Skin and subcutaneous tissue
The outer cover and cushioning layer. The fatty Camper’s layer sits superficially; the thinner, deeper Scarpa’s fascia lies beneath it.
The hernia guide
Understand the bulge.
Know your options.
Definition
A hernia occurs when tissue or part of an organ pushes through a weak point or opening in the muscle and connective tissue that normally contains it.
The location, contents, size and symptoms help determine its name and the appropriate treatment.Start with the anatomy
The abdominal wall is a layered support system.
Think of it as a flexible, living wall rather than one sheet of muscle. A hernia forms when the strong muscle-and-fascia layer has a natural opening or develops a defect.
Muscles and their strong coverings
External oblique, internal oblique and transversus abdominis wrap the sides. At the front, their broad tendons form the rectus sheath around rectus abdominis and meet at the linea alba.
Deep lining
Transversalis fascia, a variable layer of preperitoneal fat and the thin parietal peritoneum separate the abdominal wall from the abdominal cavity.
The key idea
The skin may look intact while fat, bowel or another structure pushes through a deeper defect. This is why the visible bulge does not always reveal the hernia’s true size.
Locations of hernia
The name usually tells you where it occurs.
“Hernia” is not one diagnosis. Groin, abdominal wall, scar-related and diaphragmatic hernias differ in anatomy, risk and treatment.
Groin
Inguinal hernia
Tissue pushes through a weak area in the lower abdominal wall near the inguinal canal. It may be indirect (following the canal) or direct (through a weakened posterior wall).
Upper inner thigh
Femoral hernia
A less common groin hernia that passes through the femoral canal, below the inguinal ligament. Because the space is narrow, early surgical assessment is important.
At or near the navel
Umbilical or paraumbilical hernia
Fat or bowel protrudes through a weakness around the umbilicus. It can occur in children or adults, with adult treatment considered according to symptoms and size.
Upper midline
Epigastric hernia
Usually fatty tissue protrudes through the abdominal wall between the navel and breastbone. There may be one small defect or several.
Previous operation scar
Incisional hernia
A weakness develops at or near a previous abdominal incision. The defect can vary from small and localised to a more complex abdominal wall problem.
Front abdominal wall
Ventral hernia
An umbrella term for hernias through the front of the abdominal wall, including umbilical, epigastric and many incisional hernias.
Beside a stoma
Parastomal hernia
Abdominal contents bulge through the opening created for a colostomy or ileostomy. Repair is individualised to symptoms, stoma function and abdominal wall anatomy.
Diaphragm
Hiatal hernia
Part of the stomach moves through the diaphragm into the chest. It is internal, often presents differently from an abdominal wall hernia, and requires a separate assessment pathway.
Side of the abdominal wall
Spigelian hernia
A less common hernia through the Spigelian fascia near the outer border of the rectus muscle. It may sit between muscle layers and can be less obvious on the surface.
WARNING SIGNS
When not to wait
A hernia can become urgent.
Seek urgent emergency assessment for a hernia with any of the following:
- Sudden or severe pain
- A tense, tender bulge that no longer goes back in
- Vomiting, abdominal swelling or inability to pass stool or gas
- Red, purple or dark skin over the swelling
- Fever or rapidly worsening symptoms
Repair options
Open, laparoscopic or robotic?
All three approaches aim to return the hernia contents, close or cover the defect and reinforce the abdominal wall when needed. The route to that goal differs.
ApproachHow it is performedTechniques you may hearWhere it may fit
Open repair
A single incision gives direct access to the hernia. The defect is repaired with sutures, mesh or both.
Lichtenstein, open preperitoneal repair, tissue repair, retrorectus repair, component separation.
Localised groin hernias, very large or complex defects, selected patients, or cases where direct access is advantageous.
Laparoscopic repair
A camera and long instruments are introduced through several small ports while the surgeon works from a video display.
TEP and TAPP for groin hernia; IPOM, eTEP or minimally invasive retromuscular repair for selected ventral hernias.
Often considered for bilateral or recurrent groin hernias and selected ventral or incisional hernias.
Robotic repair
The surgeon controls a robotic system from a console, using a magnified 3D view and wristed instruments through small ports.
Robotic TAPP, robotic eTEP, preperitoneal or retrorectus repair, and selected robotic TAR.
May help with precise suturing and complex reconstruction in selected groin and abdominal wall hernias. The robot does not operate autonomously.
Totally extraperitoneal
Groin hernia repair performed in the space outside the abdominal cavity, without entering the peritoneal cavity.
Transabdominal preperitoneal
The abdomen is entered, the groin repair is completed in the preperitoneal plane, and the peritoneum is closed over the repair.
Extended-view totally extraperitoneal
A minimally invasive approach that creates a wider working space outside the abdominal cavity for selected abdominal wall repairs.
Transversus abdominis release
An advanced abdominal wall reconstruction that creates space for a broad retromuscular repair in selected complex ventral hernias.
Where the mesh can sit
The route and the mesh plane are separate decisions.
Open, laparoscopic and robotic describe how the surgeon reaches the hernia. The mesh plane describes the anatomical layer in which reinforcement is placed.
Most often an open repair plane.
Onlay
On the front of the strong fascial layer, beneath the subcutaneous tissue.
Direct to access, but closer to the skin and wound.Open Rives–Stoppa, eTEP and selected robotic or laparoscopic reconstructions.
Retrorectus / retromuscular
Behind rectus muscle and in front of the posterior sheath or deeper lining.
A well-protected, extra-abdominal plane used for many ventral and incisional repairs.Open preperitoneal repair, TEP, TAPP and robotic TAPP.
Preperitoneal
Outside the abdominal cavity, immediately in front of the peritoneum.
A common groin-hernia plane; the peritoneum is restored over the mesh in TAPP.IPOM through laparoscopic, robotic or selected open routes.
Intraperitoneal
Inside the abdominal cavity, deep to the peritoneum and near the abdominal organs.
Requires a mesh approved for visceral-facing use and careful counselling about long-term considerations.Inlay or bridging is different
A mesh can span an unclosed gap—but that is not a tissue plane.
Here the mesh is attached to the edges of the defect rather than reinforcing a closed abdominal wall. For midline incisional hernias, contemporary guidance recommends closing the fascial defect when feasible and avoiding a bridged repair.
Typical route-to-plane examples
How the approach is chosen
The decision considers the hernia location and size, whether it is primary or recurrent, one-sided or bilateral, previous operations, tissue quality, overall health, expected complexity and the surgeon’s expertise. A smaller incision is not, by itself, proof of a better operation.
Mesh options
“Mesh” is a family of implants—not one material.
Selection considers the hernia, tissue plane, contamination risk, required duration of support, handling characteristics and the evidence for that specific repair. Brand choice comes after those clinical decisions.
Designed to remain
Permanent synthetic
Common materials include polypropylene, polyester, ePTFE and PVDF.Provides lasting reinforcement. Products differ greatly in pore size, weight, flexibility, filament structure and how strongly tissue grows through them.
Permanent + absorbable
Partially absorbable synthetic
Usually combines a permanent framework with fibres that dissolve over time.Leaves less permanent material after the absorbable component disappears. That does not automatically make it the right mesh for every defect or repair route.
Temporary scaffold
Fully absorbable synthetic
Resorbable polymers—sometimes called biosynthetic meshes—lose strength over a product-specific period.Intended to support tissue while healing and remodelling occur. It does not provide permanent reinforcement after it has been absorbed.
Processed tissue matrix
Biologic
Collagen-rich material derived from human, porcine or bovine tissue.Designed to remodel or be absorbed to varying degrees. It is reserved for selected situations; biologic does not mean complication-free or infection-proof.
Two functional surfaces
Composite or barrier mesh
Often combines a tissue-integration surface with a temporary or permanent visceral barrier.May be selected when a mesh will face abdominal organs. The barrier is designed to reduce tissue attachment, but it cannot remove every risk of adhesion or later complication.
How two meshes can differ
Material is only one part of a mesh’s nature.
- Pore structure
- Large or small pores influence tissue ingrowth, flexibility and the amount of material in contact with tissue.
- Filament
- Monofilament uses single fibres; multifilament uses braided or bundled fibres. Construction affects handling and biological behaviour.
- Weight & stiffness
- Lightweight meshes contain less material and may be more flexible; heavier constructions may be deliberately chosen for some defects.
- Surface
- Uncoated, self-fixating or barrier-coated surfaces are designed for different planes and fixation strategies.
No mesh is simply “best”.
Not every mesh is suitable for every anatomical plane. Expected benefits must be weighed against device- and procedure-related risks such as infection, seroma, chronic pain, adhesion, contraction, migration, obstruction or recurrence. The exact implant and its alternatives should be discussed during consent.
Terminology, translated
Words you may hear in consultation.
- Reducible
- The bulge moves back in when lying down or with gentle pressure.
- Incarcerated
- The hernia contents are trapped and cannot be returned to the abdomen.
- Obstructed
- Bowel within the hernia is blocked, potentially causing pain, swelling or vomiting.
- Strangulated
- The blood supply to trapped tissue is compromised. This is a surgical emergency.
- Recurrent
- A hernia that has returned after a previous repair.
- Mesh
- A surgical implant used to reinforce a repair. Its need, material and position depend on the individual case.
The consultation
Your repair should match your hernia—not a trend.
A proper assessment includes the history, examination and review of imaging when indicated. You should leave the consultation understanding the diagnosis, whether surgery is needed, the recommended approach, use of mesh, expected recovery and the meaningful alternatives.
Request a hernia consultationCommon questions
Clear answers before a decision.
Does every hernia need immediate surgery?
No. The timing depends on the hernia type, symptoms, examination findings, overall health and risk of complications. Some minimally symptomatic hernias can be observed after surgical assessment; painful, enlarging or complicated hernias are approached differently.
Is robotic repair always better than laparoscopic or open repair?
No single approach is best for every hernia. Robotic surgery can offer three-dimensional vision and wristed instruments, while laparoscopic and open techniques each have important advantages. The right approach depends on anatomy, prior surgery, complexity, patient factors and surgeon expertise.
Will mesh always be used?
Mesh is commonly used to reinforce many adult hernia repairs, but not universally. Hernia location, defect size, tissue quality, contamination risk and previous operations all influence the decision.
Can a hernia return after surgery?
Recurrence is possible after any repair. Technique, tissue quality, smoking, weight, wound complications, chronic cough and other factors can influence risk. A personalised plan also addresses modifiable risks where possible.
Medical references
Patient information informed by guidance from the NIDDK, SAGES and the American College of Surgeons. Anatomy and mesh explanations also reference the NCBI abdominal-wall review, FDA mesh information, 2023 European Hernia Society incisional-hernia guideline, 2023 HerniaSurge groin-hernia update and the SAGES/AHS mesh review.
Reviewed for website publication in August 2026. This guide is educational and is not a diagnosis or individual treatment recommendation.