Inguinal Hernia Surgery

How will my hernia be fixed?

The hernia can be fixed by an open repair or keyhole repair. The first question which comes to mind is that what anaesthesia will you have.

What Anaesthesia will I have?

Hernias can be repaired under local anaesthetic, and this is necessary in some patients because a general anaesthetic is considered a high risk and some patients choose to have a local anaesthetic as it is their personal preference. However, I recommend an operation under General anaesthetic as it more comfortable for the patient and can be performed faster. Local anaesthetic precludes the use of keyhole (laparoscopic surgery).

There are two types of operative approaches- open and keyhole (laparoscopic).

OPEN REPAIR

The open approach is a perfectly safe approach and in good hands associated with minimal pain/scarring. It is less invasive compared to the keyhole approach and the overall recurrence rate is 2 in a 100. The surgeon will make an incision (cut), usually over your hernia bulge. The hernial contents bulging through the abdominal wall are returned to where they belong and the defect is closed by stitches . In addition, the muscle wall around the hernia is strengthened and reinforced by placing a fine sterile synthetic mesh to prevent a hernia developing again. Subsequently the overlying muscle sheath, soft tissues and skin are closed with sutures. The skin sutures are usually absorbable. We do infiltrate local anaesthetic in the wound and sometimes do a nerve block to reduce pain.

Laparoscopic (keyhole surgery) repair- usually 3-4 small cuts in the abdomen. There are two types of Laparoscopic keyhole operations

TOTALLY EXTRAPERITONEAL (TEP) REPAIR

The hernia site is accessed between the layers of the abdominal wall, without entering the peritoneal cavity. TEP repair is considered to be technically more difficult than the TAPP technique, but it may reduce the risk of damage to intra-abdominal organs. The disadvantage is a slightly higher risk of pain.

This is my preferred approach laparoscopically.

TRANSABDOMINAL PREPERITONEAL (TAPP) REPAIR

TAPP involves access to the hernia through the abdominal cavity. The peritoneal lining is taken down followed by dissection of hernia. The mesh is placed in a preperitoneal pocket and then the peritoneum is reattached to the abdominal wall to cover the mesh.

The advantage of this approach is in bilateral hernias and in patients with diagnostic uncertainty. The disadvantage is a slightly higher risk of injury to bowel and risk of adhesions to mesh if exposed to bowel.

I only undertake this approach if the (TEP) approach is not possible due to previous pelvic or lower abdominal surgery and risk of adhesions.

COMPLICATIONS OF HERNIA OPERATIONS

As with all surgical procedures there are risks involved but steps are taken to minimise (reduce) these. Short term risks and complications may include:

• bleeding. You may develop bleeding inside your groin or from your wounds post operatively. If this occurs it will be treated accordingly. You may need a blood transfusion or another operation.
• bruising. A little bruising may develop around your wound sites. This is normal and will settle over time. wound infection. If you feel feverish or your wound becomes inflamed (hot and red) and sticky, you should see your GP. This can be treated with antibiotics and you will not usually need to be re-admitted to hospital.
• haematoma/collection. A collection of blood can sometimes develop at a wound site. This may require drainage.
• injury to surrounding structures. These can include bowel, bladder and blood vessels.  recurrence of your hernia. There is a chance that a hernia can recur in 2 patients in every 100 who have had a hernia repaired by the mesh method.
• retention of urine post operatively. After surgery a small number of patients may find it difficult to pass water immediately after surgery. If this does happen a urinary catheter may need to be passed to empty your bladder. This would be removed before you are discharged home.
• chronic pain/numbness. This can be felt round your operation site. This happens less often with laparoscopic surgery.
• scarring. You will have 1 – 4 small scars following keyhole surgery from the incision sites, dependent on the type of surgery you have.
• hydrocele. Male patients may experience a build up of fluid in the scrotum (testicles). This will improve with time, very rarely you may need an operation to treat this.
• ischaemia to testes. Male patients may develop this due to decreased blood flow to the testicles following surgery. This is rare. Depending on the extent of this you may need to return to theatre.
• mesh infection. If this were to happen you would develop inflammation (increased pain or discomfort around your wound). You can be treated with medication, but if it does not settle the mesh may have to be removed.
• deep vein thrombosis – DVT (blood clots in the leg veins) or pulmonary embolism – PE (blood clots in the lungs).

FAQs

Pre-assessment

How can I prepare for my operation?

Before any operation it helps to try and get as fit as possible as this helps in your recovery. If you are overweight, seek advice from your GP or practice nurse who will offer you support and dietary advice. Losing weight will help to reduce risks or complications during your anaesthetic and operation. If you smoke, it is advisable that you stop. Smokers are more likely to develop chest infections or blood clots after surgery. We realise this can be difficult, however, your GP, practice nurse and staff on the ward, are able to offer you advice and support.

What will happen after my operation?

After your operation you will be taken to the recovery room. Not everyone remembers waking up in the recovery room. Specially trained nursing staff will look after you until you are ready to return to your ward. If you have any pain or feel sick, let the recovery room nursing staff know. They will give you some medication to relieve it, so by the time you are transferred back to the ward you should feel comfortable.

Will I need to stay in the hospital?

Most people can have their operation as a day case patient and will not need to stay in hospital overnight. However if they are in pain or for medical /social reasons they may need to stay in hospital.

Discharge

Your discharge note will have to have stitches removed or dressings changed. A copy will also be sent to your GP. Please ask your nurse if you need a fit note. Simple painkillers will be given to you to take home.

When can I have a bath or shower again?

During the first week after your surgery you are advised not to soak in the bath. This is to help avoid a wound infection. Showering is advised.

When can I have sex again? You may have sex again when you feel comfortable unless you have been advised not to by your doctor.

When can I drive? You may drive as soon as you feel comfortable and are able to carry out an emergency stop. You should check with your insurance company for their advice on driving after keyhole surgery. When can I return to work? You may need to take 1 – 2 weeks off work. This will depend upon the type of work you do.

When will I be able to exercise? You must not do any abdominal exercises or heavy lifting for 8 weeks after your operation.

When will I be able to work again ?

Usually I would advise to take time off work for 1- 2 weeks. You may work from home when comfortable