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Patient information
The most common operation for inguinal hernia – an open repair with mesh, which can be performed under local or general anaesthetic.
An inguinal hernia is a swelling in the groin due to an area of weakness in the abdominal wall. Men are prone to inguinal hernias because there is a natural gap where the blood supply and other structures leave the abdominal wall to supply the testicle.
A hernia usually presents as a visible or palpable bulge which increases with coughing and can be painful. Sometimes a small hernia is not easily felt and a scan is needed to confirm the diagnosis. Pain particularly occurs with exertion, straining, coughing, sneezing or lifting, although many hernias, even quite large ones, are pain free.
Most hernias do not cause serious problems, but occasionally the contents (usually bowel) can become stuck outside the abdominal wall, impairing their blood supply – a ‘strangulated hernia’. This can be very serious but is rare. If the hernia is painful or the lump is very prominent, most patients opt for a repair, and an operation is recommended to prevent strangulation.
The most common operation currently performed is an open repair with mesh. It can be performed under local anaesthetic with some sedation, or under a general anaesthetic. Local anaesthetic is often preferable, particularly if you have other medical problems, as it presents very little risk.
The procedure is performed through an incision in the groin of about 5–7cm. The hernia sac is located, gently freed from the surrounding tissues and returned to the abdominal cavity. Mesh is then placed between the layers of the abdominal wall to cover the area of weakness and prevent a further hernia.
Although the operation is very safe, there are some important complications that you should consider before undergoing surgery.
A hernia can recur after an apparently successful repair. The risk depends on the size of the hernia, your activity and your job; overall it is about 2%.
The most important complication of open mesh repair. Nerves near the repair can be irritated, causing persistent ache or sharp pains. Significant chronic pain affects about 1–2%, although 5–10% may have some long-term mild awareness.
Sensory nerves in the area often cannot be preserved, leaving numbness around the scar which may extend to the scrotum. This often resolves and rarely causes any long-term problem.
Bruising can be noticeable and extend to the scrotum, but resolves over a couple of weeks. More significant swelling is more likely with very large hernias and will fully resolve.
Wound infection occurs in about 2% and usually resolves with antibiotics. Mesh infection is more serious but very rare – about 1 in 1,000 operations.
A rare complication (about 1 in 500) caused by interruption of the testicle’s venous drainage. The swelling usually resolves but the testicle may become smaller. It is more likely with scrotal or recurrent hernias.
These complications are described to support fully informed consent. The chance of experiencing a complication with long-term consequences is very uncommon.
Immediately after the operation the pain is relatively minor because long-acting local anaesthetic has been given. After a few hours the area becomes painful, and regular pain relief is recommended for the first couple of days – a combination of paracetamol and ibuprofen (taken with food). You will also be given codeine and paracetamol to take home, to be used in place of paracetamol if the pain is more uncomfortable, together with a laxative as codeine can cause constipation. The wound is usually most painful the day after surgery and gradually improves; by the middle of the second week, walking and moving are usually comfortable.
Your follow-up appointment will usually be at 2 weeks, when a plan for rehabilitation can be discussed. Usually at this stage some jogging, stretching and light exercise can begin. Several weeks after the operation all exercise can be undertaken, including weights at the gym and contact sport. The groin will be just as strong after the repair, which should not affect your occupation or lifestyle.
The wound is covered with either a waterproof dressing or tissue glue, so you can shower immediately afterwards.
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Please contact Mr Crinnion’s secretary, Maxine Levene.
Tel: 0787 028 0264
Email: enquiries@jamescrinnion.co.uk
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Mr Crinnion’s office is happy to help before and after your procedure.