Inguinal (Groin) Hernia Repair

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1 Information for patients Inguinal (Groin) Hernia Repair General Surgery Tel: DMI ref: indd(RP) Issue 1: February 2010 The Ipswich Hospital NHS Trust, All rights reserved. Not to be reproduced in whole, or in part, without the permission of the copyright owner.

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3 Introduction Your surgeon has recommended that you undergo an operation to repair your groin hernia. This leaflet has been designed to provide you with information about the nature of the surgery, what to expect in the recovery period and the potential risks. If you are unsure about anything contained in it please ask one of the medical or nursing staff. What is an inguinal hernia? An inguinal hernia is an abnormal protrusion through the abdominal wall into the groin. The protrusion contains a cavity (the hernial sac) which can be empty or it can fill with abdominal contents such as bowel. Typically hernias are more obvious when standing or straining, such as when coughing, lifting heavy items or digging, as this forces bowel into the sac. Hernias usually develop over time for no obvious reason, although in some people there may be an inborn weakness in the abdominal wall. Occasionally a strenuous activity will cause a lump to appear suddenly. They may occur at any age and are more common in men than women. Hernias may simply appear as a painless bulge that enlarges when standing or coughing, but often they cause an aching discomfort or a dragging sensation. Occasionally a piece of bowel or fat can get stuck and twisted within the hernia. This is very painful and can lead to a strangulated hernia which is a life-threatening emergency. Therefore it is generally recommended that hernias be repaired to prevent such complications arising. Hernia surgery is usually performed as a day case procedure. We might recommend you stay in hospital overnight after your operation. This will be discussed with you when you are seen in clinic and at the time of your operation. What types of treatment are available? The standard hernia operation involves placing a mesh on the outside of the weak area in the groin through a 10 cm cut overlying the hernia. It can be performed under a general or local anaesthetic. Page 3

4 There is a slightly longer recovery period due to the size of the cut. Details of this can be discussed with you by your specialist. The laparoscopic (keyhole) technique uses a mesh in a very similar way to the standard open operation, but instead of a cut in the groin you have three smaller wounds after the operation. Is the laparoscopic technique better than the standard technique for my hernia? The National Institute for Health and Clinical Excellence (NICE) has recommended that patients with two hernias (one in each groin) or those with recurrent hernias, should have their repairs performed by the laparoscopic technique. The amount of cutting used in this operation is less than the standard open technique and recovery after laparoscopic surgery is quicker. Most patients are back to their normal activities within days. Many patients return to work within seven days of surgery. Are there any disadvantages of having the laparascopic operation compared with the open technique? The only slight drawback is that you need to have a general anaesthetic. For most patients this is not an issue and modern anaesthetics have very low risks. However, if you are a patient with particular risk factors for getting complications from anaesthetics it may not be appropriate for you to have this technique. For patients who have had previous cuts in their abdomens, particularly below the navel (tummy button) this technique may not be possible. Your specialist will advise you. Is there a guarantee that the operation will be completed by the laparascopic technique? No. Unfortunately, there is never a guarantee that keyhole surgery will be possible. Occasionally there are technical reasons why conversion to an open technique is necessary. This is, however, unlikely. Page 4

5 Risks associated with hernia repair surgery Hernia repair is generally very safe, but can be a complex surgical procedure and complications can occur. Recognised complications of open repair include: wound haematoma. Bleeding under the skin can produce a firm swelling or blood clot (haematoma). This may simply disappear gradually or leak out through the wound. Rarely, it needs to be drained in theatre; infection. Minor wound infections do not need any specific treatment. Antibiotics are sometimes given during the operation to minimise the risk of deep-seated infection; damage to testicular vessels. In men inguinal hernias are very close to the spermatic cord which contains the blood supply to the testis. Damage to the blood supply can lead to swelling, pain, shrinkage of the testis or problems with sterility (having children) in the future; nerve damage. Several nerves cross the operative field in hernia surgery. It is usually possible to preserve them but some minor nerve injury, rather like a bruise, is common and usually returns to normal in time. Permanent numbness may occur however. Some patients develop chronic pain after hernia surgery. This occasionally needs further surgery; and recurrence. There is no method of hernia repair that can give a 100% guarantee that you will never develop another hernia in the same place after your operation. Fortunately, recurrence after hernia surgery is rare. The lowest reported risk is with the mesh repair technique we use and is about 1 3%. Recognised complications of laparoscopic repair include: bruising. Any bruising that occurs tends to track down into the scrotum in men and can look rather worrying. Do not be alarmed if this happens to you, it will resolve spontaneously over 2 3 weeks; bleeding. Significant bleeding after this type of surgery is very rare. If it were suspected, you would require further surgery to ensure bleeding had stopped; Page 5

6 damage to other structures. Keyhole surgery inside the abdominal cavity is associated with a very small risk of damaging other structures inside the abdomen. These include the bowel and the major blood vessels to your legs. In men, inguinal hernias develop very close to where the major structures to and from the testicles lie. These structures include the blood vessels (arteries and veins) to the testicles and the vas deferens that carries the sperm from the testicles. This can lead to pain in the testicle after the operation or problems with sterility (having children) in the future; wound infection. This can occur during the recovery period and if any of your wounds become red and sore you should see your GP in case you need a course of antibiotics. You will be given a dose of antibiotics intravenously during surgery to try to prevent this. recurrence. There is always a risk of recurrence with all hernia repairs but this should be no greater than about 1 3%. Patients who are obese have a greater risk of recurrence. The risk of long-term pain in the wounds or the groin is very small with this technique. Before the operation You will attend a pre-admission clinic where you will be seen by a member of the medical team who will be looking after you in hospital. At this clinic, we shall ask you for details of your medical history and carry out a physical examination. We will arrange any investigations and tests you require. This is a good opportunity for you to ask us any questions about the procedure, but please feel free to discuss any concerns you have at any time. You will be asked if you are taking any tablets or other types of medication these might be ones prescribed by a doctor or bought over the counter in a pharmacy. It helps us if you bring details, or the packaging, with you of anything you are taking. It is very important that you tell us if you are allergic to any medications or dressings. Page 6

7 You will be admitted on the day of your operation. If you are having a general anaesthetic, your anaesthetist will visit you on the ward. They will review your medical history. In particular, you will be asked about your medications and any health problems that you have. They will also ask you about previous anaesthetics you have had and whether you had any problems with these (for example, nausea). You will be asked if you are allergic to anything. They will also want to know about your teeth, whether you wear dentures, have caps (crowns) or a plate. Your anaesthetist may examine your heart and lungs. You may be prescribed medication to take shortly before your operation. This is known as the pre-medication or pre-med it relaxes you and may send you to sleep. Before your procedure, you will be given a general anaesthetic. This is usually performed by giving you an injection of medication into a vein through a thin, plastic cannula (tube), usually placed in your arm or hand. While you are unconscious and unaware, your anaesthetist remains with you at all times, monitoring your condition and controlling your anaesthetic. At the end of the operation, your anaesthetist will reverse the anaesthetic and you will regain awareness and consciousness in the recovery room, or as you leave the operating theatre. During the operation Open repair The operation involves an incision in the groin over the hernia, freeing up the hernia sac and replacing it inside the abdominal cavity. The abdominal muscles in the groin are strengthened with the aid of a sheet of Prolene mesh which does not dissolve directly behind the weak area in the groin. This prevents the bulge of the hernia from returning. It is strong immediately and does not require a long periods of convalescence. The mesh is made of the same material as suture (stitches) we commonly use in other operations and does not cause any reaction from your body. You will not be aware that it is there. Page 7

8 The wound is closed with dissolving stitches under the skin. A number of different dressings may be then used, including showerproof dressings or special glue. Laparoscopic repair The operation involves an incision near your navel and two or three further incisions. Each incision is about 1 2 cm long. Through these, we inflate your abdomen with carbon dioxide gas which is completely harmless. Then the sheet of mesh is placed directly behind the weak area in the groin, as with the open repair. At the end of the operation, before you wake up, the wounds in your abdomen will be treated with local anaesthetic so that when you first wake up there should be very little pain. Some patients have some discomfort in their shoulders, but this wears off quite quickly. The cuts we have made will be covered with small waterproof dressings. After the operation After your operation, you will wake up in the recovery room. You might have an oxygen mask on your face to help you breathe. You might also wake up feeling sleepy. You will have a thin, plastic tube in one of the veins in your arm, attached to a bag of fluid called a drip. Sometimes, people feel sick after an operation, especially after a general anaesthetic, and might vomit. If you feel sick, please tell a nurse and you will be offered medicine to make you more comfortable. There are no stitches to be removed. Shower for the first five days. Then you can soak in a bath and peel off the plastic dressing (if you have one) to leave the wound open to the air. Alternatively, if glue has been used on the wound, this will slowly dissolve every time you shower. If you have had an open repair you should expect some numbness beneath the scar this may be temporary or permanent. Page 8

9 Bruising around the wound or tracking down into the scrotum is sometimes seen this looks dramatic but is harmless and will settle spontaneously. Local anaesthetic is usually injected into the wound(s) to minimise pain immediately after surgery and this lasts for 4 6 hours. You will be given pain relief medication to take home and should take this regularly for the first few days, regardless of whether you have pain or not. As the discomfort subsides you will need less pain relief but you may not be fully comfortable for 2 4 weeks. If you have had a laparoscopic repair you will have some discomfort and a pulling sensation around the navel which will last 7 14 days. You will be able to drink immediately after the operation and if this is all right and you do not feel sick, you will be able to eat something. After your operation we will try to get you up and about as soon as you are comfortable. You will be allowed home when you are comfortable, have had something to drink and eat, and have passed urine. Going home You are not insured to drive unless you are confident that you can brake in an emergency and turn to look backwards for reversing without fear of pain in the wound. This is usually about days. If in doubt you should check with your insurers. If you have had an open repair, it is safe to perform light exercise immediately after your operation, but it is sensible to avoid anything strenuous for 4 6 weeks. However, the only thing to hold you back will be discomfort and, if the wound is not hurting, you can do whatever you like. You should be able to return to office work within two weeks and manual work within about four weeks. You will be given a certificate to cover the time off work you require. After laparoscopic surgery, the only limitation that you will have is the discomfort from the three small wounds. Most people who have had Page 9

10 this procedure can resume normal activities after two weeks. However, you might need to wait a little longer before resuming more vigorous activity. When you will be ready to return to work will depend on your usual health, how fast you recover and what type of work you do. You will be given a certificate to cover the time off work you require. Follow-up Provided that all is well after an open repair, we will not give you a follow-up in the hospital clinic. If you have any concerns, however, please contact your GP who will arrange for you to be seen in our clinic. After a laparoscopic repair you will be phoned at home by a senior nurse to check up on your recovery in the week after your operation. When to contact your GP In the period following your operation you should seek medical advice if you experience any of the following problems: increasing pain, redness, swelling or discharge; severe bleeding; difficulty in passing urine; high temperature over 38 C or chills; or nausea or vomiting. Page 10

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12 Produced by: The Ipswich Hospital NHS Trust Heath Road, Ipswich, Suffolk IP4 5PD Hospital switchboard:

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