Hernia surgery

An inguinal hernia repair is an operation your doctor may suggest if you have a swelling or lump in your groin (or an enlarged scrotum in men), due to a hernia that’s causing pain or other problems.

An inguinal hernia occurs when part of your intestine, or the fatty tissue around it, pokes through a weak spot in your abdominal wall muscles. It is more common in men. Most are thought to result from ageing as your abdominal wall becomes weaker with age, though it can be present from birth. Inguinal hernias can also develop suddenly after putting pressure on the abdominal muscles, such as straining as a result of constipation, and they have also been linked to a persistent, heavy cough. You may find that the pain is often worse when you cough or stand and may disappear completely when you lie down.

Inguinal hernias are the most common type of hernias, but others include:

• Femoral hernia – a lump around the top of your thigh as part of your bowel or the fatty tissue around has pushed through your groin
• Hiatus hernia – where part of your stomach has moved through a hole in your diaphragm known as the hiatus and into your chest
• Umbilical hernia – a painless lump in or around your belly button as part of your bowel has pushed through the abdominal wall where the umbilical cord once was. This is common in infants though it can occur in adulthood

An inguinal hernia doesn't tend to improve if it's left untreated, so surgery is recommended. The operation involves pushing the protruding tissue back into place and repairing the weakness in your abdominal wall, usually with mesh.

Your consultant may recommend surgery if your hernia is:

• Painful
• Interfering with daily activities such as bending or lifting
• Growing
• Making complications more likely – if a portion of the protruding tissue becomes stuck in your inguinal canal, it can cause vomiting, stomach discomfort and a painful lump in your groin (obstructive hernia). If the protruding tissue becomes trapped in your abdominal wall, the blood supply may be cut off, which is potentially life-threatening (a strangulated hernia)

Your consultant can usually diagnose a hernia by examining the lump and asking you to stand, cough and lie down.

Sometimes they may send you for these tests to confirm the diagnosis:

• An ultrasound
• CT scan
• MRI scan

You can either have traditional open surgery or laparoscopic (keyhole) surgery.

With open surgery, your surgeon will:

• Make one incision (cut) over your hernia
• Push the protruding tissue back into your abdomen
• Staple or glue mesh on to the weak part of your abdominal wall
• Close your wound with stitches

With keyhole surgery, your surgeon will:

• Make small incisions (cuts) in your abdomen – usually three incisions
• Insert gas into your abdomen so they can see your organs more clearly
• Insert the laparoscope, a thin tube with a light and tiny camera, which sends images from inside your abdomen to a video screen
• Insert tiny surgical instruments through your other incisions to move the protruding tissue back inside your abdomen
• Repair the weak part of your abdominal wall with mesh, using either the transabdominal preperitoneal (TAPP) technique or the newer totally extraperitoneal (TEP) technique
• Release the gas from your abdomen
• Close your incisions with stitches

TAPP and TEP: what’s the difference?

• TAPP – your surgeon will insert the instruments through your abdomen muscle wall and lining, known as the peritoneum, to attach the mesh to strengthen the weakened section
• TEP – your surgeon will repair your hernia from outside your abdomen lining and all incisions in your skin will be sealed after

Your surgeon will explain the pros and cons of each method and which is best for you. This will depend on:

• Your overall health – if you’re elderly or of ill-health, you may be less likely to tolerate general anaesthetic safely, it may be recommended that you receive open surgery under local anaesthetic
• The type of hernia you have – particular techniques are better at treating different types of hernia, for example, keyhole surgery is better for treating bilateral hernias (occurring on both sides)
• Whether you’ve had a hernia before – if your hernia is recurrent, keyhole surgery is likely to be the best technique to repair your condition
• Your surgeon’s preference – open surgery is a more common method and some surgeons won’t have enough experience to treat using keyhole surgery

If surgery is not for you, your doctor may recommend wearing a hernia truss or corset as an alternative. This undergarment keeps the inguinal hernia in place and will relieve your discomfort, though it should only be used temporarily and it won’t treat your lump.

Who will be involved?

As well as your chosen surgeon, you’ll also be seen by an anaesthetist who’ll administer anaesthetic during the operation.

How long does an inguinal hernia repair take?

The surgery will usually last around one hour. You’ll need to allow 30 minutes before for the anaesthetic to take effect and another 30 minutes after the procedure for these effects to wear off.

How to prepare for an inguinal hernia repair

Before your surgery, you’ll be sent some instructions about when to stop eating and drinking in preparation for your operation.

Anaesthetic choices

Your consultant will advise on what’s best, based on your health, the surgical method and where your hernia is. It will either be:

• A general anaesthetic, when you’re asleep
• A spinal or epidural anaesthetic, when you’re awake but can’t feel anything below your waist
• A local anaesthetic, when you’re awake but you can’t feel anything in your abdomen

You’ll usually need a general anaesthetic for laparoscopic hernia repair.

If you have the spinal or local options, you may be offered a sedative.

Pain after an inguinal hernia repair

There tends to be less pain with keyhole surgery than with open surgery but you’re still likely to feel some soreness and discomfort once your anaesthetic wears off. Everyone experiences pain differently, but don’t worry, you’ll be given painkillers to help you manage this afterwards.

Your hospital stay

You’ll usually go home on the same day or the following day.

You can expect to go home on the same day as your operation, though you may have to stay overnight. After one to two weeks, you should be able to perform light activities such as shopping, return to desk-based work and you may also be able to drive again. You should be back to most normal activities within six weeks. If you have keyhole surgery, you’re likely to recover quicker and experience less pain than with open surgery.

After hernia treatment, it’s normal to experience:

• Soreness
• Discomfort
• Bruising and/or swelling around your groin (and scrotum in men)

Gentle exercise such as walking can also help with your healing and recovery.

Your lifestyle after treatment

You won’t be able to drive right away, so you’ll need to arrange for someone to take you home. You’ll also need someone to stay with you for the first 24 hours and may want to arrange help with tasks such as shopping and cleaning.

Your care team will provide you instructions about how to care for your wound correctly, as well as advice on hygiene and bathing. Make sure to follow these until the wound has fully healed.

You may find that coughing and sneezing cause pain around the wound, applying gentle pressure to your incisions with a cushion or your hand should make it more comfortable. Straining on the toilet because of constipation could also cause pain around your wound. You can reduce the risk of constipation by drinking plenty of fluids and eating large portions of fruit, vegetables and foods that are high in fibre.

It will probably be a couple of weeks before you can get back to light activities, work or driving. If your work is physically strenuous, you may need to wait around four to six weeks – your consultant will advise you.

It’s also important to check with your motor insurance company before driving again and you should avoid driving until you can perform the emergency stop manoeuvre without feeling any pain (this can be practised without starting your car).

If your treatment was performed under general anaesthetic, you should avoid drinking alcohol, operating machinery and signing legal documents for at least two days.

Most people have an inguinal hernia repair without complications, but all surgery carries some risks. Inguinal hernia repair complications can include:

• Return of the hernia – this occurs in less than 5% of patients
• Painful scar, which lessens over time
• A build-up of blood or fluid in the space left by the hernia, which usually improves on its own
• Bleeding or blood clots in your veins
• Infection
• Accidental injury to internal organs or nerve damage leading to pain and numbness in the groin
• Damage to the blood supply to a testicle or injury to the tube that carries sperm to the testicles

If you develop any of the following symptoms after your inguinal hernia repair, call the hospital where you had your surgery:

• High temperature – above 38°C
• Bleeding around the area
• Swelling or pain in your abdomen
• Pain that isn't alleviated by painkillers
• Persistent nausea and/or vomiting
• Periods of feeling cold
• Persistent coughing and/or shortness of breath
• Redness around your incisions
• Difficulty in passing urine

Hernia mesh

A recent media report highlighted how a minority of hernia mesh operations are associated with complications. However, it's important to note that this included all complications, from minor and correctable issues to more serious problems. A recent study comparing hernia repairs with mesh and hernia repairs without mesh found there was no difference in chronic pain afterwards. It's also important to consider some complications can occur without treatment. Your consultant will help you make an informed opinion about whether surgery is right for you. They'll explain all the potential benefits, risks and complications with you and answer any questions or concerns you may have.

At Spire hospitals, your safety is our top priority. We have high standards of quality control, equipment and cleanliness and a rigorous system of review and training for our medical teams.