The aims are threefold:
- To remove any bowel or omentum from the hernia sac. This usually means pushing them back inside the abdomen. If the bowel or omentum is strangulated and damaged, they may need to be removed.
- To remove or push back the sac.
- To repair the weakness to prevent the hernia coming back.
We do an operation to achieve these aims, which is called a herniorrhaphy. Sometimes an open operation will be done. Other times laparoscopic surgery is done instead, with three or four tiny cuts in the lower abdominal wall and around the umbilicus. The choice is normally on a case-by-case basis and the experience or preference of the surgeon. The repair may be done with layers of nylon stitches, mesh plugs or a sheet of mesh. If you have a hernia on each side, both can usually be repaired at the same time.
You should stop having pain and the swelling will be gone. There should be no risk of a strangulated hernia. The traditional operation for a hernia repair is the open operation. Recently, laparoscopic surgery has become more common and laparoscopic hernia repair is becoming routine. But laparoscopic surgery is not possible in all cases. You should discuss the type of operation to be done with your surgeon. Laparoscopic hernia repair has a number of advantages over the open operation, namely:
- A quicker recovery.
- Less pain.
- A lower risk of infection.
- Smaller wounds.
- Less formation of adhesions.
- The surgeon can examine the rest of the abdomen.
The main disadvantages are that the operation takes longer than a straightforward open operation and injury to other organs, such as bowel, bladder or blood vessels is more likely.
The laparoscopic hernia repair has good advantages for hernias in both groins, called bilateral, because both hernias can be repaired through the same incisions, and recurrent hernias.
What are the alternatives?
Simply waiting and seeing if you have more trouble is a good idea if it is not certain that you have a hernia. Pain in the groin could be coming from a simple groin strain, which should settle over time.
However, groin strain in an athlete, such as a footballer, may actually need an operation similar to a hernia repair. Some bulges in the groin are not hernias, but just weak muscle. No operation is needed.
A special type of belt, called a truss, will usually hold a hernia in place. It is useful as a stop-gap until you have the operation. It is also good if you do not like the idea of an operation, or if you are not fit enough for one.
What if you do nothing?
The hernia will not heal itself. There is always a chance that the hernia will become strangulated and a more complicated operation, possibly with removal of the bowel, will be necessary.
Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.
© Dumas Ltd 2006