Inguinal Hernia Repair

Potential complications include:

• There is a low chance the hernia could return after the operation.
• Blood or fluid building up in the space left by the hernia. This usually gets better without treatment but can take several weeks.
• Pain and numbness in the groin area caused by a nerve being damaged or trapped during surgery.
• Damage to the blood supply to the testicles.
• Damage to the vas deferens (the tube that carries sperm to the testicles).
• There is a slightly higher risk of complication if you smoke or have another illness, such as heart disease or breathing problems.

There are two options for inguinal hernia repair, and you will have the opportunity to discuss the advantages and disadvantages of both with your surgeon before deciding on the most appropriate treatment. The National Institute for Health and Care Excellence (NICE), which assesses medical treatments for the NHS, says both keyhole and open surgery for hernias are safe and work well.

The risk of your hernia returning is similar after both operations.

The British Hernia Society recommends using the open technique to repair most primary single-sided hernias (those appearing for the first time on just one side).

Open surgery inguinal hernia repair can be carried out under local anaesthetic (the operation area is numbed so you will not experience any pain). This option is considered better for older or people in bad health who may be too weak or frail to have a general anaesthetic safely.

• Sometimes a general anaesthetic is used, and local anaesthetic is also injected into the area after surgery, so you wake up without pain.
• Your consultant makes a single 6 to 8cm long incision over the hernia and returns the lump of fatty tissue or loop of bowel back into your abdomen.
• A mesh is placed in the abdominal wall, at the weak spot where the hernia came through to strengthen it.

When the repair is complete, your skin will be sealed with stitches. These usually dissolve on their own, within a few days of the operation. These are covered with a waterproof dressing on the day of surgery that should remain in place for five days. A spare dressing is usually given to you on discharge.

Or

Your skin will be sealed with special surgical glue, that you should keep dry for the first 48 hours. After 48hrs you can shower but a bath is not advised for two weeks after surgery (as will cause the stitches to dissolve too quickly). The glue can start to peel off from seven days post operatively but can take up to two to four weeks to completely fall off. Do not pick the glue off.  

• A less invasive technique, the operation usually takes about 30 to 45 minutes to complete.
• General anaesthetic is used for keyhole inguinal hernia repair.
• Your consultant usually makes three small incisions in your abdomen instead of a single larger incision.
• A thin tube containing a light source and a camera (laparoscope) is inserted through one of these incisions so they can see inside your abdomen.
• Surgical instruments are inserted through the other incisions so your consultant can pull the hernia back into place.
• Totally extraperitoneal (TEP) is a keyhole technique involving repairing the hernia without entering the peritoneal cavity. This is the type of keyhole surgery performed at Tetbury Hospital Trust.
• Once the repair is complete, the incisions in your skin are sealed with stitches or surgical glue. The wounds will be covered with a splash proof dressing that should remain in place for at least five days. Spare dressings will be given to you on discharge.

With keyhole surgery, there is usually less pain after the operation because the cuts are smaller. There is also less muscle damage, and the small cuts can be closed with glue.

Keyhole surgery tends to have a quicker recovery time in people who have been treated before and the hernia has come back (recurrent hernia) or have hernias on both sides at the same time (bilateral hernias).

You will be able to go home the same day and must arrange for someone to drive you.

For the first 24 hours:

• Men will experience swelling and bruising of the testicles and penis (this is not unusual).
• Someone should stay with you until the general anaesthetic has worn off.
• Do not drive, operate machinery, or do any potentially dangerous activities (like cooking) until you have fully recovered feeling, movement and co-ordination.
• Do not sign any legal documents or drink alcohol.
• Get plenty of rest but stay active to avoid blood clots.
• A moderate amount of pain is normal so continue taking painkillers as advised by the hospital until your pain has settled. This is usually two to three days but can be longer.

Applying gentle pressure to your wound, using your hand or a small pillow, can make coughing, sneezing and moving between sitting and standing more comfortable.

Straining on the toilet because of constipation can cause pain around your wound. You need to reduce your risk of constipation by drinking lots of fluids and eating plenty of vegetables, fruit and high-fibre foods like brown rice, wholemeal bread and pasta. Taking a mild laxative that you can get from a pharmacist before constipation occurs will help.

Most people make a good recovery and return to their usual activities within two weeks. Here are a few things you can do to make sure you recover well:

• Gentle exercise, such as walking, can help the healing process, but you should avoid heavy lifting and strenuous activities for about four to six weeks.
• You should be able to return to work after one or two weeks if your employment involves light work, or a bit longer if more manual. The consultant will be able to give you a “Statement for fitness” to work before discharge, if this is the case.
• You may find sex painful or uncomfortable at first, but it is usually fine to have sex when you feel able.
• Avoid driving until you are able to perform an emergency stop without feeling any pain or discomfort (you can practise this without starting your car). It will usually be one or two weeks before you reach this point after having keyhole surgery, although it may take longer after open surgery. We recommend you contact your car insurance company before you start driving again.

Contact your consultant, GP or dial 111 if you get any of the following symptoms:

• A persistent, high temperature.
• Bleeding.
• Increased swelling or pain in your abdomen.
• Pain that is not relieved by painkillers.
• Persistent nausea or vomiting.
• Chills.
• Persistent coughing or shortness of breath.
• Increasing redness surrounding your incisions.
• Difficulty passing urine.