What does the surgery involve?
Repair of groin hernias can be done open or laparoscopic depending on patient factors and choice as well as hernia type, size and presentation.
- Open repair is sometimes preferred for emergency presentations with incarcerated or strangulated hernias – inguinal or femoral
- Sometimes an open repair is the only option if you cannot have a general anaesthetic
- Open repair is associated with slightly more pain in the immediate post-operative period and a slightly longer recovery.
- The scar from an open hernia repair is usually hidden in the hairline but is longer than the laparoscopic incisions.
- There are three incisions for a laparoscopic repair: 12-15mm incision above the umbilicus and two 5mm incisions on either side of the umbilicus. These two incisions may be down the midline below the umbilicus instead.
- Groin hernia repair almost always involves using a mesh.
- A mesh is a piece of synthetic (or less commonly biological) material which is used to support the weak tissues around a hernia. Groin hernial defects are usually not closed as this could create too much tension (with the exception of open repair of small femoral hernias). A mesh is placed either underneath (sublay) or on top (on-lay) of the defect. The best type of repair is one where the mesh is in the sub-lay position.
- Mesh position makes laparoscopic hernia repair superior to an open repair. In an open repair, the mesh is placed on top of the defect (on-lay). In a laparoscopic repair, the mesh is place underneath the defect (sub-lay)
- Sub-lay position is associated with reduced recurrence rates.
What are the risks of surgery?
Surgical procedural risks can be divided into anaesthetic and surgical risks.
Anaesthetic risks are usually discussed with the patient by the anaesthetic team.
Surgical risks specific to groin hernia repair include:
Infection – of the wound, the mesh or inside the abdomen.
Bleeding – inside the abdomen or within the wound (hematoma).
The risk of recurrence depends on patient factors and surgical factors. It increases with increased patient weight, size of hernial defect, smoking, increased intra-abdominal pressure by straining, lifting or coughing. Surgical factors include the position and size of the mesh, type of suture material used, post-operative complications such as bleeding or infection. The risk of recurrence is usually less than 5%.
Many patients experience occasional tingling or brief discomfort for a variable time after surgery. However, about 4% of patients can have significant chronic pain persisting beyond six months after surgery. This can be very difficult to treat. This is why hernia repair should only be performed when a true hernia is present clinically rather than just on an ultrasound report.
Following an open inguinal hernia repair, a sensory nerve may be divided (inadvertently or on purpose). The nerve is called the ilio-inguinal nerve. It supplies a small area of sensation over the inner thigh and the outer scrotum. If the nerve is likely to get caught in the mesh repair, some surgeons opt to divide it to prevent chronic pain.
Other risks of surgery include:
- Deep venous thrombosis or DVT: formation of blood clots in the legs. This risk is reduced by wearing compression stockings (called TEDS), injection of blood thinning medications (Clexane) and mechanical calf-compression.
- Chest infection: This is prevented by adequate pain-relief, deep breathing, early mobilization and chest physiotherapy. This is unlikely following groin hernia surgery.
Take regular Panadol (as long as there are no medical reasons for you not to take it such as an allergic reaction or liver disease).
Non-steroidal anti-inflammatory medication such as Neurofen and Voltaren can also help with pain and inflammation but should be taken on a full stomach. Take these for the first 3-5 days as required.
Stronger pain killers such as opioid anaelgesics (Endone, Codeine) should be taken sparingly as they can cause constipation which results in more straining.
You can have a normal diet once you are awake from the anaesthetic.
Some patients may have trouble passing urine after groin hernia surgery.
To avoid this, ensure you have adequate pain relief, are not constipated and can get up for a walk (under supervision initially – see below).
You will be able to walk normally despite some discomfort. It is important, however, that you are supervised the first time you get out of bed. This is especially important after an open groin hernia repair as the local anaesthetic may temporarily affect important motor nerves in the thigh and result in a fall.
Dressings are usually in two layers – Steristrips with a padded-Opsite on top.
These are waterproof so you can shower but cannot swim or have a bath for 2 weeks or until after your follow up wound review.
The top dressing stays on for 5-7 days.
Once the top dressing comes off, leave the Steristrips on for a few more days until they start to peel off by themselves.
You should avoid any heavy lifting or straining for at least 6 weeks after surgery to avoid hernia recurrence.
Following single side groin hernia surgery, you are likely to be discharged home on the same day. You may be admitted overnight if you are aged >70, have a history of urinary retention, are in significant pain or where the procedure finishes late in the evening.
Following surgery on both groins (bilateral), you will be admitted overnight.
A wound review by your surgeon or local doctor is advisable 1-2 weeks after surgery.
The appointment is usually made for you before leaving the hospital.