Hernia, inguinal repair

Page last reviewed: 13/07/2011

A hernia is when an internal part of the body, such as an organ, pushes through a weakness in the muscle or surrounding tissue wall.

What is an inguinal hernia?

An inguinal hernia (pronounced "ingwanal") is the most common type of hernia. It occurs when part of your bowel pokes through into your groin.

The bowel pushes through a weak spot in the surrounding muscle wall (abdominal wall). The weak area is called the inguinal canal, a channel through which your blood vessels pass.

Inguinal hernias occur mainly in men. Most are thought to be due to ageing - as you get older, the muscles surrounding your abdomen can become weaker .

The hernia can appear as a swelling in your groin or as an enlarged scrotum (pouch containing the testes), which may be painful. The swelling often disappears when you lie down.

Repairing the inguinal hernia

An inguinal hernia repair is an operation to push the bulge back into place and to strengthen the abdominal wall.

The operation is necessary as, if left untreated, the herniated tissue can get trapped and have its blood supply cut off (known as a strangulated hernia). Emergency surgery within hours is essential to release the trapped tissue and restore its blood supply so it does not die.

Outlook

Inguinal hernia repair is a routine operation with very few risks. Without an operation, the hernia will get bigger, become more painful and could lead to complications, such as a strangulated hernia.

Surgery will get rid of the hernia and prevent you from having any serious complications.

After having the operation, you should be able to go home the same day or the day after.

 

Page last reviewed: 13/07/2011

There are two ways that an inguinal hernia repair can be carried out: open surgery and laparoscopic (keyhole) surgery. The operations are usually carried out under general anaesthetic (where you are unconscious throughout the procedure).

Open surgery

  • The surgeon makes a large (6cm) cut in your groin area.
  • The inguinal canal (channel near your bowel) is opened to return the loop of bowel to your abdomen, where it belongs.
  • The canal is closed with stitches to repair the weak spot that let the hernia through.
  • The wall of your abdomen may be strengthened by fixing a patch of nylon mesh to it.
  • If the hernia has become strangulated (trapped) and part of the bowel is damaged, the affected segment may need to be removed and the two ends of healthy bowel rejoined. This is a more complex operation and you may need to stay in hospital for four to five days.  

Laparoscopic (keyhole) surgery

With laparoscopic surgery, your surgeon makes three very small cuts in your abdomen (a large cut is not needed) and inserts special instruments to pull the loop of bowel back into place.

There are two types of keyhole surgery:

  • Transabdominal preperitoneal (TAPP) - instruments are inserted through the muscle wall of your abdomen and through the lining covering your organs, called the peritoneum. A flap of the peritoneum is peeled back over the hernia and a piece of mesh is stapled to the weakened area in your abdomen wall, to strengthen it.
  • Totally extraperitoneal (TEP) - this is the newest keyhole technique. The hernia is repaired without entering the peritoneal cavity. It is more difficult to do, but there may be less risk of damaging organs in the abdomen. There is no difference in the results.

Which operation is for me?

Both types of surgery have advantages and disadvantages (see box). Keyhole surgery tends to have a quicker recovery time and results in less pain after the operation, but the risks of serious complications, such as the surgeon accidentally damaging the bowel, are higher than in open surgery.

The risk of your hernia returning is similar for both operations. You should discuss the advantages and disadvantages of both keyhole surgery and open surgery with your surgeon before deciding on the most appropriate treatment for you.

Your choice will depend on:

  • Whether you can have a general anaesthetic. Elderly people or those in bad health may be too weak or frail to safely receive a general anaesthetic, so may be advised to have open surgery, which can be done under local anaesthetic (where the area is numbed).
  • The experience of your surgeon. Open surgery is more common than keyhole surgery, partly because not all surgeons have enough experience in keyhole techniques. According to NICE, a surgeon is inexperienced if they have done the operation fewer than 20 times.

NICE recommends that keyhole surgery should always be considered if the hernia has been repaired previously and comes back (recurrent hernia), and for hernias that occur in both sides of the groin (bilateral hernia).

Keyhole surgery is especially useful if your surgeon is not sure what type of hernia you have.

Hernia repairs take about 45 minutes to perform. You can usually go home the same day, but some people stay in hospital overnight if they have other medical problems or live alone.

Keyhole surgery vs open surgery

Scars:

  • With keyhole surgery, three cuts are required: one (1.5cm) below the navel and one (0.5cm) either side of the navel.
  • With open surgery, the scar will be in your groin and will be around 5–10cm.

Post-operative pain:

  • With keyhole surgery, pain after the operation is usually less because the cuts are smaller, there is less muscle damage and the small wounds can be glued together.

Recovery time:

  • With keyhole surgery, the recovery time is much quicker and you can return to work earlier than with open surgery.

Risk of complications:

  • The risk of serious complications, such as the surgeon accidentally damaging the bowel, are higher with keyhole surgery.

Page last reviewed: 13/07/2011

As with any kind of surgery, there are some risks associated with inguinal hernia repair, which differ from person to person. Before your operation, ask your surgeon to explain how these could apply to you.

Specific complications

Complications that are specific to this operation include:

  • blood or fluid building up in the space left by the hernia (this will usually get better without treatment),
  • painful swelling and bruising of the testicles (for men),
  • pain and numbness in the groin area caused by damage of a nerve during surgery, stitches trapping a nerve, mesh applied too tightly, or scar tissue forming (this is five to 10 times more common after open surgery).

These complications are rare, but more likely if:

  • you are over 50, or 
  • you have another illness, such as heart disease or breathing problems.

General complications

Possible complications of any operation include:

  • pain,
  • bleeding,
  • infection in the surgical wound,
  • heavy scarring, and
  • blood clots.

Page last reviewed: 13/07/2011

You will not feel any pain while your inguinal hernia is being repaired, but your groin will feel sore and uncomfortable afterwards. You will be given painkillers to help relieve this.

You should be able to go home the same day or the day after your operation. Get an adult to take you home in a car or taxi.

Looking after yourself

An adult must stay with you for the first 24 hours after surgery. You can follow the tips below to ensure your recovery is as quick as possible.

  • Follow the instructions your nurse gave you about caring for your wound, hygiene and bathing.
  • If you are still in pain, continue taking painkillers as advised by the hospital.
  • Eat plenty of vegetables, fruit and high-fibre foods such as brown rice, wholemeal bread and pasta. This helps to avoid constipation, which may cause pain in your wounds from straining.
  • In general, take it easy for the first two or three days.

Activities

A general anaesthetic can affect your coordination and reasoning skills, so avoid alcohol, operating machinery or signing legal documents for at least 48 hours afterwards.

You cannot drive legally within 48 hours of a general anaesthetic. It will be at least one to two weeks before you can drive after keyhole surgery and two to six weeks after open surgery. You must not drive before you are pain free. Contact your car insurance company before driving.

It usually takes 10-15 days before you can get back to normal activities such as walking, shopping and sport. You may recover faster if you have had keyhole surgery.

You can usually return to work after two to four weeks, depending on the extent of surgery and your type of work. Gentle exercise can help the healing process, but you should avoid anything too strenuous and heavy lifting.

You may find sex painful or uncomfortable at first, but it is fine to have sex when you feel like it.

When to call a doctor

Call your GP or surgeon if you develop any of the following symptoms:

  • persistent fever (over 38°C/100.4°F),
  • bleeding,
  • increased swelling or pain of your abdomen,
  • pain that is not relieved by your medications,
  • persistent nausea or vomiting,
  • chills,
  • persistent coughing or shortness of breath, or
  • increasing redness surrounding your incisions.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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