Carla the 10-inch-long angelfish was laid out on an operating table while a vet and two assistants carried out the unusual surgery.
After being anaesthetised, the exotic fish had a tube placed in her mouth and water pumped through her body and out her gills to enable her to breathe.
Vet Sue Thornton repaired the stomach condition usually associated with humans using a scalpel, a needle and forceps during the £500 operation.
After being stitched up and brought round, the plucky fish was kept under close observation before she went on to make a full recovery.
Carla has been a resident at the London Aquarium for 10 years and staff decided to try to save her rather than put her to sleep when she developed the hernia.
James Oliver, deputy curator of the aquarium, said: 'Carla's problems began when this mystery swelling appeared on her side.
'Within a couple of days it burst and we feared for her survival when it left a large open wound and her internal organs exposed.'
Although her condition improved following a course of antibiotics, part of her stomach began to squeeze out of the wound.
James added: 'I guess it may seem a bit extreme to operate on a small fish but Carla has been with us for 10 years and she is almost family.
'The last thing we wanted to was to lose her.'
Vet Sue Thornton, of the International Zoo Veterinary Group, was called in to examine Carla and decided it was best to operate.
Carla was transferred to a smaller tank containing water with a carefully measured dose of anaesthetic which knocked her out.
She was then placed on an operating table while Sue carried out the 30-minute procedure.
Sue said: 'I must admit I didn't think the prognosis was very promising to begin with.
'As soon as she was asleep we moved her on to the operating surface and fed a tube from the tank into her mouth and kept her breathing by pumping the water over her gills.
'I then stitched the wound together as best I could. It was difficult because the wall tissue was very stiff, but I managed to close it.' After the surgery Carla was moved into clean water and within five minutes she came round.
The vet returned days later to remove the five stitches by which time Carla had returned to the attraction's Caribbean tropical fish display tank.
Sue added: 'I am as thrilled and delighted as James and his colleagues are that Carla is back to her best.'
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