Inguinal Hernia Surgery

What is an inguinal hernia?

Inguinal hernias are the most common type of hernia. They can be the result of a defect from birth or due to a weakness developing in the groin over time. They are best described as a swelling in the groin area, which is more prominent on standing or straining. Hernias may disappear on lying down.

Hernias, which do not cause symptoms, do not always need to be fixed. However, they often increase in size over time and this makes it more likely they will become symptomatic. As a result, the majority of patients with inguinal hernias opt for surgery.

In larger hernias, the swelling may contain bowel. There is a small risk of part of the bowel becoming trapped or damaged within the hernia. In males, the hernia can extend into the scrotum. Larger hernias should generally be repaired and if very symptomatic (painful) should be fixed urgently.

Surgical hernia repair

The LSG specializes in inguinal hernia surgery in London, Hampshire and Surrey. Repair involves using a synthetic mesh to reinforce the tissues and provide extra strength to the groin. This can be done with either open (groin incision) or keyhole surgery depending on the size, type and location of the hernia. Patients with hernias on both sides will be preferentially fixed with keyhole surgery.

Laparoscopic (keyhole) repair – Three small cuts are made in the abdominal wall to allow the passage of the camera and instruments. The hernia is repaired using synthetic mesh and keyhole fixation devices. The cuts are repaired with dissolvable sutures and a local anaesthetic is given. A waterproof dressing is placed over the sites so you can shower straight away. Dressings should be used for 5-7 days.

More information on Laparoscopic Surgery

Open hernia repair – This technique is often used in either small uncomplicated one-sided hernias or in very large defects when the hernia extends into the scrotum. In large hernia repairs, the recovery time can be longer and will be dependent on the type of repair required. Your surgeon will discuss this with you, as it will vary on a case-by-case basis. Again, dissolvable sutures are used and a waterproof dressing placed over the wound. For open repair of small hernias there is minimal difference in recovery time from keyhole surgery. A small incision is made and recovery time should be short.

There have been some controversies in the use of mesh in different types of surgery (particularly gynaecological procedures). The vast majority of hernia repairs in the UK involve the use of mesh and its use is supported by national and international hernia societies. For an article on the use of mesh in hernia repair click here.

What happens prior to surgery?

The secretary and hospital will organise a day for the procedure and give you the admission details. Routine blood tests and a heart tracing (ECG) may be required before admission. You will be asked not have anything to eat up to six hours prior to surgery. Water can be taken up to 2 hours prior to the surgery. The surgeon will go through the procedure again with you on the day and take your consent. The anaesthetist will also visit to discuss the general anaesthetic and your post-operative pain relief. It is not uncommon for patients to require some anti-sickness medications after a general anaesthetic.

How long will it take for me to recover from surgery?

Straight forward hernia repair is usually performed as a day-case procedure. If the procedure is carried out late in the day or if there are any other medical concerns then an overnight stay may be required. You will be discharged once you are mobile, have passed urine and are comfortable. Most patients require 3-4 days of simple pain medication but should be functional for day-to-day activities during this period. Some patients return to work after this, but it will depend on the type of repair and your occupation. Heavy lifting and strenuous exercise should be avoided for 6 weeks following surgery. A staged return to normal activities will be discussed with you at the follow-up appointment.

Which medications will I require after surgery?

You will be discharged from hospital with a supply of simple painkillers with instructions on how to use them. Regular paracetamol is particularly effective and can be combined with an anti-inflammatory (ibuprofen) or codeine-based drug (dihydrocodeine). Anti-inflammatories are not suitable for all patients and should be taken with food. The codeine-based drugs can cause constipation and should be taken with plenty of fluids. Most patients do not require regular painkillers after 5-7 days.

When can I return to work?

Generally, it is recommended to take one to two weeks off after surgery. Your ability to return to work will depend on your job and varies between individuals. Remote working obviously makes it easier to return to some work activities earlier. We would not recommend flying immediately after surgery. This should be discussed on a case-by-case basis with the consultant.

When can I return to normal activities?

Day to day activities including light lifting can begin immediately after surgery provided you are comfortable. Strenuous activities (heavy lifting, weights in the gym, HIIT training, contact sports) should be avoided for 6 weeks and reintroduced in a stepwise manner. There are usually no restrictions on lifestyle or activities after a hernia has been repaired once recovery is complete (beyond 6 weeks).

When can I drive?

Driving should be avoided in the first week after surgery. Once you can perform an emergency stop in a stationary vehicle and turn to view your blind spot then driving should be safe. It is preferable to contact your insurance company to check for any specific instructions they may have.

What are the risks?

Straightforward repair carries a very low risk of the hernia returning (1-2%). There may be some numbness in the region of the scar which often resolves over time. There should be no effect on sexual or urinary function. In more complicated cases for recurrent or very large hernias, there is a small risk to the blood supply to the testicle on the side of the hernia. Your consultant will discuss this with you if appropriate. A small number of patients develop chronic discomfort in the groin after repair. This can happen after any kind of surgery (not just hernia repair) and can be because of other pre-existing musculo-skeletal issues in the groin (or hip) or rarely the result of nerve entrapment or irritation. We tend to use lightweight meshes and dissolvable fixation devices to minimise the chances of longer-term pain.

Who do I contact if there are concerns?

The group practice telephone is answered in working hours and messages can be left out of hours. Any concerns will be relayed directly to one of the consultant surgeons on receipt. The hospital ward also provides a 24/7 means of contact. They will contact the consultant about any concerns and are able to give advice if required.

For more information on inguinal hernia surgery in London, or inguinal hernia surgery in Hampshire or Surrey please contact us on Davies@londonsurgicalgroup.co.uk