Inguinal Hernia Repair
ABOUT YOUR INGUINAL HERNIA:
About 5% of the general population will develop a spontaneous abdominal wall hernia in their lifetime. Approximately 800,000 inguinal hernia repair operations are performed annually in the United States. Most are performed by the conventional "open" fashion.
WHAT IS AN INGUINAL HERNIA?
- A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery.
- Inguinal hernias account for 80% of abdominal wall hernias.
- Both men and women can get an inguinal hernia but men are 7 times more likely to develop this type of hernia.
- You may be born with an inguinal hernia (congenital) or develop one over time.
- If you develop an inguinal hernia on one side, you have about a 15% chance of developing an inguinal hernia on the other side some time in your lifetime.
- A hernia does not get better over time, nor will it go away by itself.
- Complications of inguinal hernias such as incarceration, obstruction and strangulation do occur but at a very low rate.
HOW DO I KNOW IF I HAVE AN INGUINAL HERNIA?
- The inguinal hernias occur in the groin.
- It is usually easy to recognize an inguinal hernia. You may notice a bulge under the skin in the groin. You may feel pain when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting.
- The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day.
- Severe, continuous pain, redness, and tenderness are signs that the inguinal hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon.
WHAT CAUSES A HERNIA?
The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop an inguinal hernia at any age. Most inguinal hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, straining with bowel movements or urination can cause the abdominal wall to weaken or separate. In the groin, there is a natural weakness at the site that the spermatic cord (in men) and the round ligament (in women) pass through the muscle layers. Smoking is associated with a higher incidence of inguinal hernia formation.
WHAT ARE THE OPTIONS FOR REPAIR?
There are few options available for a patient who has an inguinal hernia. Inguinal hernias typically enlarge over time and become more symptomatic. An inguinal hernia is easier to fix and less likely to recur when it is relatively small rather than when it is a massive scrotal hernia. Most inguinal hernias require a surgical procedure at some point in time.
The open approach is done from the outside through an incision over the hernial defect. The incision will extend through the skin, subcutaneous fat and superficial fascial layers; this allows the surgeon to get to the level of the defect. The defect is usually patched with a piece of surgical mesh under no tension. This technique is usually done with a local anesthetic and sedation but may be performed using a spinal or general anesthetic.
The laparoscopic approach usually requires three small incisions the largest at the umbilicus for the video camera trocar and two smaller incisions for the operative trocars. A piece of mesh is placed inside the abdominal wall through one of the trocar sites and is held in place with surgical tacks or small absorbable hooks incorporated in the mesh. This operation is usually performed with general anesthesia or occasionally using regional or spinal anesthesia.
WHAT ARE THE ADVANTAGES OF THE OPEN INGUINAL HERNIA REPAIR?
The open approach to inguinal hernia repair is typically done under local anesthesia with sedation. In patients with heart disease or some other conditions which increase the risks of a general anesthetic this may represent a significant advantage over the laparoscopic procedures. Some studies have suggested a slightly lower risk of recurrence with the open approach. The open and laparoscopic procedures both typically use mesh for the repair and are tension-free repairs. There are fewer intra-abdominal complications with the open approach but these types of complications are very rare. Return to work times are very similar for the two approaches and both are done as an outpatient.
WHAT PREPARATION IS REQUIRED?
- Most hernia operations are performed on an outpatient basis, and therefore you will probably go home on the same day that the operation is performed.
- Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
- After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
- It is recommended that you shower the night before or morning of the operation.
- If you have difficulties moving your bowels, an enema or similar preparation may be used after consulting with your surgeon.
- After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
- Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
- Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
- Quit smoking and arrange for any help you may need at home.
HOW IS THE PROCEDURE PERFORMED?
There are few options available for a patient who has a hernia.
- Use of a truss (hernia belt) is rarely prescribed as it is usually ineffective.
- Most hernias require a surgical procedure.
The open approach is done from the outside through a three to four inch incision in the groin or the area of the hernia. The incision will extend through the skin, subcutaneous fat, and superficial fascial layers; this allow the surgeon to get to the level of the defect. The hernia contents are then reduced back into the abdomen. The surgeon in most cases will choose to use a small piece of surgical mesh to repair the defect or hole. This technique is usually done with a local anesthetic and sedation but may be performed using a spinal or general anesthetic.
WHAT SHOULD I EXPECT AFTER SURGERY?
- Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
- Once you are awake and able to walk, you will be sent home.
- With any hernia operation, you can expect some soreness mostly during the first 24 to 72 hours.
- You are encouraged to be up and about the day after surgery.
- You will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.
- Call and schedule a follow-up appointment within 2 weeks after you operation.
WHAT COMPLICATIONS CAN OCCUR?
- Any operation may be associated with complications. The primary complications of any operation are bleeding and infection but these are uncommon with inguinal hernia repair.
- There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.
- Difficulty urinating after surgery is not unusual and rarely may require a temporary tube into the urinary bladder for as long as one week.
- Any time a hernia is repaired it can come back. The long-term recurrence rate is less than one percent. Your surgeon will help you decide if the risks of inguinal hernia repair are less than the risks of leaving the condition untreated.
- The pain patients may have experienced prior to surgery is usually resolved but some patients continue to have groin pain postoperatively.
WHEN TO CALL YOUR DOCTOR
Be sure to call your physician or surgeon if you develop any of the following:
- Persistent fever over 101 degrees F (39 C)
- Increasing abdominal or groin swelling
- Pain that is not relieved by your medications
- Persistent nausea or vomiting
- Inability to urinate
- Persistent cough or shortness of breath
- Purulent drainage (pus) from any incision
- Redness surrounding any of your incisions that is worsening or getting bigger
- You are unable to eat or drink liquids