NUH Hernia Centre is the first dedicated centre in Singapore offering comprehensive hernia repair procedures. The centre was set up to meet the growing need for expert care to look after the increasing number and diversity of people suffering from complex hernia-related conditions. As one of the most common surgical procedures performed worldwide, we see over 400 new hernia cases yearly with an annual increase of 10 - 15% in NUH.
Our multidisciplinary group of hernia specialists utilise a wide variety of surgical techniques and are among the first in the world to apply robotic-assisted surgery in complex abdominal wall hernia and reconstruction.
What is a hernia?
A hernia is a bulge over the abdominal wall caused by a weakness or tear of the muscles. This results in organs such as the intestines and fatty tissue inside the abdomen to protrude through the defect. Patients usually notice a swelling under the skin and may experience pain and discomfort occasionally. Symptoms may worsen after prolonged standing, walking or straining (e.g. lifting of heavy objects).
What are the different types of hernias?
Hernias are named according to their location on the abdominal wall or occasionally, their specific cause.
- Groin Hernia: There are two types of groin hernias – Inguinal and Femoral. Inguinal hernia is the most common type of hernia and has two varieties – Indirect and Direct. Indirect hernia occurs through the groin in an area on the muscle where the male testis pierces and descends down during foetal development. Femoral hernia is more common in women and is known to cause acute problems.
- Umbilical Hernia: This is one of the most common hernias. Women are more commonly affected than men – likely due to a previous pregnancy. This area is particularly weak because of the umbilical cord attachment during birth.
- Incisional Hernia: This form of hernia develops at the site of previous surgical incisions. The muscles around the incision site becomes weak and may lead to hernia formation. At times, multiple areas of weakness may develop with multiple hernias along the entire length of the scar and these can develop weeks, months or years after the initial surgery. Every subsequent surgery further weakens the muscle and increases the risk of hernia formation.
- Midline Ventral Hernia: This can be epigastric (in upper abdomen), para-umbilical (around the umbilicus), supra-pubic (in lower abdomen) and sub-xiphoid (just below the rib cage in the midline).
- Spigelian Hernia: This occurs through the spigelian fascia which is just beside the rectus muscles of the abdomen. The hernia lies in between two muscles of the abdominal wall and is hence difficult to diagnose clinically. The surgeon may need to perform an ultrasound or computed tomography (CT) scan.
- Rare Hernia: This includes lateral hernia, obturator hernia, lumbar hernia, sub-xiphoid hernia and parastomal hernia.
Most hernias occur as a result of weakness or defect in the muscles of the abdomen since birth. As one ages, this defect is further weakened by strenuous physical activity, lifting of heavy objects or incisions of a previous surgery.
The risk of developing a hernia increases with:
- Lifting heavy objects/strenuous physical activity
- Chronic cough (e.g. Asthma/ Chronic Obstructive Pulmonary Disease (COPD)
- Straining due to constipation or when passing urine
- Taking medications
Hernia can be diagnosed in most cases through a physical examination. In recurrent hernia, complex cases or in certain group of patients (e.g. obese, patient with previous surgery), an Imaging Diagnosis (Ultrasound, CT scan, MRI) may be necessary. Most hernias need to be repaired surgically to treat symptoms and prevent complications (e.g. strangulation of the intestine). Truss or abdominal binders are temporary measures for patients awaiting surgery or for very high risk patients.
At the NUH Hernia Centre, besides Open and Laparoscopic (Keyhole) Surgery, we perform novel surgical techniques such as Single Incision Laparoscopic (SILS) Hernia Repair, Robotic Surgery and Muscle Release surgeries such as Endoscopic Component Separation and Transversus Abdominis Release, among others.
Your surgeon will determine suitable treatment options for you after a thorough examination.
Inguinal Hernia Surgery
Open Hernia Repair
Laparoscopic (Keyhole) Surgery
- TAPP (Transabdominal pre-peritoneal)
- TEP (Totally extra-peritoneal)
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Ventral Hernia Surgery
Open Mesh Repair
Laparoscopic (Keyhole) Surgery
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With large incisions, increased pain and wound complications may occur after surgery. The robot is an advanced technology used by surgeons to perform complex manoeuvres not possible by laparoscopy. The robot also allows your surgeon to perform the surgery through similar small incisions.
Single Incision Laparoscopic (SILS) Hernia Repair
The surgery is performed through just one incision of about 1.5 – 2cm over the abdomen using a special device and instruments. By using only one cut, it results in lesser pain and better cosmesis.
Endoscopic Component Separation (ECS)
In hernias with large defects, it is difficult to achieve closure of the abdominal wall. Your surgeon will incise on the muscles in the lateral abdominal wall to release the attachments and bring them to the midline to cover the defect.
What should you expect after a day surgery procedure?
Following the surgery, you will be transferred to the recovery room where you will be monitored until you are fully awake
You will be discharged once you are awake and able to pass urine and walk
- Upon your discharge, you will be seen at the clinic
- As with any hernia surgery, you may experience some soreness, mostly during the first week post-surgery
With Laparoscopic Hernia Repair, you will be able to resume your normal activities within a shorter time
Avoid activities that require straining (such as weight-lifting) for at least the first 2 weeks post-surgery
What are the complications that can occur?
Any surgery may be associated with complications including:
Bleeding and infection
Difficulty urinating after surgery is not common. However, a temporary tube may be inserted into the urinary bladder
Collection of fluid at the site of the hernia (seroma) may happen in large hernia; in most cases, the fluid will be reabsorbed within 4-6 weeks post-surgery, and rarely requires an intervention
- Minimal risks include injury to the urinary bladder, intestines, blood vessels, nerves or the sperm tube going to the testicles that may require a conversion to open surgery or a reoperation
Late complications are possible recurrence of the hernia and chronic pain
When should you call your doctor?
Please call your physician or surgeon if you develop any of the following:
Persistent fever above 38.5 degrees Celsius
Increasing abdominal pain
Pain that is not relieved by medications
Persistent nausea or vomiting
Inability to urinate
Persistent cough or shortness of breath
Purulent drainage (pus) from any incision
Redness surrounding any of your incisions that is worsening or getting bigger
Inability to eat or drink