What is a hernia?
If a hernia has been present for a long time, then it can become very large, and in a man can even fill the scrotum. When this happens, it may stay out most of the time, and prove very difficult to push back.
Inguinal hernias are less common in women than men but another kind of hernia (a femoral hernia) is commoner in women than men, and can usually be distinguished by specialist examination. Repair is almost always advised for femoral hernias because there is greater risk of complications caused by the hernia becoming trapped (strangulated).
Is a hernia harmful?
How can a hernia be treated?
an incision in the groin (“Open repair”) or by laparoscopic (keyhole) surgery which is done through three small incisions. Operation is usually advised because a hernia will not go away and may get larger: it can cause inconvenient symptoms and there is a small danger of strangulation. If a hernia is causing no problems, then an operation is not essential, and you can discuss the need for operation with the surgeon.
A truss (a supportive undergarment) can be used to hold a troublesome hernia inside while you are up and about. It is essential that it is put on before you get up, and while the hernia is not bulging out. In general, an operation is a much better treatment for any hernia which is causing symptoms. Since local anaesthetic can be used, and general anaesthetics are very safe nowadays, advanced age or medical problems should not usually prevent any troublesome hernia from being repaired by an operation.
How is a hernia repair operation done?
Principles of hernia repair
As described above, hernias may be inguinal or femoral. They may be new (primary) or recurrent (after a previous repair operation). They may be in male or female patients. All of these things contribute to the type of operation which is suggested (or to the suggestion not to have an operation) A new (primary) hernia on one side in a man will usually be repaired through at an open operation through an incision in the groin (usually 6-12 cm long). This can be done under either local or general anaesthetic as a day-case procedure in a community hospital. A new (primary) hernia on one side in a woman will usually be repaired with a laparoscopic (keyhole) operation. This is because of the greater incidence of femoral hernias in women, which may be missed during an open operation. First time hernias in both groins or recurrent hernia will usually be repaired with a laparoscopic (keyhole) repair. Some surgeons offer laparoscopic (keyhole) repairs to individuals (male or female) for one- sided primary hernias because it may lead to an earlier return to normal activities.
It is important to be aware that:
- Laparoscopic repair is not always possible if a patient has a previous history of low abdominal or pelvic surgery (appendicectomy, prostate surgery, hysterectomy etc.). Your surgeon will advise you about this.
- Laparoscopic hernia repair can only be performed once due to scarring after the procedure.
- If laparoscopic repair is performed for a primary hernia on one side and a hernia develops later on the other side, or if the repaired hernia recurs, laparoscopic repair will not be an option.
- Occasionally the surgeon will need to convert from a laparoscopic repair to an open repair during surgery for technical reasons.
Laparoscopic repairs (‘keyhole surgery’)
What about the anaesthetic?
Will I have any stitches?
What about the recovery?
This depends on how fit you are, who is at home with you, and how comfortable you are after the operation. A plan may be made for you to go home on the day of operation, but you may stay in hospital one night after a hernia repair (occasionally longer if you are unfit or live alone). In general you can go home as soon as you feel able to do so.
Pain and painkillers
Bathing and showering
Work, sport, and heavy lifting
You can get back to sport and other physical activity as soon as your discomfort allows. It is sensible to start these activities gradually, and work your way back to full fitness. Violent or contact sports are best avoided for about one month. Avoid very heavy lifting for a month.
What problems can occur after a hernia operation?
Bruising, swelling, and hardness are common in the area the hernia repair. They are caused by the fluid and blood clot under the wound, pulling together of the tissues by stitches, and later by the formation of scar tissue. This will all settle with time. Sometimes bruising may go down into the genitals, which may become black and blue.
This is simply the easiest direction for bruising to go after a hernia repair, and it will all return to normal.
Sometimes bruising can be very extensive. Occasionally bleeding from a small blood vessel under the skin or near the repair can produce a collection of blood, visible as a bulge under the wound (a haematoma). This may settle slowly on its own, but sometimes needs to be let out by a further operation. If a bleeding spreads down into the scrotum, some swelling may remain around the testicle for a long time.
After laparoscopic hernia repair you may develop a lump at the site of the previous hernia. This does not necessarily indicate that the operation has failed. It is fairly common to develop small collections of blood in the space from which the hernia was removed. These settle by themselves, initially becoming hard and painless then disappearing altogether. Rarely a patient can bleed into the pelvis after a laparoscopic hernia repair because of the amount of dissection required. If this happens, the patient will be transferred or readmitted and advised further.
Patients can develop shoulder-tip pain for up to 24 hours after laparoscopic surgery which should settle with the painkillers given.
Risk to the testicle
Deep vein thrombosis (DVT)
Recurrence (the hernia coming back)
If – after the operation – you have difficulty passing urine, you should contact your emergency doctor for advice. This may occasionally require the insertion of a urinary catheter through the penis for a couple of weeks until things have settled down.
The risks of a general anaesthetic
If you choose a general anaesthetic, this has some risks. Some of the risks are increased if you have chronic medical conditions, but in general they are as follows:
- Common temporary side-effects (risk of 1 in 10 to 1 in 100) include bruising or pain in the area of injections, blurred vision and sickness (these can usually be treated and pass quickly).
- Infrequent complications (risk of 1 in 100 to 1 in 10,000) include temporary breathing difficulties, muscle pains, headaches, damage to teeth, lip or tongue, sore throat and temporary difficulty speaking.
- Extremely rare and serious complications (risk of less than 1 in 10,000). These include severe allergic reactions and death, brain damage, kidney and liver failure, lung damage, permanent nerve or blood vessel damage, eye injury, and damage to the voice- box. These are very rare and may depend on whether you have other serious medical conditions.
What should I do if there is a problem?
Should you be unable to get urgent medical help from a General Practitioner, then come to the Emergency Department of the Royal Devon and Exeter Hospital. The surgical team who did your operation will always be prepared to see you at the request of your own doctor or the doctors who see you urgently in the hospital. If you attend hospital urgently, you may be looked after by a different surgical team initially. If there is any concern in the longer term, the surgeon responsible for your operation will see you in clinic at the request of your family doctor.