Inguinal hernia repair
An inguinal hernia is a bulge or lump in your groin. Often it can be seen when standing and disappears when lying down.
A hernia is a general term used to describe where fatty tissue, or an internal part of the body such as the bowel, pushes through a hole or weakness in the muscle or surrounding tissue wall.
Inguinal hernias are more common in men. This is because of a small natural hole where the blood supply to the testicles leaves the abdomen and the sperm tube (the vas deferens) enters.
Causes of an inguinal hernia can include:
- severe coughing
- straining when going to the toilet
- lifting heavy objects
- being overweight
It is also possible for a hernia to happen for no reason at all.
Symptoms of an inguinal hernia
Not everyone who has a hernia has symptoms.
An inguinal hernia can be uncomfortable especially when you bend or lift. The lump can move into the scrotum (the bag that holds the testicles) making it swollen or sore.
Some people can feel a gurgling sensation in the lump.
Diagnosing an inguinal hernia
An inguinal hernia is diagnosed by the history and examination of a lump in the groin that goes away when lying flat and is bigger on coughing or straining.
Scans are not needed or helpful in most cases.
Treating an inguinal hernia
Although having a hernia is not usually a serious condition, hernias will not go away without having surgery to repair it. Untreated inguinal hernias can get bigger, more painful and more uncomfortable.
To repair a hernia the surgeon will operate and push the lump back into place, then cover it with a mesh patch to repair the hole. The wound is then stitched.
The mesh is placed with the layers of muscle in the tummy wall and not next to internal organs. Most surgeons only offer mesh repair for inguinal hernias as the success rate is so much better than non-mesh repair.
The operation takes about 45 minutes. Surgery is usually carried out as day surgery so you can leave hospital on the same day but occasionally people need to stay in hospital overnight.
If your hernia is small and not causing a visible bulge or lump, this usually does not need a repair. It can be repaired at a later time if a lump starts to appear. You can carry on with your normal activities.
Sometimes a hernia can become stuck out and very painful. This is referred to as a strangulated hernia and requires an urgent operation. This happens to about 2 in 100 people with an inguinal hernia per year.
If you are older and have serious medical conditions, for example with your heart or you have difficulties breathing, you and your doctor may decide to leave the hernia alone.
As an alternative to surgery, some people might try a 'hernia truss' or support. These may help a few people if they are not very fit or have decided against having surgery, but we do not routinely recommend them.
There are 2 ways surgery can be carried out.
Open surgery can be done under general, spinal (epidural) or local anaesthetic. A cut (about 10cm long) is made so that the surgeon can see and access the muscle.
Open surgery may be more suitable for you if you need or want surgery sooner as the waiting time is usually shorter.
We usually recommend open surgery if:
- you have a larger hernia
- you have previously had tummy (abdominal) surgery
- you have previously had keyhole surgery to repair an inguinal hernia
- your surgeon advises using a local or spinal anaesthetic
- you need an emergency hernia repair
Keyhole (laparoscopic) surgery
Keyhole surgery is always done under general anaesthetic.
The surgeon makes 3 small cuts (about 1 or 2cm long) in your tummy. A thin tube with a light and camera on the end (called a laparoscope) is passed down to your groin. The camera allows the surgeon to see inside your groin. The surgeon uses special instruments to push the bulge or lump back into your groin and the hole is closed with a mesh patch and stitches are used to repair the wounds.
Keyhole surgery may be more suitable if you have:
- a small hernia
- a hernia on both sides
- previously had open surgery to repair an inguinal hernia
- significant pain before surgery
- a very active lifestyle
Risks of having an inguinal hernia repair
Common (1 in 10 or more people)
Feeling sick (nausea). The anaesthetic can make you feel sick.
Bruising and swelling. Usually around the scar(s), in the groin and possibly the scrotum and/or penis. This will settle in 1 to 2 weeks.
Difficulty having a wee (urinary retention). Sometimes patients are unable to pass urine immediately after the operation. It is not a long term complication and we will make sure you pass a good amount of urine before you go home. It is more common in patients who already have urinary or prostate problems. Sometimes a temporary catheter tube needs to be inserted.
Pain and numbness. Some discomfort after surgery should be expected and will improve with time but some patients will develop ongoing pain and/or numbness in the groin after surgery. This chronic groin pain happens in about 5 to 10 in 100 people. It is more common for patients who have small hernias, had open surgery and those with severe pain before surgery, and further treatment may be required.
Less common (1 to 2 in 100 people)
Bleeding. More common if on blood thinning medicines.
Haematoma. A collection of blood under the wound or at the hernia site. Will usually get better over time but occasionally needs another operation
Seroma. A temporary build-up of fluid in the wound or hernia site. Usually gets better without treatment.
Recurrence. As with any type of hernia repair, there is a risk that the hernia may can come back in the future.
Wound infection. An infection inside the tummy or in the wound.
Rare (less than 1 in 100 people)
Mesh infection. An infection of the mesh is very rare (1 in 500 people). You may need further treatment.
Testicular problems. It's common to have slightly swollen testicles for a few days after the operation. Rarely the testicles become very painful which may be caused by damage to the blood supply to the testicle and the testicle later shrinks in size.
Injury to blood vessels and other organs. This is more likely with keyhole surgery but still rare.
Injury to the vas deferens. It’s possible to damage the tube (called the vas deferens) that carries sperm from each testicle to the penis. If this happens, you might not be able to produce sperm.
Switching to open surgery. Your surgeon might start the operation using the keyhole method but then might need to cut open your groin part way through.
Risk of the anaesthetic. Having an anaesthetic is very safe and the risk of a serious complication is very low.
Preparing for a hernia repair
It is important that you follow the instructions given to you by your doctor or nurse. If you do not, we may have to cancel your surgery. Please read more about our day surgery theatres.
If you have children or care for an adult, please make arrangements for someone else to help you with this after your surgery. If you think this will be a problem, please contact us before your surgery.
You will need someone to escort you from hospital and stay with you for 24 hours after your surgery.
It is important that you stop smoking for at least 48 hours before your surgery to lower the risk of chest problems. Smoking can also delay healing because it reduces the amount of oxygen that goes to your wound. Coughing, caused by smoking, can interfere with the healing process.
We have a no-smoking policy at our hospitals. For your safety, we cannot allow you to leave the unit to smoke while you recover from your surgery.
Giving your consent (permission)
We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.
If you would like more information about our consent process, please speak to a member of staff caring for you.