What is it?
A hernia is a weakness in the muscles of the front of the body wall. Usually, the bowel or some fat, and more rarely other organs, can push through this weak spot and create a bulge in the area. In this case the hernia is in the groin. Sometimes they are in both groins.
They can be caused by the body wall being weak from birth. Sometimes the body wall weakens with the passing of time. Other times, the body is overstrained by coughing, heavy work, multiple pregnancies or sport.
Hernias are very common and are easily treated. If left untreated, they get bigger and cause pain.
More dangerously, the bowel can sometimes get trapped in the weak spot of the muscles. This can cause a blockage of the bowel, which can eventually cause it to become strangulated and necrotic (where the blood supply is cut off). An emergency operation is then required to deal with the problem. For children, please see 'child's inguinal hernia operation'.
The groin is often numbed with local anaesthetic to reduce the pain you may experience when you wake up. However, it is also possible to have the groin numbed with a local anaesthetic and have the whole operation under local anaesthetic. In this case, you will be awake during the operation and you will feel that something is being done in the area of the operation, but you will not feel pain.
The operation can be done under local anaesthetic when the hernia is relatively small and your general medical condition doesn't allow you to tolerate the stress of a general anaesthetic.
A cut is made into the skin overlying the hernia. The bulge is freed from the surrounding tissues and pushed back or cut off. The weak part is mended/closed and strengthened using strong stitches.
Another alternative is to patch the weak spot with a piece of synthetic material. This is usually done when the tissues around the weak spot are not strong enough to be stitched up together with strong stitches or when the weak spot is so big that it is impossible to close it just by using stitches.
The synthetic patch is placed on top of the weak spot and is stitched to the healthy tissues around it. Soon, a lot of scarred tissue develops above and under the patch which makes it very strong and doesn't allow the hernia to come back again. The cut in the skin is then closed up.
The operation takes about 40 minutes. If you have a hernia in each groin, they can usually both be mended at the same time.
Keyhole surgery for hernia repair is only carried out in some specialised centres and for selective cases. It is carried out under general anaesthetic and there is no clear evidence at the moment that it offers a significant advantage compared to the traditionally performed operations. Ask your surgeon to explain his own method.
You may well be able to have the operation on the day you come in and go home the same day. You may need to stay in hospital for a day or two, if you are over 50, having trouble passing urine, have other illnesses, or if you cannot manage at home.
Simply waiting and seeing if you have more trouble is not a good idea. The hernia may get worse. A truss will usually hold the hernia back in place. It is useful as a stop-gap until you have the operation. It is a good idea if you do not like the idea of an operation, or if you are not fit enough for one.
Before the operation
If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control.
Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation.
Bring all your tablets and medicines with you to the hospital. On the ward, you will be checked for past illnesses and will have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.
You will have the operation explained to you and will be asked to fill in an operation consent form. Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.
Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.
After – in hospital
There may be some discomfort on moving. Painkilling tablets should easily control this discomfort. If not, you can have painkilling injections.
Many hospitals are now using what is called PCA (patient controlled analgesia). By pressing a button on a device you can inject painkillers into your bloodstream through a very fine plastic tube that goes into one of the small blood vessels (veins) in your hand. A small computer controls the amount of painkiller that is released and prevents any accidental overdose.
Alternatively, you may have a fine tube in your back through which pain relief can be given to help control the pain. By the end of one week the wound should be just about pain-free. The local anaesthetic in your wound may make your leg give way for 12 hours or so. Be especially careful when getting in or out of bed. Ask a nurse to help you.
A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during this time.
The discomfort of the operation can make it difficult to pass urine and empty the bladder. It is important that your bladder does not seize up completely. If you can't pass water, and this can sometimes happen soon after an operation, let the doctor or nurses know. It may be that you need a catheter (fine plastic draining tube) put in your bladder for a few days.
The wound may be closed with stitches or clips which need to be taken out 10 to 14 days after the operation. Sometimes there are stitches under the skin instead. These melt away and they don't need to be removed. A plaster on the wound makes it more comfortable.
You can wash, bathe, or shower but try to keep the wound area dry until the stitches or clips are taken off. If you only have stitches under the skin, try to keep the wound dry for a week. Soap and tap water are quite all right. Salted water is not needed.
Some hospitals arrange a check-up about one month after you leave the hospital. Others leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.
After – at home
At first discomfort in the wound will prevent you from harming yourself by lifting things that are too heavy. After one month you can lift as much as you used to lift before the operation. There is no value in attempting to speed the recovery of the wound by special exercises before the month is out.
You can drive as soon as you can make an emergency stop without discomfort in the wound, ie after about 10 days.
You may restart sexual relations within a week or two, when the wound is comfortable enough.
You should be able to return to a light job after about two weeks, and any heavy job within four to six weeks.
If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs.
The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
If you delay the operation and the bowel gets trapped in the weak spot of the hernia, or gets strangulated and necrotic, then you might become very ill.
It's worth bearing in mind that there's a higher risk of complications if you delay an emergency operation. However, every effort will be made to ensure that you are properly prepared to reduce the chances of complications.
Complications are rare and seldom serious. If you think that all is not well, please let the doctors and the nurses know.
Bruising and swelling may be troublesome, particularly if the hernia is large. The swelling may take four to six weeks to settle down.
Serious bleeding that might require another operation to stop it happens in less than 1 per cent of cases.
Infection happens in 1 to 2 per cent of cases and usually settles down with antibiotics in a week or two. The infection can cause more trouble in situations where the hernia was repaired with a synthetic patch. The patch is a foreign body and if it gets infected it makes it difficult to control the infection with the antibiotics. If this happens, you may require antibiotics for a longer period of time and, very rarely, you might need another operation to remove the patch. In this case, you will most probably need another operation in the future to repair the hernia again.
Extremely rarely (1 in 2000 cases) the bowel or other organs of the abdomen can be damaged during the operation and in if this occurs you will need another operation to fix the problem.
Aches and twinges may be felt in the wound for up to six months. About 1 to 2 per cent of patients experience some pain for longer than this (chronic incisional pain) and if this happens the doctors will discuss with you the best way to deal with the problem.
Overall, the chances of the hernia coming back again is about 3 to 5 in 100. The chances of the hernia coming back are higher if the hernia was very big, the patient is very obese, which puts a lot of tension on the area of the repair, or the patient's tissues are not very healthy and are not healing well, for example if the patient is elderly or diabetic.
Do leave yourself enough time to get over the operation. Practically all patients are back to their normal duties within one month.
We hope these notes will help you through your operation. They are a general guide. They do not cover everything.