Inguinal Hernia Surgery

  • The risk of inguinal hernia increases with age

    Each year, about 1 in 200 adults will seek advice about a hernia

  • It is not uncommon to have a hernia on both sides

    As many as 3 in 10 people who develop a hernia on one side, will develop a second hernia on the other side

  • Inguinal hernias are the most common hernias

    In fact, around 1 in 30 men have an inguinal hernia

  • Day Case Surgery is possible for many hernia surgeries

  • Did you know?

    Inguinal hernias were first described by the Egyptians in 1500 BC

  • Most patents with hernias do not seek their doctor’s advice

Did you know?

  • Around 1 in 200 adults will seek advice from their doctor about a hernia
  • Almost all hernias can be repaired
  • Hernia repair is the most common surgery performed in men
  • Inguinal hernia are the most common hernia
  • 90% of all abdominal hernias occur in men
  • Around 2% of men have a hernia
  • A chronic cough may predispose to hernia formation

A hernia is a lump that occurs when part of the small bowel, or other abdominal tissue protrudes through an area of weakness in the wall of the abdomen. When this occurs in the groin, it is described as an inguinal hernia.

Over 70% of all hernias occur in the inguinal region. They are much more common in boys and men (98%). They may be present at birth or develop later in life, when straining, heavy lifting, coughing or obesity increases the pressure within the abdomen, applying strain on the muscles in the groin area. When an abnormal opening or defect occurs on both sides of the groin, it is called a bilateral inguinal hernia.

The only treatment for a hernia is surgical repair.  The operation is most commonly performed either as an “open” surgery, involving an incision to the lower abdomen. This is usually a “tension-free” technique that uses a mesh of inert, sterile material (usually includes polypropylene plastic) to cover the affected area. Alternatively, the operation may be performed as “keyhole” surgery (laparoscopic), through small incisions in the skin using special instruments.

Hernia repair is usually carried out as a day case, with no overnight stay in hospital. The open operation can be done using local anaesthetic which involves using an “inguinal block” i.e. injection of local anaesthetic to completely block feeling from the groin region for the duration of the operation. A general anaesthetic may also be used.

Surgeon performing a laparoscopic operation

Laparoscopic surgery

Keyhole  (laparoscopic) surgery and the “tension-free” open procedures lead to quicker recoveries compared to the older traditional darn repairs which are now rarely used. However, keyhole surgery is associated with different risks, such as a slightly higher risk than the open procedure of damage to neighbouring organs.

People are typically required not to eat or drink for about six hours before a general anaesthetic. Some anaesthetists allow a few sips of water until two hours beforehand. 

Both open and keyhole procedures take about 30-60 minutes. An open hernia repair is performed through a cut about 7cm (3”) long in the groin. The hernia is replaced back through the gap into its proper place inside the abdomen and the gap is then closed with stitches. A synthetic mesh is inserted in order to reinforce the wall of the abdomen. Finally, the abdomen is closed in layers with further stitches.

Keyhole hernia surgery involves making a small cut near the umbilicus (belly button) and inserting a tube-like telescope called a laparoscope. Gas is inflated to separate the tissues to allow the surgeon to get better view of the interior spaces. Instruments are then inserted through the laparoscope or via further small cuts to perform the repair.

On clinical and cost-effectiveness grounds, the National Institute of Clinical Effectiveness, which advises the NHS, recommends an open repair for a first inguinal hernia. It suggests that the laparoscopic method may be better for hernias that occur on both sides of the groin (bilateral hernias) and for recurrences.

Conditions that may be confused with a hernia

There are a number of conditions that may give rise to a swelling in the groin. These include

  • Enlarged lymph nodes
  • Cysts
  • Enlarged artery (aneurysm) or enlarged vein (varicocele)
  • Growths (a fatty lump  e.g. lipoma)
  • Scrotal swellings e.g. testicular problems or fluid in the scrotum (hydrocele)

Can I undergo inguinal hernia surgery at the Scottish Hernia Centre?

Yes. Richard Molloy undertakes both open tension-free repair and laparoscopic inguinal hernia surgery on a regular basis at the Scottish Hernia Centre, based at Ross Hall hospital Glasgow. At the initial consultation, your hernia and any other medical problems will be assessed before discussing the surgical options for repair.Picture of the main entrance to RossHall hopsital

The Scottish Hernia Centre is based at Ross Hall hospital Glasgow. BMI Ross Hall Glasgow is Scotland’s premier private hospital, where highly trained nursing and medical staff work within a state of the art hospital enabling our experienced team to safely treat even the most complex hernia.

Download an information sheet on inguinal hernias

What can I expect after inguinal hernia surgery?

It will be necessary to rest for a while after coming round from a general anaesthetic, and painkillers may be needed to relieve the discomfort. People are also usually encouraged to get out of bed and move about fairly soon after they have recovered from the anaesthetic. This may be uncomfortable but, as long as they are reasonably careful, it will not cause any damage and will probably help speed-up recovery.

If the operation is a day case, most people go home within 4 hours after the operation. 

A general anaesthetic can temporarily affect co-ordination and reasoning skills, so people are advised to avoid drinking alcohol or signing legal documents for 24 hours afterwards. We advise to avoid driving for a week after hernia repair so they will need to arrange for a friend or relative to drive them home and stay with them for the next 24 hours. You should take someone with you the first time you go out driving. You should feel comfortable performing an emergency stop before going on public roads.

Before discharge, a nurse will advise you about caring for the wound and bathing, and arrange a date for a follow-up appointment (about six weeks later).

Once home, painkillers should be taken as prescribed. Whether recovering from open or keyhole surgery, it will be necessary for you to take it easy for the first two or three days. You will give specific advice about resuming normal activities.

In general most people will be able to move around the home freely, but you should avoid strenuous exercise and lifting weightHigh fibre diet including grapes, nuts and cerealss more than 10 kg. for the first few weeks

A high fibre diet is recommended (plenty of fruit, vegetables and wholegrain cereals). This will help you to avoid constipation, which can cause straining of the wound and discomfort.

Most people continue to experience some discomfort in the groin area for a few weeks after the operation, but this will gradually settle and can be helped by wearing close-fitting underwear.

People who have a tension-free mesh repair are usually up and about the day after surgery, albeit that they are somewhat tender. They are usually over the worst within a week and most can return to work in less than two weeks.

Should everyone who has a hernia undergo surgery to repair an inguinal hernia?

If the hernia is very small, it may be left alone. However, a hernia will not get better by itself. Wearing a truss may help to relieve the discomfort of a hernia, but will not improve the condition, and in some cases can cause further damage. Surgery is the only cure for a hernia.

Inguinal hernia repair is a commonly-performed and generally safe operation. For most people, the benefits in terms of treating a condition that can become dangerous if left untreated, are much greater than the disadvantages.

However, in order to make a fully informed decision, anyone deciding whether to have this procedure needs to be aware of the possible side-effects and the risk of complications.

What are the risks and complications of surgery?

Side-effects are the unwanted but usually mild and temporary effects of a successful procedure. Common side-effects of hernia repair include discomfort, bruising or minor swelling at the site of the operation. Feeling sick as a result of the anaesthetic or painkillers is also quite common, and medicines are available to help avoid this.

For a few days after the operation, emptying the bladder may be more difficult than usual, and in men, the scrotum may swell for a few days. These symptoms will clear up over a week or so, without the need for specific treatment. There will be small scars from the keyhole incisions and a longer scar if open surgery is performed.

Complications:

Complications are unexpected problems that can occur during or after the operation. Most people are not affected, but the main possible complications of any surgery are an unexpected reaction to the anaesthetic, or developing a blood clot, usually in a vein in the leg (deep vein thrombosis).

To help prevent this, most people are given compression stockings to wear during the operation.

Complications may require further treatment such as returning to theatre to stop bleeding, or antibiotics to deal with an infection. Other complications can occur after a hernia operation. There’s a small chance of continuing pain in the groin area, caused by the handling of a nerve during surgery, or by the pressure on the nerves by scar tissue that forms during healing. In men, painful swelling of the scrotum or testicles occasionally occurs. This may require further surgery.

Inguinal hernias recur in 1-4% of cases treated. A small percentage of people have an inherited tendency to scars that are unusually red and raised. The chance of problems depends on the exact type of operation and other factors such as general health. If a recurrent hernia develops, a repeat operation can be performed, although it is best that this is performed by a surgeon with a special interest in this type of more complex surgery.

Download and information sheet on inguinal hernia surgery including detailed information on complications

Will my hernia come back after repair?

With traditional surgery, up to 10% of hernias can recur after operation.

With modern techniques and in the experienced hands of surgeons at The Scottish Hernia Centre, recurrence rates of less than 1% can be expected with inguinal and femoral hernia repair. Recurrence rates of around 5% can be expected after incisional hernia repair with mesh (up to 1/3 will recur if no mesh is used).

Surgery is considered the only cure, and the prognosis is excellent if the hernia is corrected before it becomes strangulated.

Consulting with surgeon about alternatives to surgery

Is surgery the only option to treat my hernia?

Once an abdominal hernia occurs it tends to increase in size. If your hernia is not painful, is not getting larger, and is not trapped, you may choose to wait to have surgery. If you choose to wait, it is important to contact your doctor if you feel the hernia is getting bigger or if you experience sudden pain in the hernia. There are benefits and risks with both waiting and surgery. You should discuss both options with your doctor.

If after discussion with your surgeon, you have decided to adopt a watch and wait approach, it is important to avoid strenuous physical activity such as heavy lifting or straining with constipation. Some patients may find that a truss makes them more comfortable.

It is important to contact you doctor immediately if your hernia is getting bigger, more painful, if you develop nausea, vomiting, constant pain or discomfort in the hernia, or if the bulge does not return to normal when lying down or when you try to gently push it back in place. Ultimately, surgery is the treatment in almost all cases.

There are risks to not repairing a hernia surgically. Left untreated, a hernia may become incarcerated, which means it can no longer be reduced or pushed back into place. With an incarcerated hernia the intestines become trapped outside the abdomen. This could lead to a blockage in the intestine. If it is severe enough it may cut off the blood supply to the intestine and part of the intestine might actually die.

When the blood supply is cut off, the hernia is termed “strangulated.” Because of the risk of tissue death (necrosis) and gangrene, and because the hernia can block food from moving through the bowel, a strangulated hernia is a medical emergency requiring immediate surgery. Repairing a hernia before it becomes incarcerated or strangulated is much safer than waiting until complications develop.