What is Inguinal Hernia Repair?
Inguinal hernia repair is a surgical procedure performed for the treatment of a condition called an inguinal hernia.
A hernia is a bulge that has formed when the internal organs of the body push through a weak spot in the abdominal wall. An inguinal hernia, also known as a groin hernia, is a bulge that forms when a part of your small intestine or fatty tissue protrudes through a weak spot in the groin (area between the upper thigh and lower abdomen) or scrotum (muscular sac containing male testes). Symptoms may include pain, aching, discomfort, or heaviness in the affected area.
During a hernia repair surgery, your surgeon pushes the hernia back into the abdomen while stitching and strengthening the section of the weak abdominal wall with a synthetic mesh. This is performed either through an open surgery or a minimally invasive laparoscopic surgery.
Indications for Inguinal Hernia Repair
Your physician may recommend inguinal hernia repair when your hernia is causing pain and other associated symptoms that are affecting your daily activities. Sometimes the intestine gets trapped in the opening (incarcerated hernia) and blood flow gets blocked (strangulated hernia), leading to tissue damage and complications. This is a dangerous situation requiring emergency medical intervention. Symptoms of an incarcerated/strangulated inguinal hernia include:
- Fever
- Increased heart rate
- Sudden quick intensifying pain
- Reddish or bluish discolouration of the bulge
- Nausea and vomiting
Preparation for Inguinal Hernia Repair
Preoperative preparation for inguinal hernia repair will involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to the surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from medications such as blood thinners or anti-inflammatories for 1 to 2 weeks prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You should shower with an antibacterial soap the night or morning prior to the operation.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery has been explained.
Procedure for Inguinal Hernia Repair
Open Inguinal Hernia Repair
Open surgery, also called herniorrhaphy, for an inguinal hernia can be done under general or local anaesthesia. Your surgeon makes an incision of about 5-10cm long (depending on the size of the hernia) in the inguinal area to view and access the surgical site. Your surgeon pushes the part of the intestine that is protruding back into its normal position and repairs the weakened muscle layer by sewing the edges of the healthy muscle wall together. A synthetic mesh is often placed and sewn over the weakened area to provide additional support and strength, by a procedure called hernioplasty. The incision is closed after the procedure using dissolvable stitches.
Laparoscopic Inguinal Hernia Repair
Laparoscopic surgery, also called keyhole surgery, is a minimally invasive surgical method that uses a device called a laparoscope (a small thin tube with a light and tiny video camera connected to a television monitor), which helps visualise the internal organs during the operation.
The surgery is performed under general anaesthesia. Your surgeon will make several small incisions on your abdomen, through which a laparoscope and other special instruments will be inserted. Air or carbon dioxide is injected into the abdomen to inflate the abdominal cavity, enabling your surgeon to better visualise the internal organs. The video camera attached to the laparoscope will send magnified images to a monitor, which will guide the surgeon during surgery. Your surgeon will push the bulge into your abdomen and either stitch the abdominal wall (herniorrhaphy) or use mesh to support the weakened wall (hernioplasty). Once the repair is complete, the scope and other tools are withdrawn, and the small abdominal incisions are closed with stitches or surgical tape.
Advantages of a laparoscopic procedure over the open surgical method include shorter hospital stays, smaller incisions, less post-operative pain, and a faster recovery.
Postoperative Care Instructions and Recovery
In general, postoperative care instructions and recovery after inguinal hernia repair will involve the following steps:
- You will be transferred to the recovery area where your nurse will monitor your vital signs as your recover from the effects of anaesthesia.
- Most patients are able to go home the same day or the next day if it is a laparoscopic procedure or after two to three days if it is an open surgery.
- You may notice some pain, swelling, and discomfort in the inguinal area. Pain and anti-inflammatory medications are provided as needed.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- You are encouraged to walk with assistance as frequently as possible to prevent the risk of blood clots.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from strenuous activities, lifting heavy weights, and driving at least for the first few weeks. A gradual increase in activities over a period of time is recommended.
- Typically, you will be able to return to work and resume your daily activities in a week or two after surgery.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications of Inguinal Hernia Repair
Inguinal hernia repair surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection at the incision site or mesh
- Blood or fluid accumulation
- Bleeding
- Anaesthetic reactions
- Recurrence of hernia
- Deep vein thrombosis or blood clots
- Injury to surrounding structures
- Urinary retention
