OPEN GROIN HERNIA REPAIR - Chesterfield Royal Hospital
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OPEN GROIN HERNIA REPAIR
What are the benefits of groin hernia
Your surgeon has diagnosed a hernia in your surgery?
groin and has recommended an operation to
repair it. This booklet answers questions you The main benefits are the relief of any pain
may have before you decide to go ahead with and discomfort caused by the hernia and, in
surgery. emergencies, the treatment of obstruction or
strangulation.
If you want further information about hernias
or what surgery involves, please contact your Current national guidelines state that surgery
consultant who will be more than happy to is not recommended for most groin hernias
answer your questions. which are not causing problems
(asymptomatic hernias).
What is a groin hernia
Are there any alternatives to surgery?
A hernia occurs when some of the abdominal
(belly) contents bulge through a weakness In adults, a hernia will not go away by itself.
(defect) in the muscles of the abdominal wall.
A padded hernia belt (truss) can control the
A hernia is often felt as a swelling under the bulge, but is usually only recommended for
skin which can be pushed back, only to pop patients who are not fit enough for surgery.
out again. A hernia may be more prominent The only permanent remedy for the condition
during straining or exercise; some disappear is to repair the hernia surgically.
when lying flat.
What would happen if my hernia was left
Hernias are common in the groin, the lowest untreated?
part of the abdomen just above the crease of
the thigh. Groin hernias may be classified as Groin hernias may remain asymptomatic for
inguinal or femoral, depending on the precise years. In general, there is a tendency for groin
location of the defect. There may be a hernia hernias to become larger over time.
on just one side (unilateral) or in both groins
(bilateral). A small proportion of groin hernias may
become suddenly painful and impossible to
In men, a larger inguinal hernia may involve push back (incarceration). In some cases, the
the scrotum on that side. blood supply to the contents of the hernia
may become blocked leading to strangulation;
again, when this occurs the hernia becomes
hard and tender and the skin over it may
become reddened. In a minority of hernias66
which contain bowel, the bowel may become The aim of using mesh is to encourage the
blocked (obstructed) causing waves of pain development of scar tissue (fibrosis) to
and vomiting, which is often greenish or strengthen the repair. Excessive fibrosis which
brown. If you develop any of these symptoms causes problems is unusual after mesh groin
whilst waiting for your operation, you should hernia repair.
seek immediate medical advice as emergency
surgery is likely to be necessary. Is there an alternative to mesh repair?
Open Groin Hernia Repair When a hernia occurs, the tissues in the area
through which the bulge occurs are usually
In an open operation, the hernia is repaired weak and they do not hold stitches well.
through an incision directly over the bulge. Evidence shows that when groin hernia repair
The technique relies on the use of a was based on stitches only, the chance of
permanent plastic mesh to reinforce the recurrence was much higher than when mesh
repair and minimise the chance of the hernia is used. Few experienced surgeons would
coming back (recurrence). recommend groin hernia without a mesh.
Open mesh repair for groin hernias was In summary, for most patients, using mesh is a
popularised in 1986 and, since then, millions safe and reliable way to repair a hernia.
of groin hernia repairs have been successfully Further information is available at
performed worldwide using the mesh, without www.britishherniasociety.org
complications. Whilst the use of mesh in other
types of surgery has been associated with Complications of hernia surgery
significant problems, this use of mesh to
repair groin hernias is associated with a very Serious complications are rare after groin
good safety record. hernia surgery. A small proportion of patients
do have problems after their operation but
Hernia meshes require approval by UK these are usually simple to treat.
regulatory authorities before their use. Using a
mesh greatly reduces the chances of hernia Bruising and Swelling
recurrence after surgery. Some patients develop bruising around the
wound and, in men, this may involve the
Can the mesh cause any problems? scrotum. As with any other bruise, it will fade
in time.
Open groin hernia repair with mesh is simple,
effective and safe for most patients. However, Less commonly, there may be minor bleeding
the mesh is a foreign material and, like any after the operation which leads to a swelling
synthetic implant, (e.g. artificial joints or heart (haematoma) under the scar or around the
valves), has the potential to become infected, testicle. Often the best treatment is to leave a
but the risk of this is small. haematoma to resolve of its own accord,
although this may take several weeks.
A small proportion of patients who undergo Occasionally, a further operation may be
groin hernia repair develop pain after the recommended.
operation which may persist and, sometimes,
require further treatment. There is no Swelling may also occur because of fluid
evidence that the use of mesh significantly collecting around the operation site (seroma).
increases this risk. A seroma can easily be removed by drawing
the fluid off with a needle (aspiration).66
be easy to control with mild pain killers and
Haematomas and seromas rarely increase the should settle within a couple of weeks. Some
likelihood of a hernia recurring after surgery. patients (3-5%) experience discomfort that
can last for many months after their operation
Infection and there is often no obvious explanation for
Infection is uncommon after planned hernia this. Sometimes additional treatment in the
surgery. Signs of infection include increasing form of local anaesthetic and anti-
redness or swelling of the wound. The patient inflammatory injections to the wound may be
may feel unwell or feverish. required. Further surgery is rarely necessary.
When infection occurs, it can usually be Other potential complications in male
treated with antibiotics. Sometimes, it may be patients
necessary to open the skin wound to allow any In men, the stalk that attaches the testicle to
infected fluid to drain. Provided that infection the body (spermatic cord) passes through the
is treated promptly, it is unusual to have to re- groin (inguinal) canal. The spermatic cord
operate to remove a mesh. contains the testicle’s blood vessels and the
If you experience any of the symptoms which sperm duct (vas deferens). These structures
suggest infection after your hernia repair, you can be damaged during inguinal hernia
should seek prompt medical advice. surgery, but the risk is small (1%). Damage is
more common when a recurrent inguinal
Recurrence hernia is repaired. The testicle may shrink as a
result (atrophy) but this does not cause any
Recurrence after mesh groin hernia surgery is change in masculinity or fertility, provided that
uncommon when a mesh is used; the other testicle is normal.
approximately one in one hundred cases (1%).
Some men may find it difficult to pass urine
Further surgery can be offered for recurrent immediately after their groin hernia repair
hernias. Most recurrent hernias operated on (urinary retention) and, if this occurs, a
nowadays were first repaired before mesh temporary tube (catheter) to drain the
was widely used. bladder may be necessary; however, this is
uncommon.
Nerve Injury
General complications
Some of the nerves which supply the lower
belly wall and upper thigh need to be There is a small risk of a clot forming in the leg
protected during groin hernia surgery. veins (Deep Venous Thrombosis or DVT)
Nevertheless, injury to them may be associated with any form of abdominal
unavoidable. Often this is just temporary surgery. This is the same type of clot that
bruising and, whilst there may be numbness passengers on long aeroplane flights may
for several weeks, normal sensation will develop. A DVT may cause the leg to swell and
return. However, some patients may occasionally the clot may break loose and
experience a permanent numb patch around lodge in the lung (Pulmonary Embolism or PE).
the scar. Overall the risk of a DVT or PE is small and we
will take active measures to minimise this risk
Persistent groin discomfort to you.
It is usual to expect some discomfort
immediately after hernia repair but this should A DVT is more likely if you are overweight or
smoke. You can reduce the risk of developing66
a DVT by getting up and walking about as soon surgeon.
as possible after your operation. A DVT may How long will I be in hospital?
only be obvious after you have gone home. If
you notice any swelling of the calf or more You may be able to come into hospital, have
rarely the thigh, or you experience pain or your operation and go home on the same day.
tenderness in the calf, or notice that your leg However, depending on the circumstances
is shiny or discoloured you should seek you may need to stay in hospital overnight.
medical advice quickly. You should also
contact a doctor immediately if you develop What sort of anaesthetic will I have?
shortness of breath or pain on breathing
following surgery. Most groin hernia operations are carried out
under a general anaesthetic, meaning you will
There is an increased risk of post-operative be fully asleep. In some cases the operation
complications if you are overweight or if you may be carried out with a local or spinal
smoke. anaesthetic. Your anaesthetist and surgeon
will recommend which is best for you.
What happens before the operation?
What should I expect after the operation?
You will need to have a pre-operative
assessment sometime before your admission. You will have a scar approximately three
This is a health assessment to make sure you inches long on the side of the groin affected.
are fully prepared for your admission, Even if you have a general anaesthetic you will
treatment and discharge. The pre-operative have been given local anaesthetic into the
assessment nurses are there to help you with wound and painkilling drugs and therefore you
any worries or concerns that you have, and should not wake up with severe pain. You
can give you advice on any preparation may have soreness for up to two weeks but
needed for your surgery. you will be given some painkillers to take
Before the date of your admission, please read home with you. If your pain is very bad please
the instructions given to you very carefully. speak to the nurse or doctor and a stronger
You will be given specific instructions about drug can be prescribed for you.
when to stop eating and drinking; please
follow these carefully as, otherwise, there How long will it take me to recover from the
could be an anaesthetic risk and we may have operation?
to cancel your surgery.
Once you go home you will gradually be able
Getting ready for the operation to build up to your normal everyday activities.
You will experience some discomfort over the
You should bath or shower before coming to first two weeks or so but it is important that
hospital. you keep mobile.
When you come into hospital for your It takes several weeks for the mesh to fully
operation you will be asked some routine bond with the tissues and, in order to
questions about your general health, the minimise the risk of hernia recurrence, you
medicine you take at the moment and any should avoid heavy lifting or other strenuous
allergies you have. You will be asked to sign a activity for four to six weeks.
consent form to confirm that you have read
and understood this information leaflet. You
will be able to discuss the operation with your66
How much pain can I expect? Can I eat and drink normally after the
operation?
It is normal to experience some pain and
soreness around the scar, particularly over the Yes, you can return to your normal diet as
first few days. It is, therefore, important that soon as you are ready. You may feel bloated
you take painkillers regularly over the first two or constipated for a few days. You may
to three days (but remember that you should experience occasional feelings of nausea
not exceed the stated maximum daily dose). (sickness) and loss of appetite over the first
After your discharge if the level of pain is not week or so. Eating a high fibre diet and
controlled, your local GP or chemist should be increasing your fluid intake will help to
able to offer you advice. If your pain should maintain a regular bowel movement. You
become increasingly worse you should consult should normally open your bowels within 2-3
your GP. days of your operation although this may be
uncomfortable at first. If you do feel you are
You may notice some discomfort for several becoming constipated mild laxatives should
weeks after the operation. On rare occasions, help. If you do not have laxatives at home
a more chronic discomfort may persist. Whilst your local pharmacist should be able to give
the full reasons for this are not known, it may, you advice.
among other things, be a result of nerve
damage. This may require further When will I be able to go back to work?
investigation or treatment.
You can return to work as soon as you feel
How do I care for my wound? well enough. Depending on how you are
feeling and the type of job that you do, you
You can remove any dressings the day after will generally need about two weeks off work.
your surgery. You may then shower and bathe If you have a job that involves heavy lifting or
as required. strenuous activity you may need at least four
to six weeks off work.
It is not unusual for men to notice bruising of
the scrotum and penis. This will subside over a Please discuss this with your Consultant and, if
couple of weeks. Men may find it more you require a sick note for work, ask for it
comfortable to wear supportive underwear. before you are discharged home.
As the wounds heal, you may notice a numb Will I be able to drive?
area below the wounds. This may be due to
bruising of the nerves during surgery. Whilst in You should avoid driving for at least seven to
most cases sensation will gradually return, for ten days. Before driving you should ensure
a few patients the numbness may be that you are able to perform an emergency
permanent. stop, have the strength and capability to
control the car, and be able to respond quickly
If you notice that the wounds become to any situation that may occur. You must be
swollen, painful, or if a discharge develops, able to wear a seatbelt before resuming
arrange to see your Practice nurse or GP or driving. Please be aware that driving whilst
alternatively you can ring the secretary of your unfit may invalidate your insurance.
Consultant in charge to seek advice. You can
do this via the Hospital switchboard.66
When should I seek help?
If you develop a fever above 38C or
chills.
Persistent vomiting or nausea.
Increasing abdominal pain or
distension.
Increasing pain, redness, swelling or
discharge of any of the wound sites.
Severe bleeding.
Difficulties in passing urine
Where should I seek advice or help?
If you are unwell or develop any of the
symptoms above please contact your GP or
111. If you are not unwell but do wish to
discuss a problem please contact your
surgeons secretary via switch board and they
will arrange for you to be seen in clinic.
July 2020
Review date: July 2022
Reviewer: Upper GI Surgeon
Open Groin Hernia Repair
Version 1
© Chesterfield Royal Hospital NHS Foundation Trust
Reviewed Date: July 2020
Next Planned Reviewed Date: July 2022
Directorate: Surgical Services DivisionYou can also read
