Inguinal Hernia Repair Surgery Patient Information from SAGES

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About Your Inguinal Hernia:

Approximately 600,000 inguinal or groin hernia repair operations are performed annually in the United States. Some are performed by an open method. Some hernia repairs are performed using minimally invasive approaches, such as with a small telescope known as a laparoscope or with a robotic surgical system. If your surgeon has recommended a hernia repair, this brochure can help you understand what is an inguinal hernia and what are your treatment options.

What is a Hernia?

A hernia occurs when the inside layers of the abdominal wall 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 balloon like sac. This can allow a loop of intestine or abdominal tissue to push into the tear. In some patients, the hernia can cause discomfort, pain, or other potentially serious problems that require emergency surgery.

Both men and women can get hernias.

You may be born with a hernia (congenital), or develop one over time (acquired).

A hernia does not get better over time, nor will it resolve on its own. There are no exercises or physical therapy regimen that can cure a hernia. Control of some risk factors may help reduce symptoms from the hernia. Hernias may become larger over time if left unaddressed.

How Do I Know If I Have an Inguinal Hernia?

Most hernias are recognizable as a bulge under the skin in the groin. You may feel pain or discomfort at the hernia with certain activities, such as moving heavy objects, coughing, strain during urination or with bowel movements, and with prolonged standing or sitting. The pain may be sharp or dull and may get worse toward the end of the day.

Some hernias may be detected by your doctor on a routine physical examination or with imaging.

It may be normal for a hernia bulge to come and go. If the bulging is no longer reducible and is stuck out (incarcerated) or there is severe continuous pain, with redness and tenderness at the hernia (strangulated), then these are critical signs. These symptoms may be cause for concern and you must immediately contact your physician or surgeon or proceed to an emergency room for urgent evaluation.

What Causes an Inguinal Hernia?

The wall of the abdomen has natural areas of potential weakness. Hernias can develop in these or other areas due to straining, aging, injury, a prior incision, or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness, heavy lifting, persistent coughing, straining with bowel movements or urination, can cause the abdominal wall to weaken, tear, or separate in these areas.

Do All Inguinal Hernias Need To Be Repaired?

Inguinal hernias are generally repaired if they are causing symptoms which affect daily activities. Inguinal hernias which do not cause symptoms may be observed, though the majority will cause symptoms within a few years. Your surgeon may decide with you that elective surgery is not the best decision based on your medical conditions, and may prescribe a truss. A truss is an external belt which can hold the hernia in, thereby allowing you to continue with your daily activities.

What Are The Different Types of Inguinal Hernia Repair Surgeries?

Inguinal hernias may be repaired using either open or minimally invasive approaches.

What Are The Advantages Of Minimally Invasive Inguinal Hernia Repair?

Robotic and Laparoscopic Hernia Repair are techniques which use small incisions, specialized surgical instruments, and often the use of mesh. Patients undergoing minimally invasive repairs usually benefit from an easier recovery, shorter return to work and normal activity, as compared to open repair.

Are You A Candidate For Minimally Invasive Inguinal Hernia Repair?

Only after a thorough examination can your surgeon determine whether a minimally invasive hernia repair is an option for you. The operation may not be best for some patients, such as those with previous major abdominal operation or those with certain underlying medical conditions.

What Preparation Is Required?

In preparation for your operation, you will need a physical examination. You may need other tests to make sure you are healthy to undergo the operation with anesthesia.

The surgeon who will do your hernia repair will inform you about the risks and benefits of the operation. You will sign a form confirming you understand and agree to the planned operation.

Your surgeon’s office will advise you about what to do and avoid before your operation. The exact instructions depend on your surgeon, but here are some common things to do:

• Take a shower the night before or the morning of your operation. Your surgeon may ask you to use an antibiotic soap. Please DO NOT shave your belly or groin areas.
• Stop eating and drinking at the time your doctor tells you before the operation.
• The morning of your operation, you may take certain medications your doctor has allowed. Take them with only a sip of water.
• You may be asked to stop taking certain medications before your operation. These include blood thinners, certain supplements, and medicines that affect your immune system. Talk to your surgeon’s staff to clarify which of your medications and pills are safe to take.
• Smoking will increase the risk of the hernia recurrence (failure of the hernia repair), and the risk for infection. In some cases, your surgeon may require that you quit smoking at least 4-6 weeks prior to your operation in order to improve your outcomes.
• You will need someone to drive you home from surgery. Ask your doctor or nurse how much help you may need after you are home.

How Is The Operation Performed?

Inguinal hernia repair surgery can be performed under sedation, spinal anesthesia or general anesthesia. Minimally invasive inguinal hernia repair most often requires general anesthesia. You will meet the anesthesia team on the day of your operation.

The operation is performed in one of three approaches:

The open approach is an operation involving an incision in the groin or the lower abdomen. The incision will extend through the skin and fat, and allow the surgeon to get to the level of the muscle or fascial defect or hole. The hernia is repaired at this level. Often, the surgeon may use a piece of surgical mesh to cover the defect or hole. Your surgeon can talk to you about various repair options and the use of mesh. The skin and other tissue layers are then closed.

The laparoscopic approach is an operation involving multiple small incisions on the abdomen. The laparoscope (a camera), is inserted through a cannula (a hollow tube) placed in one of these incisions. Other cannulas are placed in the other incisions and your surgeon will then work “inside” using special instruments. The hernia is repaired from the inside. A piece of surgical mesh is placed to cover the hernia defect. The mesh may or may not be fixed in place using staples, tacks, adhesive sealant, or sutures. This operation is usually performed under general anesthesia.

The robotic approach is similar to the laparoscopic repair, except that the surgeon uses a robotic-assisted laparoscopic system and instruments to perform the operation.

Ask your surgeon for further details and which approach they would recommend for you.

What Happens If The Operation Cannot Be Performed Or Completed By The Laparoscopic Or Robotic Approach?

In some patients, the laparoscopic or robotic approach cannot be completed. Factors that may increase the possibility of choosing or converting to the “open” approach may include obesity, a history of prior abdominal operation causing scar tissue, inability to visualize critical organs, bleeding, or other problems during the operation. The decision to convert to the open approach is made by your surgeon either before or during the actual operation and depends on the surgeons’ judgement.

What Should I Expect After Surgery?

Most hernia operations are performed on an outpatient basis, and therefore you will probably go home on the same day of the operation.

After completion of the operation, you will be transferred to the recovery room where you will be monitored until you are fully awake, your pain is well controlled, and you can walk unassisted. Discharge criteria may vary based on your surgeon and the surgical facility.

With any hernia operation, you can expect some soreness during the first 48 hours, and in some, this can extend for more days.

You are encouraged to walk the day after surgery. You should discuss postoperative activity and restrictions with your surgeon. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.

Call and schedule a follow-up appointment as directed by your surgeon.

What Complications Can Occur?

Any operation may be associated with complications. The primary complications of any operation are bleeding and infection, which are uncommon with either an open or minimally invasive inguinal hernia repair.

There is a very low risk of injury to adjacent organs, including the urinary bladder, the intestines, blood vessels, nerves or the sperm tube and blood vessels going to the testicle.

Difficulty urinating after surgery can occur and may require placement of a catheter, or tube, to drain the bladder after surgery. If you have a history of urination difficulty or enlarged prostate, you should let your surgeon know in advance. If you have difficulty urinating after surgery, you must address this with your surgeon immediately.

Bruising and swelling of the incisions, scrotum, the base of the penis, the testicles, and the labia are not unexpected. This will resolve on its own.

Any time a hernia is repaired, there is a chance that it can recur (come back). The long-term recurrence rate after inguinal hernia repair is low in patients who undergo any approach for their hernia repair by an experienced surgeon.

Your surgeon will help you determine the risks and benefits of hernia repair as compared to no operation (watchful waiting).

Pain in the region of hernia repair may occur after surgery. If it does not resolve, there are various factors which may be the cause. Your surgeon can help determine how to address this.

When To Call Your Doctor

• Be sure to call your physician or surgeon if you develop any of the following:
• Fever over 101 degrees F (39 C)
• Chills
• Bleeding or other drainage from your incision(s)
• Foul smelling drainage (pus) from any incision
• Redness surrounding any of your incisions that is worsening or getting bigger
• Abdominal or groin swelling
• Nausea, vomiting, and/or inability to eat or drink liquids
• Inability to urinate
• Pain that is not relieved by your pain medications
• Cough or shortness of breath

This brochure is not intended to take the place of any discussion with your surgeon about your need for inguinal hernia surgery. We encourage that you contact your surgeon and their office staff if you have questions about your need for hernia surgery, alternatives, billing or insurance coverage, your surgeon’s training and experience, or any technical questions about the operation.