Inguinal hernia repair - laparoscopic and open

If you would like to know about inguinal hernia repair, and the cost of an inguinal hernia repair operation, the information in these pages will be of interest to you.

Before you agree to have your inguinal hernia repair operation it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when treating an inguinal hernia, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your hernia treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You have a bulge or swelling in your groin. It may be in the left or the right groin. The groin is also called the inguinal area. Your swelling is a hernia, called an inguinal hernia. You may have a hernia in both groins.

What is a hernia?

A hernia is commonly called a rupture. A hernia is a pouch that pushes through a muscle sheet, such as the abdominal wall. In the groin, there is already a gap in the muscles of the abdominal wall, called the inguinal canal.

In males, the inguinal canal lets the baby’s developing testicle and blood vessels drop into the scrotum. The tube that carries sperm, called the vas, also runs along the canal.

In females, there are similar inguinal canals. There is a strand of tissue called the round ligament that runs through the canal and into the skin low down in the groin.

What has gone wrong?

In an inguinal hernia, the pouch is the lining of the inside of the abdominal wall and is called the sac. This sac pushes through the inguinal canal. Inside the sac, there may be bowel or fatty tissue, called omentum. The sac gets steadily larger and can be painful.

Sometimes the swelling can be pushed back; this is called a reducible hernia. Other hernias are called irreducible and cannot be pushed back. The bowel and omentum may get stuck in the sac. The blood supply can be cut off and the bowel and omentum can die. This is called a strangulated hernia. The strangulated bowel in the hernia can block the bowel above it, causing vomiting and pain.

The inguinal canal can be weak from birth or the abdominal wall weakens with age. Sometimes coughing, heavy work, sport or an injury overstrains the tissues and causes the hernia. Inguinal hernias are very common. They are easily treated, preferably early on, to prevent strangulation.

The aims

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.

The benefits

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

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