge of an old incision, at a stoma, or high up near the diaphragm each favour a particular approach, because of what lies around them. A hiatal hernia is a different operation altogether, even though both carry the word hernia.
Small defects are patched. Large ones have to be closed. Closing a wide defect without tension is the technical problem that shapes the whole operation. Sometimes the layers of the abdominal wall have to be released to make it possible. That is planned before the day, from the scan. It is not discovered on the table.
A recurrence changes the plan. Scar tissue and old mesh make the first plane hostile. The repair is usually taken through a different plane from the first operation. Someone who had an open repair may be better served by a keyhole or robotic route. The reverse is also true.
Previous abdominal operations, weight, smoking, uncontrolled diabetes, a chronic cough, constipation and heavy lifting at work all bear on the choice and on the timing.
Some of them are worth correcting before the repair rather than after. A hernia repaired around an untreated cough is being repaired against a force that has not gone away.
An obstructed or strangulated hernia is operated on the basis of what is safest that hour. Planned decision making does not apply.
Open repair places mesh through one cut over the hernia. It is still the right choice for many small hernias. It can be done under a spinal or a local block, so it suits a patient who should avoid a general anaesthetic. The trade is a larger wound at the site, and more discomfort in the first week for bigger repairs.
Keyhole repair works through small ports with a camera. Less wound pain, and an earlier return to work for larger and two-sided repairs. Fine suturing deep in a tight plane is harder with rigid instruments. That is what limits it in complex reconstructions.
Robotic repair is keyhole surgery with wristed instruments and steady three-dimensional vision. Its advantage is in suturing: closing a defect, or placing mesh where a rigid instrument cannot reach a good angle. So it is most useful in large ventral, incisional, recurrent and hiatal repairs. It is least different from keyhole in a small groin hernia, where the keyhole route already does the job. It also carries an extra consumable cost.
There is no fixed ranking between the three. The question is always which route fits this hernia.
Where the hernia sits, and the route that usually suits it
| Hernia | Route that usually suits it | Why |
|---|---|---|
| Groin, first time, one side | Open, keyhole or robotic | All three work well here. Fitness and the anaesthetic decide. |
| Both groins | Keyhole or robotic | One anaesthetic reaches both sides through the same ports. |
| Small umbilical | Open | A short cut over the defect is enough. |
| Large ventral or incisional | Robotic or open | The muscle layer has to be closed, sometimes after a release. |
| At an old scar or a stoma | Robotic or open | The plane around it is scarred, so the approach is chosen from the scan. |
| Hiatal | Keyhole or robotic | Deep suturing near the diaphragm. Wristed instruments help there. |
| Recurrent after a front repair | Keyhole or robotic | The work goes through a plane the first operation did not use. |
Consultations are at the Gota OPD, Ahmedabad.
A repair closes a defect and reinforces the wall. It does not remove the reason the wall gave way.
Where a hernia formed against a steady load, that load is dealt with alongside the repair, not instead of it. A chronic cough. Straining. Heavy manual work. Significant weight.
This is the part of the discussion most often skipped. It matters more to the long term result than the choice between two techniques.
Bring any scans, previous operation notes and a list of your medicines to the OPD. The examination and the imaging together decide the route. You should leave the consultation knowing which repair is proposed, and why that one.
Individual repairs are described on the services pages. If you are travelling from outside Gujarat, the planning from another city page may be more useful first.
A hernia is a defect in a muscle layer. No medicine or exercise closes it. A truss or belt can make a hernia more comfortable, and is sometimes used where surgery is genuinely unsuitable. It supports rather than repairs. Surgery is the only repair.
A hernia that does not hurt and goes back easily is usually not urgent. The risk that matters is obstruction, when bowel enters the defect and cannot come back. Narrow necked hernias and femoral hernias carry more of that risk than a wide necked one. That is why the site and the width of the neck are assessed, not just the symptoms.
It depends on the repair and on the work. Desk work after a small groin repair is usually days. Heavy manual work after a large abdominal wall reconstruction is measured in weeks, and is set for each patient rather than by a standard number.
Not always. Many groin and small umbilical hernias are diagnosed by examination. Imaging is used where the diagnosis is uncertain, where the hernia is large, recurrent or incisional, and where the size of the defect will decide the operation.
All three routes are available in Ahmedabad, robotic included. The decision is made on the same clinical grounds anywhere. The site, the size, the history and your fitness. Not geography.
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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