Surgery is the only way to cure a Groin or Inguinal Hernia
Most patients undergoing inguinal/groin hernia repair can go home on the day of surgery
If you have been told that you have a hernia, we are sure you will want to know what can be done to fix your hernia? You may not want to hear that surgery is the only way to fix an abdominal hernia! However, modern surgical techniques have advanced a lot over the years and you may not be aware that in experienced centres, most patients who undergo hernia repair can go home on the same day as their operation.
Surgeon holding a laparoscope while performing a laparoscopic hernia repair
Groin hernias can be fixed using an open or keyhole approach.
Open repair of a groin hernia involves a small incision in the lower abdomen over the hernia. Experienced surgeons at the Scottish Hernia Centre use a “tension-free” technique where we insert a small piece of mesh (made of sterile, inert, polypropylene) to cover the affected area.This tried and trusted techniques has been performed many hundreds of thousands of times around the world and has been shown to have the best long-term results. Typically, it is performed as a day case (no need for an overnight stay) and most patients are suitable for either general or local anaesthesia.
Alternatively, the repair may be performed using keyhole (laparoscopic) surgery. In this technique, the operation is performed using special long thin instruments and a long thin camera (laparoscope), all of which are inserted through small incisions in the skin. A small mesh is also used to fashion the repair in laparoscopic surgery.
How is a groin hernia repaired?
Inguinal/groin hernias can be repaired using either an open surgery or laparoscopic/keyhole surgery
Both open tension free and laparoscopic hernia surgery techniques lead to quicker recoveries compared to the older traditional darn or stitched repairs. These are now rarely. However, keyhole surgery is associated with different risks, such as a slightly higher risk than the open procedure of damage to neighbouring organs.
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 in the abdominal wall muscle 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.
Out surgical team at the Scottish Hernia Centre are experienced in both open tension free and laparoscopic hernia repair
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 or groin hernias 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
Can I undergo inguinal hernia surgery at the Scottish Hernia Centre?
The Scottish Hernia Centre is based at RossHall hospital in 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. We work with all the major insurers. If you do not have healthcare insurance, we offer competitive fixed price packages which ensure all your costs are covered. Please see our Prices & Payment page for more information
Although it is usually fairly clear if you have a hernia, on occasion hernias can be difficult to diagnose. The following points may help
A hernia is a lump that occurs when part of your intestines protrudes through an area of weakness in the wall of the abdomen.
The groin or inguinal region is the most common site of hernias.
The vast majority of groin hernias occur in men
The swelling of a groin hernia typically get bigger on standing, coughing or lifting
When a hernia occurs on both left and right groins, it is called a bilateral hernia
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
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)
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.
Driving is possible within a week of hernia surgery
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).
A high fibre diet is important to avoid constipation
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 weights 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 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.
Surgery is considered the only cure, and the prognosis is excellent if the hernia is corrected before it becomes strangulated. With traditional surgery, up to 10% of hernias can recur after operation.
However, with modern techniques, experienced surgeons can achieve recurrence rates of less than 1% with inguinal and femoral hernia surgery repair. Recurrence rates of around 5% can be expected after incisional hernia repair.
Make an appointment to see Richard Molloy, Consultant Surgeon at the Scottish Hernia Centre in Glasgow for a detailed assessment of your hernia.
Is surgery the only option to treat my hernia?
It may be difficult to decide if a non-operative approach to a hernia is the right option
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 See approach (Watchful Waiting), 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.
If you have decided to adopt a non operative approach to managing your hernia, 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.