Open Inguinal Hernia Repair

What Is an inguinal hernia?

An inguinal hernia is a protrusion of fatty tissue or sometimes a part of the bowel through a weakness in the muscles of the groin in an area known as the inguinal canal. Inguinal hernias are more common in men and become more common with age. Muscles become weaker with age allowing a hernia to develop. Hernias can occur at any age and there may be a genetic reason why some individuals might be prone to developing one particularly at a young age. Sometimes a hernia can appear suddenly and may be caused by a period of excessive straining such as with heavy lifting, straining to go the toilet i.e., constipation or with a prolonged cough.

Symptoms are present in about two thirds of affected people. This may include pain or discomfort especially with coughing, exercise, or bowel movements. The swelling often appears on standing or exertion and tends to disappear when lying down. Most people describe their symptoms including the swelling as getting worse throughout the day but go away after a night’s sleep.

When is an inguinal hernia repair recommended?

For small hernias that are not causing any symptoms a surgical repair may not be necessary. All surgery carries the risk of complication so for some patients watchful waiting is advised. A hernia repair is usually advised if a hernia becomes symptomatic i.e., starts enlarging causing discomfort, or generally interfering with the activities of daily living. The inability to ‘reduce’ or push back the bulge into the abdomen usually means the hernia is ‘incarcerated’ this requires urgent treatment.   

There are different techniques for repairing an inguinal hernia. These involve either open or laparoscopic (also known as keyhole) approaches. Your surgeon  will discuss the options with you. Open surgical repair of an inguinal hernia usually involves pushing back any bulge and strengthening the abdominal wall muscles usually with a synthetic mesh.

What does the procedure involve?

When patients arrive at the hospital, they will meet a nurse, the anaesthetist and their surgeon. Most open inguinal hernia repairs are carried out under a general anaesthetic. Some hernias are suitable for repair under a local anaesthetic instead and the surgeon may discuss this option with you. An open repair involves making a small incision in the groin over the site of the hernia. The hernia is then found between the muscles it is separated from the surrounding tissues and replaced within the abdomen. The muscle layers are then reinforced with a soft, synthetic, non-absorbable mesh which is fixed in place with a few stitches. The individual layers of the incision are then repaired. The skin is closed with an absorbable sub-cuticular or “invisible” stitch so that there is no need for stitch removal afterwards. The operation itself takes around 30 minutes to complete. Patients are usually able to go home later the same day.

What are the potential risks and complications?

Wound infections are uncommon after this type of surgery. When they do occur patients may need a course of antibiotics. Sometimes bruising may occur around the wound or a swelling develop beneath the wound. This is usually blood and / or tissue fluids which accumulates in the space where the hernia was. The fluid will normally gradually resolve. Very occasionally a collection of fluid may need to be drained.

You should contact your doctor if after the operation you develop any of the following: 

• Redness around or drainage from the incision
• Fever
• Bleeding from the incision
• Pain that is not relieved by medication or pain that suddenly worsens

Some patients, particularly men, can find it difficult to pass urine after a hernia repair. It is always important to tell your surgeon, before coming into hospital, if you are experiencing any difficulties passing urine.

Occasionally a catheter may need to be passed if a patient is unable to pass urine and if that is necessary patients usually will have to stay overnight before the catheter can be removed the next day. After an open procedure some patients might experience some numbness or a slightly odd sensation in the skin below the scar and this can extend to the upper part of the scrotum. This happens when a nerve is bruised or damaged during the procedure. In many cases the numbness will improve over period of time. A few patients may continue to experience pain in a hernia wound that does not settle down straightaway. We think that this may occur if a nerve is trapped in the mesh material, a suture or the scar. A course of physiotherapy can be helpful initially and sometimes a local anaesthetic and steroid injection will relieve symptoms. It is very rare that a wound need be re-explored because of pain. A small number of patients may develop a recurrence of the hernia. Recurrences are far less common these days with the use of mesh but nevertheless can occur occasionally.

After the procedure

We encourage all patients to stay active following surgery. Walking regularly is the most useful exercise after the operation. Following the operation patients should avoid heavy lifting for four to six weeks. After about 4 weeks patients should be able to increase their exercise activities. Starting with gentle rhythmic exercises such as cycling or cross-training and gradually building up to their normal exercise regimen. Provided there are no wound problems swimming can also be good at this stage. Patients should be able to return to work within one or two weeks but if their job involves any strenuous activities, they may need to be off work for longer or carry out only light duties. Patients can usually drive again after one to two weeks but the surgeon will provide specific instructions regarding this.