Bookmark:           

Operation to repair inguinal hernia

Indications

Having a hernia is often an indication for its repair. Repair will prevent serious complications of inguinal hernia. Only if a patient is very unfit for operation should conservative management (no operation) be considered.

Risks

Risks of any operation (anaesthetic, DVT etc)

Risks specific to inguinal hernia repair:

Immediate:

• Bleeding at the time of surgery
• Damage to the testicular vessels (rare)

Early:

• Bruising after surgery including haematoma formation in the wound or scrotum
• Infection of the wound (<5%)
• Retention of urine. A complication in patients with existing urinary outflow problems, especially if they experience post operative groin pain.

Late:

• Recurrence: <5% life time risk.
• Damage to nerves: normal to expect some numbness below the scar as cutaneous nerves are divided gaining access to the inguinal canal. Ongoing pain in the groin occurs in 3-5% of patients due to damage or entrapment of the ileoinguinal nerve (care should be taken to protect this at operation).

Benefits

• Alleviation of symptoms
• Prevention of complication of inguinal hernia
• Improved cosmetic appearance

Methods

Open repair

Laparoscopic repair

Alternatives to operation

As well as the potential risks and benefits of surgery and the operation itself and have been explained to the patient alternative treatments should be discussed as part of informed consent. Traditionally a truss (a belt like device worn to keep the hernia reduced) has been prescribed. In practice however the truss does not keep the hernia reduced and may in fact trap a hernia beneath its edge leading to complications. The other alternative is to do nothing. This may be the best option if the patient is in very poor health with an asymptomatic, easily reducible hernia. Others may elect not to have surgery but must understand that they will continue to have symptoms and the hernia may progress in size or develop complication in the future.

Where to perform operation?

Specialised centers perform nearly all as day case. In NHS 20% of inguinal hernias performed as day case (infirm patient, poor social back up, insufficient day case provision).

Type of anaesthesia?

Inguinal hernia repair performed under local anaesthesia in 70% of patients in USA and 6% in UK. Contraindications are an anxious patient and obesity. Laparoscopic repair requires general anaesthetic.

Perform regional block using 2mg/kg bupivicaine plain or 4mg/kg bupivicaine with adrenaline. Have a little extra local anaesthetic ready to infiltrate as you perform the procedure if the patient experiences discomfort.

Antibiotics?

Always give antibiotics to cover aerobes and anaerobes at induction of anaesthesia in emergency cases. There is little evidence to support the giving of prophylactic systemic antibiotics in elective cases.

NICE guidelines

External link to NICE guidelines on inguinal hernia repair (issued July 2004)