Why Choosing a Hernia Specialist Matters: What the Research Shows

If you need a hernia repaired, you may assume that any general surgeon who performs hernia surgery can provide essentially the same result.

The research suggests otherwise.

Many general surgeons perform excellent hernia repairs. However, studies consistently show that surgeons who perform hernia surgery more frequently tend to have lower recurrence rates and, in some studies, fewer complications than surgeons who perform these operations only occasionally.

In other words, the type of repair matters, but so does the experience of the surgeon performing it.

Hernia Repair Is Common, but It Is Not Always Simple

Hernia repair is one of the most commonly performed operations in general surgery. Because it is so common, it is sometimes described as a routine procedure.

Routine does not necessarily mean simple.

No two hernias are exactly alike. A small first-time inguinal hernia is very different from a large scrotal hernia, a femoral hernia, a recurrent hernia, or an incisional hernia following prior abdominal surgery.

Even relatively straightforward hernias can involve important decisions:

• Should the repair be performed through an open, laparoscopic, or robotic approach?

• Is mesh appropriate, and if so, what type and size should be used?

• Is there a hernia on the opposite side?

• Is the patient’s pain actually coming from the hernia?

• Would surgery be helpful, or would observation be more appropriate?

• How should previous operations, scar tissue, activity level, and overall health affect the plan?

These decisions require more than simply knowing how to perform an operation. They require judgment developed through experience with many different patients, hernia types, and surgical approaches.

What the Research Shows

The connection between surgical experience and outcomes has been recognized in many areas of surgery. Hernia repair is no exception.

One landmark study published in the BMJ analyzed more than 86,000 groin hernia repairs recorded in the Swedish Hernia Register. Surgeons who performed only one to five hernia repairs per year had a significantly higher risk of reoperation for recurrence than surgeons who performed more.

What makes that finding especially important is that approximately half of the surgeons in the study were considered low-volume hernia surgeons. They performed hernia repairs, but they did not perform them often.

A later systematic review examined studies evaluating surgeon volume and recurrence after groin and primary ventral hernia repair. The authors found that higher-volume surgeons generally had lower recurrence rates. They concluded that the available evidence supported concentrating groin hernia repair among surgeons who perform these operations regularly.

More recent research has reached similar conclusions.

A 2024 nationwide Swedish study evaluated more than 20,000 laparoscopic total extraperitoneal, or TEP, groin hernia repairs performed at 75 surgical units. Units performing fewer than 51 repairs per year had a significantly higher risk of reoperation for recurrence than units performing more than 150 repairs annually.

The difference was greatest in the lowest-volume group. Units performing fewer than 12 repairs per year had an adjusted risk of reoperation for recurrence that was 87% higher than that of the highest-volume units.

Research involving ventral and incisional hernias has also found a connection between surgeon experience and outcomes. A 2024 registry study of more than 15,000 ventral hernia repairs found that higher annual surgeon volume was associated with fewer postoperative general complications and a shorter length of stay.

Not every study measures the same outcomes, and volume alone cannot guarantee a successful repair. However, the overall pattern is difficult to ignore. Surgeons and surgical teams that perform hernia repairs more frequently tend to achieve better results in several important areas.

Why Focused Hernia Experience Makes a Difference

The value of a hernia specialist is not simply that the surgeon has performed a large number of operations.

The real advantage is what is learned from that experience.

A surgeon who regularly treats hernias is more likely to have encountered a wide range of anatomy, including large indirect hernias, direct hernias, femoral hernias, bilateral hernias, recurrent hernias, abdominal wall defects, and unusual findings that may not be obvious before surgery.

That experience may help the surgeon recognize when a standard approach is appropriate and when the plan needs to be modified.

Focused experience can also improve the decisions made before surgery. Not every patient needs the same repair, and not every patient with a hernia necessarily needs an operation right away.

A surgeon who is comfortable with several techniques can recommend an approach based on the patient’s specific situation rather than simply recommending the one operation the surgeon performs most often.

For one patient, an open repair may be the most appropriate option. For another, a minimally invasive laparoscopic or robotic repair may offer important advantages. Patients with bilateral, recurrent, femoral, or more complex hernias may require a different level of planning and experience.

The best operation is not necessarily the newest operation or the operation with the smallest incision. It is the operation that best fits the patient, the hernia, and the surgeon’s expertise.

Experience Matters With Minimally Invasive Hernia Repair

Laparoscopic and robotic hernia repair involve a meaningful learning curve.

The International Guidelines for Groin Hernia Management estimate that approximately 100 supervised laparo-endoscopic repairs may be needed before a surgeon reliably achieves outcomes comparable with an experienced open hernia surgeon.

That does not mean that every surgeon becomes an expert after completing a specific number of cases. It does show that becoming consistently proficient in minimally invasive hernia repair takes substantial training and repetition.

A surgeon who performs only a handful of these procedures each year may take much longer to move beyond that learning curve than a surgeon whose practice is focused on hernia care.

Experience also needs to be specific to the operation being performed. A surgeon may be highly experienced in general surgery but perform relatively few robotic, laparoscopic, recurrent, or complex abdominal wall repairs.

That is why it is reasonable for patients to ask not only whether a surgeon performs hernia surgery, but how often the surgeon performs the particular type of repair being recommended.

What International Guidelines Say

The HerniaSurge Group’s International Guidelines for Groin Hernia Management were developed by hernia experts and endorsed by hernia societies around the world.

The guidelines identify low surgical volume and limited surgical experience as risk factors for hernia recurrence. They also state that the caseload of the individual surgeon may be more important than the overall volume of the hospital or surgery center.

This is an important distinction.

A high-volume hospital does not necessarily mean that the surgeon performing your operation is personally experienced with that procedure. Conversely, an experienced hernia surgeon may achieve excellent results in a smaller facility with an established surgical team.

The guidelines also recognize the importance of specialized experience when treating recurrent and complex hernias. When a hernia has returned after previous repairs, the anatomy and surgical decision-making can become significantly more challenging.

Questions to Ask When Choosing a Hernia Surgeon

Patients should feel comfortable asking a surgeon about their experience.

Reasonable questions include:

• How frequently do you perform hernia repairs?

• How much of your practice is devoted to hernia surgery?

• How often do you perform the specific repair you are recommending?

• Do you regularly perform open, laparoscopic, and robotic repairs?

• Why do you believe this approach is best for my hernia?

• How do you manage bilateral, recurrent, femoral, or complex hernias?

• What factors might increase my risk of recurrence or complications?

A case number by itself does not define expertise, and no surgeon can guarantee a particular outcome. However, the answers to these questions can tell you a great deal about the surgeon’s experience, judgment, and ability to individualize your care.

Why See a Surgeon Who Focuses on Hernia Repair?

If you needed a joint replacement, you would probably look for an orthopedic surgeon who performs joint replacements regularly. If you needed heart surgery, you would want a surgeon whose practice is focused on heart surgery.

The same reasoning applies to hernia repair.

A hernia may be common, but it is still your operation, your recovery, and your long-term result.

Choosing a surgeon who specializes in hernia care may provide access to broader experience, more surgical options, and a more individualized treatment plan. Most importantly, research suggests that surgeons who perform hernia repairs regularly tend to have lower recurrence rates and may achieve better outcomes than surgeons who perform them only occasionally.

That does not mean every patient needs the most complex operation or the newest technology. It means your hernia should be evaluated by someone who understands the full range of options and can explain which approach makes the most sense for you.

Hernia Care at Advanced Hernia Specialists

At Advanced Hernia Specialists, hernia repair is not a small part of a broad general surgery practice. It is the focus of what I do.

Over more than 26 years in surgery, I have performed thousands of hernia repairs, including open, laparoscopic, and robotic procedures for inguinal, femoral, umbilical, ventral, incisional, bilateral, and recurrent hernias.

That experience does not mean that every patient needs surgery or that there is one best operation for everyone. In fact, one of the most important parts of specialized care is knowing when an operation is appropriate, which approach is most likely to fit the patient’s needs, and when another option should be considered.

My goal is not simply to repair a hole in the abdominal wall. It is to understand the patient, the anatomy, the symptoms, and the patient’s goals, and then recommend a thoughtful and individualized plan.

Schedule a Consultation

If you have been diagnosed with a hernia, or you suspect that you may have one, it is worth having it evaluated by a surgeon who focuses on hernia care.

Advanced Hernia Specialists offers in-office consultations in Jacksonville, Florida, as well as telehealth consultations for patients who live farther away, or out of state.

I would be happy to review your diagnosis, discuss your options, and help you decide what approach makes the most sense for you.

Schedule a Consultation

Sources

1. Nordin P, van der Linden W. Volume of procedures and risk of recurrence after repair of groin hernia: national register study. BMJ. 2008;336(7650):934–937. doi: 10.1136/bmj.39525.514572.25

2. Christophersen C, Fonnes S, Andresen K, Rosenberg J. Lower recurrence rate after groin and primary ventral hernia repair performed by high-volume surgeons: a systematic review. Hernia.

   2022;26(1):29–37. doi: 10.1007/s10029-020-02359-4

3. Widman F, Bergström M, Widhe B, Bringman S, Melkemichel M. Surgical unit volume and reoperation for recurrence following total extraperitoneal groin hernia repairs: nationwide population-based register study. BJS Open. 2024;8(6):zrae136. doi: 10.1093/bjsopen/zrae136

4. van den Berg R, den Hartog FPJ, Menon AG, Tanis PJ, Gillion JF, The Hernia Club members. Is surgeon annual case volume related with intra and postoperative complications after ventral hernia repair? Uni- and multivariate analysis of prospective registry-based data. Hernia. 2024;28:1935–1944. doi: 10.1007/s10029-024-03129-2

5. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1–165. doi: 10.1007/s10029-017-1668-x

6. Stabilini C, van Veenendaal N, Aasvang E, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023;7(5):zrad080. doi: 10.1093/bjsopen/zrad080

This article is provided for general educational purposes and does not constitute individualized medical advice. Please consult a qualified surgeon to discuss your specific diagnosis and treatment options.