Inguinal Hernia Repair

Most patient’s present with a lump in the groin. It is usually something that develops slowly, but some people describe a lump suddenly appearing after heavy lifting.
The lump gets bigger after a day of standing up and usually goes away when the patient lies down.
If the lump becomes suddenly painful, then it is possible that the hernia has become trapped. If this occurs, you should lie down immediately, try to relax and gently press over the lump to make it go back in. If the lump goes back in, you should contact your surgeon and let them know what has happened. If it does not go back in, or remains painful in any way, you should urgently attend the emergency department.

Once you have a hernia, there is nothing you can do to make it go away. As time goes on, they become progressively larger and more uncomfortable.
Groin support garments or trusses do not work and can make the hernia worse.
The most serious complication of not repairing a hernia is strangulation of a piece of bowel contained in the hernia. This may require a big operation to remove a piece of bowel.

There are two ways to fix an inguinal hernia

• Open technique
• Laparoscopic or “Key-hole” surgery technique (not suitable for everyone)

In my experience and in the literature, there is very little difference in recovery between the two techniques. Both methods are currently very acceptable.
In open inguinal hernia repair, a small cut is made over the lump. Then the contents of the hernia lump are reduced and placed back in the abdomen. A “tension free” repair is then performed to cover the hole that the hernia has come through. This is done by inserting a soft nylon “mesh”. This mesh acts like a frame, for your body to grow strong fibrous tissue into and repair the defect. The mesh used partially absorbs over time and you will not feel it.

Hernias may be repaired under general anaesthesia (completely asleep), regional anaesthesia (needle in the back to numb the legs but you are awake) or local anaesthesia (injections into the groin to numb the area, you are awake). Your anaesthatist will discuss this with you.

Specific Risks:

• Recurrence of the hernia: Occurs in approx. 1% of patients. No repair is perfect and the hernia may come back. You will require another hernia operation if this occurs. Commonly they come back, because the patient has continued to lift heavy objects in the post-op period or they are a smoker with a chronic cough.
• Nerve damage: this is rare. Occasionally patients may have chronic groin pain due to nerve entrapment in scar tissue.
• Infection: Wound infection is quite uncommon after surgery. If it occurs, it may require treatment with antibiotics. Very rarely infection of the mesh may occur. This may result in the need to remove the mesh at another operation.
• Bleeding: occasionally there is bleeding under the skin that requires a return to the operating theatre in the first few days after surgery.

It is also quite common for there to be some bruising around the wound. With time, this bruise may travel down and cause bruising on the penis and scrotum. This will get better.

• Urinary Retention: in is very common for men over 60 to have an enlarged prostate. Sometimes after hernia surgery, the symptoms of an enlarged prostate get worse and the patient cannot pass urine. This will require a urinary catheter to be inserted. This is usually temporary and normal urine flow will occur again a few days later. Occasionally though, it will result in needing a prostate operation. This is usually in patients with severe urinary symptoms before the surgery.
• Removal of the testicle: occasionally hernias are so large that the blood supply to the testicle is at risk during the repair. The surgeon must then make a decision whether or not to remove the testicle. You would usually be warned about this prior to surgery. You can live normally with one testicle, although your fertility may be reduced.
• Damage to the testicular artery: this is very rarely damaged during the surgery and may result in a painful swollen testicle. This usually gets better with no treatment.

General Risks:

• Death: approx. 1/40,000 risk for all patients having a general anaesthetic.
• Blood vessel problems: heart attack, stroke. This is very rare.
• Infections: Wound, pneumonia, urine, IV line related.
• Clots in the legs that may travel to the lungs and be fatal.
• Wound pain, abnormal (keloid) scarring or hernia of the wound.

Pain Relief

Every effort will be made to minimize the discomfort. Your surgeon and nurses will be monitoring your level of pain control frequently.
Local anaesthetic will be used in the wound and lasts for about 12 hours.

There are two major types of pain relievers after hernia surgery.

• Panadol: You will be amazed the power of regular panadol. It will cut down the need for the very strong pain pills. It does not cause constipation. Do not take more than 8 tablets a day.
• NSAIDs (Indocid, Brufen, Mobic): Also excellent pain relievers. They do not cause constipation.Must be used very cautiously in the elderly and those with kidney   problems.They may cause stomach ulcers.  If you experience any pain in the upper abdomen you must stop this medication immediately and seek advice.It is uncommon to need anything stronger than panadol after you go home. Try and avoid codeine containing products – like Panadeine and Panadeine Forte, they cause constipation and may put strain on your hernia repair.

Eating

It is usual to return to a normal diet within a day of hernia surgery. There are no restrictions.
It is very common to feel slightly nauseated for 12 hours following surgery.

Urinating/Bowel Movements

After any surgery a patient may have trouble passing urine. This is uncommon and usually temporary. Occasionally a catheter needs to be inserted to help you pass urine.  (see above)
There may be some disturbance to your bowels in the week after surgery. Discuss this with your local doctor if this occurs.

Activity

It is usual to be discharged one – two days after routine hernia surgery. It is very important to begin light activity shortly after surgery. This is to prevent pneumonia, clots in the legs and loss of general condition. You must not lift heavy weights or play strenuous sport until six weeks after your surgery. After this time, the wound will not get any stronger.

Your Incision

You can expect to have a waterproof dressing over your incision. You may remove this after five days or earlier if it is dirty. You will be able to shower with this dressing. It is quite common to have a small amount of leakage from the wound or a bubble of fluid under the dressing.
You can peel the dressing off 5 days after the surgery. The wounds should be healed by this time. It is common for the wounds to be bruised.
You may get the wounds wet after 5 days. Gently wash dried material around your incision and let water run over it. Pat it dry with a towel. Do not rub soap or moisturizer into your incision for at least 4 weeks or until it is fully healed. After this you may rub vitamin E cream along the wound.
Most commonly you will not have stitches to remove; they will be of the dissolving type.
Your incision may be slightly red along the cut. This is normal.
It is normal to have a hard ridge of tissue under the wound. All patients get this and it disappears after about three months. It is normal to feel a ridge along the incision. This will go away. It is normal to have a patch of numbness under the wound.
Over the next few months your incision will fade and become less prominent.

Activity

• Do not drive until you feel you could respond in an emergency.
• You may walk normally and climb stairs.
• Don’t lift more that 10 kg for 6 weeks after surgery. (This is about the weight of a briefcase or a bag of groceries) This applies to lifting children.
• You may start some light exercise when you feel comfortable. Strenuous sport should be avoided for 6 weeks.
• You may gently swim after 2 weeks
• Heavy exercise may be started after 6 weeks – but use common sense and go slowly at first.
• You may resume sexual activity when you feel ready unless your doctor has told you otherwise.

How you may feel

It is quite common to feel quite tired for a few weeks after surgery.

Costs to be incurred from this surgery

There will not be any out of pocket expenses for your surgery. Your health fund will be billed directly. Outpatient consultations are not covered by the health funds and there will be a small out of pocket fee. An account will be sent to your home address. You will get some of the money for outpatient consultations back from Medicare.

Your anaesthetist may also charge an out of pocket fee. You should ask them ahead of time about this cost. Ask who will be performing your anaesthetic and you can make enquiries with them as to any out of pocket expenses.
You will also have to pay any hospital excesses that your policy dictates.