General Surgery

Inguinal Hernia

Inguinal hernias are the most common types of hernia and occur in the groin. They can be the result of a defect from birth or due to a weakness developing over time. They are best described as a swelling in the groin area, which is more prominent on standing or straining. The hernias usually disappear on lying down.

Hernias, which do not cause symptoms, do not always need to be fixed. However, in younger patients it is likely they will become symptomatic with time.

In larger hernias, the swelling may contain bowel. There is a small risk of part of the bowel becoming trapped or damaged within the hernia. In males, the hernia can extend into the scrotum. Large hernias should be repaired and if very symptomatic should be fixed urgently.

Surgical Hernia Repair

Repair involves using a synthetic mesh to reinforce the tissues. This can be done with either open or keyhole surgery depending on the size, type and location of the defect. Patients with hernias on both sides will be preferentially fixed with keyhole surgery.

Laparoscopic (keyhole) repair – Three small cuts are made in the abdominal wall to allow the passage of the instruments. The hernia is repaired using synthetic mesh and keyhole fixation devices. The cuts are repaired with dissolvable sutures and a local anaesthetic is given. A waterproof dressing is placed over the sites so you can shower straight away. These should be left for 3 days. On removal if the wound is not dry another dressing should be applied for a few more days.

Open hernia repair – This technique is often used in either very small uncomplicated hernias or in very large defects when the hernia extends into the scrotum. In large hernia repairs, the recovery time can be longer and will be dependent on the type of repair required. Your surgeon will discuss this with you, as it will vary on a case-by-case basis. Again dissolvable sutures are used and a waterproof dressing placed over the wound. For open repair of small hernias there is minimal difference in recovery time from keyhole surgery. A small incision is made and recovery time should be short.

Frequently Asked Questions

The secretary and hospital will organise a day for the procedure and give you the admission details. Routine blood tests and a heart tracing (ECG), maybe required before admission. You will be asked not have anything to eat up to six hours prior to surgery. Water can be taken up to 2 hours prior to the surgery. The surgeon will go through the procedure again with you on the day and take your consent. The anaesthestist will also visit to discuss the general anaesthetic and your post surgery pain relief. It is also not uncommon for patients to require anti-sickness medications after a general anaesthetic.

Straight forward hernia repair is usually performed as a day procedure. If the procedure is carried out late in the day or if there are any other medical concerns then an overnight stay maybe required. You will be discharged once you are fully mobile, passed urine and comfortable. Most patients require 2-3 days of simple pain medication but should be fully functional during this period. Some patients return to work after this, but it will depend on the type of repair and your occupation.

You will be discharged from hospital with a supply of simple painkillers with instructions on how to use them. Regular paracetamol is particularly effective and can be combined with an anti-inflammatory drug (ibuprofen) or a codeine based drug (dihydrocodeine). Anti-inflammatories are not suitable for all patients and should be taken with food. The codeine-based drugs can cause constipation and should be taken with plenty of fluids. Most patients do not require painkillers after 5 days.

Generally it is recommended to take two weeks off after surgery. Your ability to return to work will depend on your job and varies between individuals. Patients can often return to work a week after surgery if required. We would not recommend flying immediately after surgery. This should be discussed on a case-by-case basis with the consultant.

There are usually no restrictions on lifestyle or activities after a hernia has been repaired once recovery is complete. Strenuous activities (gym) should be avoided for 6 weeks.

Driving should be avoided in the first week after surgery.Once you can perform an emergency stop in a stationary vehicle and turn to view your blind spot then driving should be safe. It is preferable to contact your insurance company to check for any specific instructions they may have.

Straightforward repair carries a very low risk of the hernia returning. There maybe some numbness in the region of the scar. There should be no effect on sexual or urinary function. In complicated cases for recurrent hernias or very large hernias, there is a small risk to the testicle on the side of the hernia. Your consultant will discuss this with you. A small number of patients develop chronic discomfort in the groin after repair. This could be the result of nerve entrapment or irritation from the mesh. Lightweight meshes and dissolvable fixation devices are used to avoid this.

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