Inguinal Hernia Repair

Patient Information and "Risk" Form

Mr James Francombe, General and Colorectal Consultant Surgeon

To download the pdf version of this factsheet please click on this link

Definition

An inguinal hernia is where some of the contents of your abdominal (tummy) cavity have passed through a defect or weakness in your abdominal wall and appear as a lump which you can see or feel in the groin region. The symptoms are:

1. an unsightly lump

2. discomfort or pain

3. obstruction or strangulation

Admission

The vast majority of these operations today are performed as day cases where you are discharged home on the same day as the operation. Sometimes this is not possible and if you are not suitable for day care surgery you should expect to be in hospital for 1 or 2 nights. If your operation is in the morning you should fast from midnight and if it is in the afternoon usually a light breakfast at 08:00 is permitted.  

Anaesthetic

Most hernias are repaired under a general anaesthetic. Sometimes, for various reasons, the operation is performed using anaesthetic whilst you remain awake (local anaesthetic). This will have been decided in clinic. 

The operation

This is termed an intermediate operation (ie less than major but more than minor). I will make an incision over the lump approximately 2 to 4 inches in length. The abdominal contents in the hernia are replaced back into the abdominal cavity and the defect through which the hernia occurred is repaired by fixing a piece of nylon mesh into the groin. This stays there forever and becomes incorporated into your body to make the groin region a lot stronger. The skin is closed usually with a dissolvable stitch but sometimes with a stitch that needs to be removed. This is done a week later by your family doctor's practice nurse. There will always be a scar where the incision was but with time this will become white and less noticeable. It will usually be situated below the 'bikini line '. 

Problems that can occur during the operation

1. Transfer to inpatient

Problems occurring during surgery are rare. Very occasionally if you are booked as a day case you may be asked to remain in hospital for a short period after the operation.

2. Damage to other structures

(a) Common

A small nerve may have cut to perform the operation. This can result in some residual numbness at the base of the penis and a small part of the scrotum in males or a small bit of the labia majora in females. Your body will soon adapt and you will not notice this much after a short time.

(b) Very rare

Whilst great care is taken to avoid damaging structures during the operation very rarely structures such as the spermatic cord (the tube that carries sperm from the testicle to the penis during ejaculation) or the blood supply to the testicle on that side may be damaged. If the cord is damaged you will not normally notice any difference and fertility is rarely affected. If the blood supply to the testis is disrupted you may notice that the testicle on that side becomes slightly smaller.

Once again this should make no difference to your fertility or masculinity.

After the operation

As soon as you awake from the anaesthetic you can have something to eat or drink. After a short while a nurse will run through a checklist to ensure you are fine to go home. A responsible adult will have to remain with you for 24 hours after the procedure, as it takes this time to fully recover from the anaesthetic. You may experience some pain over the operation site, but you will have been given pain killers. It is important that you take these regularly in the first 48 hours, even if you are not experiencing pain. 

Problems that can occur after the operation (post-operative complications)

The vast majority of patients have no problems following this type of operation. However it is important that you are aware of some of the rare complications prior to undergoing surgery.

1. Bleeding

Whilst every attempt is made to stem all bleeding during the operation, sometimes excessive bleeding afterwards can occur. The nursing team will check for this prior to your departure. Occasionally a blood clot can form under the skin (haematoma). This manifests itself as a painful swelling under the skin. This is more likely to happen if you take aspirin or other blood thinners. More often than not this will settle of its own accord but sometimes requires further intervention to remove the clot and stop the bleeding.

2. Infection

Superficial wound infections may occur as the wound is in a contaminated area (ie the groin). You may notice the wound becoming progressively more painful, red or swollen. Occasionally you may notice a discharge. It is important that you see your family doctor who will prescribe appropriate antibiotics. This is usually all that is needed.

If the mesh itself becomes infected (this is exceptionally rare) then we may be forced to remove the mesh and repair the hernia a different way until we can replace a new mesh.

3. Pain

Rarely some people complain of persistent low grade pain in the area of the groin. There are different causes for this and if you are referred back to your specialist with this problem they may wish to do some investigations. There are a number of treatments available to help this condition. Very occasionally your surgeon may suggest re-exploring the area under anaesthetic.

4. Recurrence

With todays modern techniques the chances of your hernia coming back in the same place in your lifetime is much less than 1 in 100. If you are unlucky enough to experience this then your hernia can be re-repaired. You may be offered a keyhole approach for this.

5. Fluid collection over scar

Sometimes whilst the mesh is incorporating into your own tissues fluid is produced. This can settle as a non-painful pocket of fluid under the scar termed a seroma. These settle with time. Sometimes your surgeon may drain the fluid away with a simple needle in clinic. 

After discharge

Any pain will subside fairly rapidly and you should be able to get back to normal activities within 1 to 2 weeks. It is preferable that you do not do any heavy lifting during the first 2 weeks, whilst this should not affect the repair it may be painful.

When you do start heavy lifting again it is advisable to do it gradually. Your specialist will advise when you can go back to work. This will depend on your job. If you are concerned that you may be developing a complication you should either contact your GP or my secretary or the Warwickshire Nuffield Hospital.  

Follow up

I will see you for follow up in approximately six weeks time.