Inguinal hernias are common; the lifetime risk for men is 27% and for women 3%. Operation rates vary between countries from 100-300 per 100 000 population per year meaning that worldwide over 20 million repairs of inguinal hernia are carried out each year.
Symptoms of inguinal hernia
Inguinal hernias usually present with a bulge in the groin or lower part of the abdomen. This may be not be painful but most people suffer discomfort. The lump may disappear when lying down and may not be as obvious when waking in the morning. Sometimes an inguinal hernia extends as far as the scrotum. Symptoms can be worsened when coughing, sneezing or when taking exercise. If they become larger they may contain intestine which leads to the risk of becoming stuck (incarceration), having it’s blood supply restricted (strangulation) or blocking the bowel (intestinal obstruction). These complications require emergency surgery.
Causes of inguinal hernia
There may be no obvious cause but inguinal hernias may be more common in association with heavy lifting, straining (constipation or difficulty in passing urine), pregnancy or with exercise.
Treatment of inguinal hernia
It is usually recommended that hernias are repaired to relieve symptoms and prevent the risk of complications (see below).
Inguinal hernia repair is a day case operation meaning that no overnight stay in hospital is necessary. These repairs are usually carried out under general anaesthetic. The Berkshire Hernia Centre offers different approaches to inguinal hernia repair;
1. The conventional (or open) approach involves a small incision just above the swelling. The weakness in the abdominal wall is repaired and a nylon mesh inserted to reduce the risk of the hernia coming back. The incision is closed with an invisible dissolving stitch.
2. A laparoscopic (keyhole) repair is carried out from within the abdomen (trans-abdominal preperitoneal, TAPP) or between the layers of the abdominal wall (totally extraperitoneal, TEP). Very small incisions are made in the abdominal wall to enable specialist keyhole instruments to be inserted. These are then used to repair the weakness and insert a nylon mesh.
Your surgeon will discuss these options with you.
You will usually have a pre-op assessment in the week before surgery where blood tests, chest X-ray and an ECG (heart recording) may be taken. You will be admitted a few hours before the approximate planned time of surgery having had nothing to eat for six hours before the start time (you may drink water up to two hours before your proposed time of surgery – with any of your regular medications). You will see your surgeon and the anaesthetist before your operation.
After your surgery you will wake up in the recovery room, and then be transferred back to the ward. Later the same day you may have something to eat and drink if you wish. Most people are discharged home later the same day.
You will be provided with painkillers before discharge but it is recommended that you take regular paracetamol and ibuprofen (unless you are sensitive to these) after a few days of these. Stronger painkillers such as cocodamol may be necessary but if so it is important to take a laxative such as lactulose at the same time. You can expect to have some discomfort for up to 3 weeks after surgery, but this will gradually subside and in fact most people are able to resume normal activities before this. It may be slightly more uncomfortable for longer if you have had an open procedure but most people are predominantly back to normal by six weeks. With both types of surgery there will still be minor twinges for many months as the tissues around the mesh organize themselves. You will be able to take gentle exercise but should avoid heavy lifting or strenuous work for 4 weeks. You may drive a car when you are able to perform an emergency stop safely. There are no stitches to be removed.
You will be seen for follow-up six weeks following your surgery.
Risks of surgery
There are very few potential complications.You may develop some bruising around your groin which can be extensive and may take several weeks to settle. You may also feel bloated for a few weeks. If the wound swells, becomes more painful and hot, or starts to discharge, you may have a wound infection and should contact the Berkshire Hernia Centre or your General Practitioner. The risk of recurrence is around 1-2% and of persistent numbness or ongoing pain about 1%.