Inguinal Hernia Surgery

An inguinal hernia occurs when fatty tissue or intestine pushes through the weaker section of the abdominal wall into a region known as the inguinal canal. It will The hernia may manifest either as a lump or a swelling in the groin region or as an enlarged scrotum, which is the sac that holds the testicles. The swelling may cause pain. An inguinal hernia is more common in men as the muscles near the abdomen get weaker with age.

The surgery may be performed in the following ways:

• Open surgery: A cut is made through which the surgeon will push the lump back into the abdomen.
• Laparoscopic surgery: Also called as keyhole surgery, the surgeon makes multiple smaller incisions and passes special instruments through it to repair the hernia. It is a more difficult but less-invasive surgery. 

The recovery time after an inguinal hernia repair is generally six weeks, but within two weeks, most people start with light activities, driving and work.

This surgery may be recommended for people in whom the hernia is causing pain or showing symptoms, or is any complications develop due to an inguinal hernia. 

Inguinal hernia shows the following symptoms:

• A lump on either one or both sides of the groin that may disappear when you lie down
• An enlarged scrotum in men
• Pressure felt in the groin
• Sharp pain or discomfort when doing activities, such as lifting weight, exercise or straining while passing bowels, and improvement of pain while resting
• An aching, burning or gurgling feeling in the bulge

The following complications may arise due to an inguinal hernia:

• Obstruction: A part of the intestine gets stuck in the inguinal canal and causes stomach pain, vomiting, nausea and pain in the lump. 
• Strangulation: The blood supply of the tissue that is stuck in the inguinal canal is cut off. This condition requires emergency surgery to restore the blood supply and save the tissues from dying.

Although surgery can remove the hernia, there is a chance that it may reoccur.

Inguinal hernia surgery is recommended in the following conditions:

• Strangulated hernia - needs emergency surgery.
• If the hernia is a loop of the intestine (incarcerated hernia), the surgery should be performed at the earliest to prevent it from advancing to strangulated hernia. 
• If the hernia is painless and can be pushed back into the abdomen, and you are healthy, you may have the surgery to repair the hernia whenever it is convenient for you. In some cases, if the hernia is too small and painless, surgery is not required. 

Surgery is not recommended in the following conditions:

• In people with chronic illnesses, if the hernia is not of the strangulated or incarcerated type. 
• In case you have scar tissue in your liver (cirrhosis), there may be a fluid build-up in your abdomen (ascites); the fluid may cause the hernia to reoccur after surgery.
• If a person has undergone radiation therapy in the groin region, the recovery after the surgery would be poorer, and the risk of reoccurrence of a hernia would be higher.
• In men with an enlarged prostate that is causing them problems in urinating, the prostate should be treated before the hernia surgery is performed.

Your doctor will take your detailed clinical history, including any other conditions that you might have (any cardiac, respiratory or cerebrovascular diseases) and any previous surgeries. He/she will ask if you have any allergies to anaesthetics or disinfectants - this is done to reduce the chances of complications in the surgery. List out to the doctor all the medications that you are consuming. 

Some drugs, such as blood thinners, aspirin, anti-inflammatory medicines that may be needed for arthritis and vitamin E, need to be discontinued for some days before the surgery. Your doctor will inform you when you need to do so. 

Two weeks before the surgery, stop the use of St. John’s Wort and any diet pills. Before the surgery, you should also quit smoking as it may raise the risk of the hernia reoccurring after the surgery.

Your doctor will perform a physical exam and the following tests:

• Electrocardiogram 
• Chest x-ray
• Pulmonary function test 
• Abdominal ultrasound
• Laboratory tests, including blood count, coagulation analysis, glucose levels in the blood, electrolyte levels in the blood, urea and creatinine levels. 

He/she will also examine the site and size of the hernia and the skin at the site of the operation. 

Additionally, your doctor will:

• Inform you about the care required around the time of the operation. 
• Tell you about the procedure, along with all the risks involved. 
• Give you instructions for the day of the surgery.
• Ask you to sign a consent form allowing him to perform the surgery.

The night before the surgery, you will need to stop eating and drinking anything. You may take the medicines that you are allowed along with small sips of water. Also, you can take a shower the night before or in the morning of the surgery. Make sure to use antibacterial soap.

The operation generally lasts for 30-45 minutes. Based on the procedure used for surgery, you may be allowed to go home on the same day or may need to stay overnight. The surgery may be performed using one of the following methods:

Open surgery

The procedure for the surgery is as follows:

• You will be administered local anaesthesia into your spine. Thus, you will be awake but may not feel anything during the surgery as the area to be operated will be numb. In some cases, you may need general anaesthesia. It means you will be asleep during the procedure and will not feel anything. 
• Once the administered anaesthesia becomes effective, the surgeon will make a 6-8-cm long incision over the hernia. 
• Through the incision, the surgeon will place the lump of fatty tissue or part of the intestine back into the abdomen. 
• The surgeon may place a mesh in the abdominal wall to strengthen the weak area from where the hernia protruded. 
• Once the repair is done, the surgeon will seal the skin with stitches. These stitches generally dissolve in a few days after the surgery. 
• In case of strangulated hernia or if there was any damage to the intestine, the affected part may need to be removed, and the two ends of the intestine need to be re-joined. Open surgery is a more complex surgery, requiring a hospital stay for about four to five days.

Laparoscopic (minimally invasive) surgery: The procedure for the surgery is as follows:

• You will be given general anaesthesia prior to the surgery. 
• Through a small incision at the belly button, the doctor will insert a laparoscope (a thin tube that has a camera). This will enable him/her to see inside of your body on a screen in the operating room. 
• Your abdomen will be filled with carbon dioxide that will create space for the surgeon to view the internal structures.
• Through two other such incisions, special surgical instruments will be inserted into your abdomen, and the surgeon will pull the tissue back into your body.
• The inner lining of your abdomen will be cut, and a mesh will be placed to strengthen the weak abdominal wall. 
• Once the mesh is placed, the surgeon will seal the incisions with one or two stitches or surgical tape. 

Robotic hernia repair surgery:

• The procedure for robotic surgery is the same as the laparoscopic surgery.
• One significant difference between laparoscopic surgery and robotic surgery is that in the robotic surgery, the surgeon will be sitting at the console and controlling the surgical instruments from using the console. 
• Robotic surgery provides three-dimensional images of the internal structures; whereas, laparoscopic surgery provides only two-dimensional images.

You will be administered pain medication after the surgery. Rest and gentle movement will be encouraged. A nurse will help you move around. Depending on the procedure, you may either go home on the same day or in four to five days.

Take rest for two to three days after going home. You may ask a family member or friend to help you with your routine activities. 

For the first few days, there may be some bleeding and drainage at the incision site. You may apply some antibiotic ointment or solution if your doctor tells you to do so.

About 36 hours after the surgery, you may take a shower. If the incision is covered with gauze, remove it before you take a shower. If the surgery wound is covered with small pieces of tape (sterile-strips), you can get these wet in the shower. Use a mild soap with water to clean the surgery site. Gently pat the surgical wound dry. Around seven to 10 days after surgery, these tapes will start to peel. Once they start to peel, you may take them off. You may remove them before the follow-up visit. Do not have a bath in the bathtub, go swimming or sit in the hot tub for two weeks after the surgery.

To relieve pain, your doctor may prescribe narcotic pain medication, or you may be advised to have non-prescription pain medicines, such as paracetamol or ibuprofen. In the first few days after the surgery, you may apply a cold compress at the site of the incision for 15-20 minutes to reduce the pain and swelling. Place the cold compress or ice wrapped in a towel (and not directly on the site) to prevent cold injury. Do not drive if you take narcotic pain medicines.

The pain medicine may cause constipation. To help reduce constipation, eat foods that are rich in fibre and drink plenty of fluids. If it is not enough, take non-prescription fibre products for constipation.

You may resume your normal activities, such as walking, driving and sexual activities, when you feel ready. However, avoid performing strenuous activities for a few weeks. You will be asked not to lift any heavy weight (exceeding 4.5 kg) for four to six weeks. Try not to perform any activity that may strain the area of the surgery. Ask the surgeon before starting with any high-impact activities or sports.  

The benefit of the surgery is that it can remove the hernia and strengthen the abdominal muscles. Thus, it can help alleviate serious symptoms and prevent any major complications from occurring.

When to See the Doctor?

See the doctor if you have any of the following conditions:

• Bleeding at the incision site
• Persistent fever
• Increase in the groin swelling or abdominal swelling
• Persistent nausea or vomiting
• Constant pain despite taking medication
• Chills
• Inability to urinate
• Foul-smelling pus from the surgery wound
• Persistent cough or shortness of breath
• Inability to eat or drink
• Worsening of redness around the surgical wound

Although the surgery is relatively safe, few risks may occur. These include the following:

• Reoccurrence of hernia.
• Risk due to general anaesthesia (nausea, vomiting, sore throat, headache, stroke, heart attack, blood clots in the legs and pneumonia).
• Infection in the surgical wound.
• Bleeding inside the incision.
• Injury to internal organs, such as the bladder, intestine, kidneys, blood vessels supplying blood to the legs, reproductive organs and the nerves in the region where the surgery is done.

You will likely have a follow-up appointment with the doctor two weeks after the surgery. During the appointment, the doctor will check for infection in the wound and ask you about the pain. In complex cases, bandaging and dressing will also need to be checked to prevent infections. If there are any stitches on the skin, the doctor will remove the stitches. 

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.