Groin Hernia Repair

Inguinal and Femoral

The Condition 

A hernia occurs when tissue bulges out through an opening in the muscles. Any part of the abdominal wall can weaken and develop a hernia, but the most common sites are the groin (inguinal), the navel (umbilical) and a previous surgical incision site. 

Common Symptoms 

• Visible bulge in the scrotum or groin area, especially with coughing or straining 
• Pain or pressure at the hernia site 

 

Treatment Options 

Surgical Procedure 

Open hernia repair: An incision is made near the site and the hernia is repaired with mesh or by suturing (sewing) the muscle closed. 

Laparoscopic hernia repair: The hernia is repaired by mesh or sutures inserted through instruments placed into small incisions in the abdomen. 

Benefits and Risks of Your Operation 

Benefits: An operation is the only way to repair a hernia. You can return to your normal activities and in most cases will not have further discomfort. 

Possible risks include: Return of the hernia; infection; injury to the bladder, blood vessels, intestines or nerves, difficulty passing urine, continued pain, and swelling of the testes or groin area. 

Risks of not having an operation: Your hernia may cause pain and increase in size.
If your intestine becomes trapped in the hernia pouch you will have sudden pain, vomiting, and need an immediate operation. 

Expectations 

Before your operation: Evaluation may include blood work and urinalysis. Your surgeon and anesthesia provider will discuss your health history, home medications, and pain control options. 

The day of your operation: You will not eat or drink for 6 hours before the operation. Most often you will take your normal medication with a sip of water. You will need someone to drive you home. 

Your recovery: If you do not have complications you usually will go home the same day. 

Call your surgeon: If you have severe pain, stomach cramping, chills, or a high fever (over 101°F or 38.3°C), odor or increased drainage from your incision, or no bowel movements for 3 days. 

The Hernia 

A groin hernia occurs when the intestine bulges through the opening in the muscle in the groin area. A reducible hernia can be pushed back into the opening. When intestine or abdominal tissue fills the hernia sac and cannot be pushed back, it is called irreducible or incarcerated. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. This is a surgical emergency.

There are two types of groin hernias: 

An inguinal hernia appears as a bulge in the groin or scrotum. Inguinal hernias account for 75% of all hernias and are most common in men.

A femoral hernia appears as a bulge in the groin, upper thigh, or labia (skin folds surrounding the vaginal opening). Femoral hernias are ten times more common in women. They are always repaired because of a high risk of strangulation. 

Herniorrhaphy is the surgical repair of a hernia. Hernioplasty is the surgical repair of a hernia with mesh. 

Symptoms 

The most common symptoms are: 

• Bulge in the groin, scrotum, or abdominal area that often increases in size with coughing or straining. 
• Mild pain or pressure at the hernia site. 
• Numbness or irritation due to pressure on the nerves around the hernia.
• Sharp abdominal pain and vomiting can mean that the intestine has slipped through the hernia sac and is strangulated. This is a surgical emergency and immediate treatment is needed. 

Surgical Treatment 

The type of operation depends on hernia size and location, and if it is a repeat hernia (recurrence). Your health, age, and the surgeon’s expertise are also important. An operation is the only treatment for a hernia repair. Your hernia can be repaired either as an open or laparoscopic approach. The repair can be done by using sutures only or adding a piece of mesh. 

Open Hernia Repair 

The surgeon makes an incision near the hernia site and the bulging tissue is pushed back into the abdomen. Most inguinal hernia repairs use mesh to close the muscle. An open repair can be done with local anesthesia. 

For an open mesh repair: The hernia sac is removed. Mesh is placed over the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia site. Mesh plugs can also be placed into the inguinal or femoral hernia space. The mesh plug fills the open site and is sutured to the surrounding tissue. 

An additional mesh patch is applied and may or may not be sutured. Mesh is often used for large hernia repairs and may reduce the risk that the hernia will come back. The site is closed using sutures, staples, or surgical glue. 

For a suture-only repair: The hernia sac is removed. Then the tissue along the muscle edge is sewn together. This procedure is often used for strangulated or infected hernias or small defects (less than 3 cm)

Laparoscopic Hernia Repair 

The surgeon will make several small punctures or incisions in the abdomen. Ports (hollow tubes) are inserted into the openings. The abdomen is inflated with carbon dioxide gas
to make it easier to see the internal organs. Surgical tools and a laparoscopic light are placed into the ports. The hernia is repaired with mesh and sutured or stapled in place. The repair is done as a Transabdominal Preperitoneal (TAPP) procedure, which means the peritoneum (the sac that contains all of the abdominal organs) is entered, or the repair is done as a Totally Extraperitoneal (TEP) procedure. 

Nonsurgical Treatment 

Watchful waiting is an option if you have an inguinal hernia with no symptoms. Hernia incarceration occurred in 1.8 per 1,000 men who waited longer than 2 years to have a repair. Femoral hernias should always be repaired because of the high risk (400 of 1,000) of incarceration and bowel strangulation within 2 years of diagnosis. Trusses or belts can help manage the symptoms of a hernia by applying pressure at the site. A truss requires correct fitting and complications include testicular nerve damage and incarceration may result 

 

Preparing for Your Operation 

Home Medication 

Bring a list of all of the medications, vitamins, and any over-the-counter medicines that you are taking. Your medications may have to be adjusted before your operation. Some medications can affect your recovery and response to anesthesia. Most often, you will take your morning medication with a sip of water. 

Anesthesia 

Let your anesthesia provider know if you have allergies, neurologic disease (epilepsy, stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), or loose teeth; use alcohol or drugs; take any herbs or vitamins; or if you have a history of nausea and vomiting with anesthesia. 

If you smoke, you should let your surgical team know, and you should plan to quit. Quitting before your surgery can decrease your rate of respiratory and wound complications. 

The Day of Your Operation 

• Do not eat or drink for at least 6 hours before your operation. 
• Shower and clean your abdomen and groin area with a mild antibacterial soap. 
• Brush your teeth and rinse your mouth out with mouthwash. 
• Do not shave the surgical site; your surgical team will clip the hair nearest the incision site. 

What to Bring 

• Insurance card and identification 
• List of medicines 
• Loose-fitting, comfortable clothes 
• Slip-on shoes that don’t require that you bend over 
• Leave jewelry and valuables at home 

 

After Your Operation 

You will be moved to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be closely watched. Be sure that all visitors wash their hands. 

Preventing Pneumonia and Blood Clots 

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. 

When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and, for high-risk patients, taking a medication that thins your blood. 

Your Recovery 

Thinking Clearly 

If general anesthesia is given or if you are taking narcotics for pain, it may cause you to feel different for 2 or 3 days. You may have trouble remembering and feel tired. You should not drive, drink alcohol, or make any big decisions for at least 2 days. 

Nutrition 

• When you wake up from the anesthesia, you will be able to drink small amounts of liquid. If you do not feel sick, you can begin eating regular foods. 
• Continue to drink about 8 to 10 glasses of water each day. 
• Eat a high-fiber diet so you don’t strain while having a bowel movement. 

Activity 

• Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clot formation. 
• Patients usually take 2 to 3 weeks to return comfortably to normal activity.7 
• You may go home the same day after a simple repair. If you have other health conditions or complications such as nausea, vomiting, bleeding, or difficulty passing urine, you may stay longer. 
• Persons sexually active before the operation reported being able to return to sexual activity in 14 days (average). 

Work 

• You may return to work after 1 to 2 weeks after laparoscopic or open repair, as
  long as you don’t do any heavy lifting. Discuss the timing with your surgeon. 
• Do not lift items heavier than 10 pounds or participate in strenuous activity for at least 4 to 6 weeks. 
• Lifting limitation may last for 6 months after complex or recurrent hernia repairs 

Wound Care 

• Always wash your hands before and after touching near your incision site. 
• Do not soak in a bathtub until your stitches, Steri-Strips, or staples are removed.
  You may take a shower after the second postoperative day unless you are told not to. 
• Follow your surgeon’s instructions on when to change your bandages. 
• A small amount of drainage from the incision is normal. If the dressing is soaked with blood, call your surgeon. 
• If you have Steri-Strips in place, they will fall off in 7 to 10 days. 
• If you have a glue-like covering over the incision, just allow the glue to flake off on its own. 
• Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for them to heal. 
• Protect the new skin, especially from the sun. The sun can burn and cause darker scarring. 
• Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year. 

Bowel Movements 

Avoid straining with bowel movements by increasing the fiber in your diet with high- fiber foods or over-the-counter medicines. Be sure you are drinking 8 to 10 glasses of water each day. 

 

When to Contact Your Surgeon 

Contact your surgeon if you have: 

• Pain that will not go away 
• Pain that gets worse 
• A fever of more than 101°F or 38.3°C 
• Continuous vomiting 
• Swelling, redness, bleeding, or bad-smelling drainage from your wound site 
• Strong or continuous abdominal pain or swelling of your abdomen 
• No bowel movement by 2 to 3 days after the operation