Inguinal (and Femoral) Hernia Repair

Background

Open vs laparoscopic repair

Broadly speaking there are two main techniques for an inguinal (and femoral) hernia repair - open or laparoscopic. Both have their advantages and disadvantages.

An open procedure involves a single cut in the groin. The hernia is reduced and a mesh is placed over the defect for reinforcement.

A laparoscopic (keyhole) procedure involves a small cut next to the umbilicus and 2 small cuts just above the pubis. The hernia is reduced from the inside and mesh is inserted.

A laparoscopic procedure has a slightly faster recovery and less risk of chronic pain. There is a slightly higher risk of major bleeding. Laparoscopic procedure isn’t always possible and can be difficult after previous abdominal surgery, including prostatectomy and cesarean section. We are also reluctant to perform laparoscopic repairs on those people taking strong blood thinning medications (anticoagulants).

Hospital stay

Inguinal hernia repair is usually performed as either a day case or one overnight stay. If you do stay in hospital, most can go home the following day.

Post-operative care

Lifting and exercise

We recommend that you avoid heavy lifting or strenuous exercise for up to four weeks after your surgery. Walking is OK and encouraged.

Wound care

You will leave hospital with a dressing on the wound. This can usually be removed five days after the surgery. There will sometimes be steri-strips under the main dressing. These can stay on til they start to peel off on their own. The stitches are usually under the skin surface and not need removal. You should avoid baths or swimming for at least two weeks after the surgery. Showers are OK.

Driving

You can drive when you are pain free and can comfortably push your foot on to the brake in an emergency. This will often take up to a couple of weeks after the surgery.

Pain relief

On discharge, you will be supplied with pain killers. Take them as you need.

Complications

Bleeding

Bruising after a hernia repair is common however major bleeding is quite rare. Any bleeding after a hernia repair will usually track down to the scrotum with the help of gravity! Don’t be too alarmed if the scrotum becomes bruised and swollen after a hernia repair. It will usually get better on it’s own.

Infection

Intravenous antibiotics are given at the time of surgery. This is usually the only antibiotics that are required. Infection after hernia repair is uncommon. Infection of the mesh is even rarer.

Recurrence

Hernia recurrence after a mesh repair, either open or laparoscopic is uncommon. Overall that risk is less than 5% over a lifetime. Factors that increase the risk are obesity, smoking, chronic cough and constipation.

Nerve damage

There are two nerves in the region that supply sensation to skin over the hernia. These nerves can be damaged in the process of repairing the hernia resulting in either numbness or chronic pain. A laparoscopic hernia repair has a lower risk of nerve damage.

Testicular vascular damage

Within the inguinal canal are all the structures that go to and from the testes, including it’s blood supply. There is a rare chance that this blood supply can be damaged which may compromise the testes. This is rare for a first time hernia repair, though does increase the risk with recurrent repairs.

General complications of surgery and anaesthesia

Any surgery and anaesthesia carries risks. The general risks of operations include drug reactions, deep vein thrombosis, heart and lung complications and rarely death.