Patient Information Leaflet

Inguinal hernia

Background:

An inguinal hernia is an abnormal bulge in the groin. The hernia is a defect (hole) in the abdominal wall through which either fat or the intestines can protrude. This can occur on one side or can appear in both groins. The hernia will usually disappear on lying down and be more noticeable on lifting or coughing. The majority of inguinal hernias occur in men.

An inguinal hernia can cause discomfort in the groin, particularly after exercise or standing for long periods of time. Rarely the hernia can become stuck and cause pain, necessitating emergency surgery to repair a strangulated hernia (approximate risk of 2-3%).

An inguinal hernia can be managed conservatively if asymptomatic, with the aid of a supportive belt if required. A hernia will always be present and can grow in size with time. At your consultation we will have discussed whether surgery is in your best interests.

Surgery:

The benefits of surgery are to provide relief from any pain or discomfort and to prevent any complications from strangulation of the hernia.

Surgery is a daycase procedure under a general anaesthetic. The approach to repairing your hernia is either via an open technique or a laparoscopic approach. We will have discussed in clinic the best approach for your individual hernia. Either approach involves placing a piece of mesh (an inert polypropylene based mesh) into one of the layers of the abdominal wall.

Open approach:

A 4-6 inch (depending on your body habitus) cut will be made in your groin to expose and repair the hernia. The mesh will be secured in place with sutures.

The skin wound will be closed with dissolvable sutures beneath the skin and a glue will be placed along the length of the wound. In addition, a dressing may be applied over the wound. The dressing should be left in place for 5 days and you can shower but not bathe during that time.

As the wound heals you will notice a ridge of tissue directly beneath the scar, this is to be expected and is part of the body’s reaction to the operation. It will resolve between 2-3 months.

Laparoscopic Approach:

There will be three small cuts on your lower abdominal wall, an inch cut directly below the belly button and two smaller button hole size cuts below that. This allows ports to placed into the space that we will be operating in. Carbon dioxide gas is then used to create and maintain the space for the surgery, this is released at the end of surgery. Occasionally patients report some shoulder pain for 24hours, due to diaphragmatic irritation from the gas.

The space where the mesh is to be placed can be approached as indicated in the diagram below. The mesh is usually fixed in place with an inert glue, very occasionally a metal tack is used to fix a large sac if present.

TEP: the hernia is approached by dissecting above the peritoneal cavity.

TAPP: the hernia is approached by entering the abdominal cavity and incising the peritoneum to gain access to the hernia and its contents.

The small wounds are closed with dissolvable sutures and skin glue. You can shower but not bathe for 5 days after surgery.

Risks and Complications:

The complications of hernia surgery are bleeding, pain, infection, hernia recurrence (1-5% lifetime risk), chronic pain (estimated at between 3-4%), bruising and haematoma formation. There is a risk of urinary retention necessitating the need for a urinary catheter, this is more common in bilateral hernias.

There is the possibility of developing a deep vein thrombosis after surgery, so early mobility is important. There are rare cases of ischaemic orchitis at 0.5% (death of the testicle) and damage to the vas deferens (0.3%) that can affect fertility.

It is not uncommon to have some discomfort in the weeks following surgery and this can last for 2-3 months after the operation. The mesh will stimulate your body to create scarring and this scarring needs time to adapt to your daily activities. The discomfort can be in the wound itself or can spread to the testicle on the side of the surgery.

If you experience any issues or concerns during the post-operative period, please contact the hospital you had your surgery at on the contact number provided to you on your discharge. Alternatively, my secretary can be contacted by email (secretary@sussexsurgeon.com) or phone 07963 466976. Her working hours are between 09:00 to 16:30 Monday to Friday, except Wednesday.

Post-op activity levels

You are free, and encouraged to do so, to walk as far as you feel comfortable. The distance you can walk will increase with time. You will be able to walk up and down stairs.

I would advise that you do not drive until you can confidently and safely perform an emergency stop in your car. This is likely to be at around 4-5 days after surgery, but will vary from individual to individual.

I would like you to avoid any strenuous exercise, particularly anything that involves straining or heavy lifting, for 4 weeks. The reason for this is to allow the mesh time to become fixed in place.

I am happy for you to return to work when you feel comfortable to do so, if you have an office-based job. You may want to consider working from home for the first week after surgery. If you have a physical job, I request that you are placed on light duties for the four weeks that follow your surgery. We can provide you with a sick note if required by your employer.

Andrew Day