Hernia Repair - Inguinal

About the Procedure

Inguinal Hernia Repair (Herniorrhaphy; Herioplasty) is a surgical procedure to resolve a herniated area in the lower abdomen just above the groin. It may be performed laparoscopically or by a traditional surgical incision. Inguinal hernias occur mostly in men and are one of the most common reasons for surgery. There are two types of inguinal hernias - direct and indirect. Direct hernias occur when contents of the abdominal cavity squeeze through an area of weakness in the inguinal canal due to straining, lifting, or coughing. Indirect hernias are usually congenital, the result of incomplete development of the canal while in utero. When the tissue that has slipped down can not be pushed back, there is a risk of cutting off the blood supply to the bowel and/or abdomen or causing a bowel obstruction. Patients may not be aware they have a hernia because the tell-tale bulge in the lower abdomen is evident only when coughing or straining and disappears from sight upon lying down. Because there is usually no pain associated with an inguinal hernia, if it does occur, it indicates a serious problem, as detailed above. Hernias can be managed but do not repair themselves. Physicians encourage patients to consider elective surgery due to the potential for unexpected emergency surgery.

The procedure is performed by a general surgeon or by a colorectal surgeon. Laparoscopic surgery can be done in a hospital or an out-patient facility using general, local, or spinal anesthesia. The surgeon cuts a few small incisions in the abdomen and inserts a laparoscope (telescopic video camera) and the cutting and gripping instruments. He/she removes the bulging sac and stitches the weakened area. In a technique referred to as "tension-free", a mesh graft is placed over or under the hole in the canal, to fortify it and prevent recurrence. When the procedure is finished, the incisions are closed with stitches or other preferred material.

What to Know Before the Procedure

Complications for a laparoscopic hernia repair include: cutting or twisting blood vessels and nerves, injury to the bowel or bladder, including infection, and blood clots. There is a higher incidence of infection when the mesh is used, especially in patients with immune system disorders. Because the mesh is a foreign item, there is a risk of rejection which would require a second surgery to mend.

Preparation for this procedure is similar to other operations. A health assessment, blood work, x-rays, and adding or changing medications to avoid excess blood loss during the operation. Depending on the type of surgery and anesthesia, pre-operative instructions on food and water restrictions will be provided. Advanced planning for a ride at discharge and assistance for the first day is recommended because pain and tiredness are the chief complaints at that time.

What to Know After the Procedure

When the procedure is done in an out-patient facility, the patient is usually discharged the same day following a period of observation. With a traditional procedure, an in-patient stay of two or more days is typical and discharge is dependent on many factors. Low level physical activity and exercise may be resumed immediately, moderate activity within a week, and return to pre-surgery activity at about 14 days following the laparoscopic procedure. Some tenderness around the surgical site and discomfort when activities involve pressure on the abdomen, e.g., moving from lying to a seated position and from sitting to standing, lifting, sneezing, coughing, etc. are to be expected. The more invasive surgical method requires a much longer recovery and an extended period of restricted physical activity.

If you Need to Travel Outside of your Local Hospital

Due to quick recovery times following this procedure, long-distance travel to have it performed is not prohibitive. Choosing the right surgeon is the highest priority in a laparoscopic hernia repair. Research supports that recurrence rates are lowest when surgeons are experienced with the laparoscopic procedure. It’s for this reason that your main reasons for deciding on a location should focus on skill of the surgeon, overall price, and the amount of time you are able to set aside for yourself for recovery. When choosing to have this procedure done abroad, be sure to speak with your doctor in detail about post-operative care, recommended recovery times, and travel plans.