Inguinal Hernia Repair is done to repair a hernia that develops when a part of the intestine or tissue bulges through a spot in the groin muscle that is weak. It pains during strenuous activities or bowel movement. This can pose serious problems, especially if a part of the organ or tissue protrudes into a hernia and gets stuck. This may result in strangulation of that part of the organ as blood supply to it may be cut. Surgery is a suitable solution for Inguinal Hernias to ease the pain and prevent complications as a result of Hernia. Inguinal Hernia Repair can be performed by two methods:
- Open Hernia Repair Surgery
Open Hernia Repair is done by making a single large incision under general, spinal, or local anesthesia. This incision is made in the hernia region and the hernia sac is put back in position. However, if hernia is present on both sides, another incision would also be required. After this, the surrounding abdominal tissue is repaired. This can be done in two ways.
- In Herniorrhaphy or Open Tension Repair, the healthy tissue is pulled together and the edges are sewn. Smaller indirect hernias present at the time of birth are treated this way. Sometimes the surgeons use this method when it is possible to sew the healthy tissues together without undue stress, but the approach depends on the surgeon’s preference and the area of the abdominal wall to be fixed.
- In Non-Tension repair or Hernioplasty, synthetic mesh patches are used for hernia repair. After a hernia is put back in position, the area of the abdominal wall is reinforced with a mesh patch that is sewn over the affected area. This is done in case of large hernias or hernias that recur. The patch helps to reduce the tension in that area reducing chances of recurrence. The mesh patch is made from a flexible synthetic material that allows growth of new tissue into it. These patches are available in different kinds such as plugs, patches, expanding, self-gripping, self-absorbing and three-dimensional. The surgeons use the latest procedures according to comfort and experience.
During keyhole or Laparoscopic surgery performed under general anesthesia 2-4 small incisions are made. The surgery is performed with special instruments guided with the help of the laparoscope inserted through one of the incisions. The weak spot is covered with mesh and fixed into the muscle tissue to strengthen the abdominal wall. This surgery is less painful and has faster recovery time due to the small incisions.
- You will undergo few Blood Tests, Chest X-Ray and ECG to ascertain the condition of your lungs and heart.
- Make sure to inform your doctor about all the medications you are taking including any nutritional supplements.
- Medications like Ibuprofen or Asprin increase the risk of bleeding and you will be advised to stop taking these medicines 10 days prior to surgery.
- Once you are through with the hospital admission procedures including the signing of consent form etc. you will be given hospital gown. The blood pressure will be checked and you will be put on intravenous line or IV. Scrubbing and shaving of the area of the surgery may be done to avoid infection.
- Anesthesia is administered in accordance with the surgery and the collective pre-decision of the surgeon and the patient regarding anesthesia. Open Hernia Surgery can be done under general or spinal anesthesia. Sometimes, local anesthesia along with sedatives may also be used for open hernia repair but laparoscopic procedures for a hernia always use general anesthesia. It is given under the supervision of the anesthesiologist who monitors the patient throughout the surgery.
Procedure for Open Surgery
- A 3-6 inch single incision is made in the abdomen area. In the case of a direct hernia, where the hernia sac is protruding out of the wall of the abdomen, it is pushed back and set in its place. In case of indirect hernia, where the hernia sac is projecting down in the inguinal canal, it is put back in its place or sometimes removed after tying off.
- The healthy tissues that surrounded the hernia sac or the abdominal wall through which hernia bulged through have to be repaired after the hernia sac is pushed back in position or removed. This is done by Herniorrhaphy or Hernioplasty.
Procedure for Laparoscopic Surgery
- Three or four incisions are made in the abdomen. These are nearly ¼ to ½ inches in size. One is made near the navel and the remaining in the lower area.
- The laparoscope which is a tiny camera attached at the end of a fiber optic tube is inserted into the abdomen to giving the surgeon a view of the area on the TV screen.
- The space inside the abdomen is expanded with the help of a harmless gas to give more working room to the surgeon.
- The surgery is performed with very small surgical instruments while viewing the area with the camera/laparoscope. These instruments are inserted into the abdomen through the other incisions.
- Mesh is used for reinforcement in laparoscopic surgeries and is sutured or stapled in a position ensuring the lesser risk of recurrence of a hernia.
- Once the surgery is complete, the instruments are taken out and the holes are stitched or sealed with surgical tape.
- After the surgery, fluids and medications will be given through IV. The incisions will be covered by small bandages.
- The patient is released only after the patient begins to eat, drink, becomes steady and be able to urinate which is mostly the same day or the next day.
- Pain medications will be recommended post surgery and few Do’s and Don’ts will be given.
- Total recovery takes nearly 3 weeks after which light activity such as driving can be resumed
- You will need to rest for the first few days post-surgery. Lifting heavy weights must be avoided for some time. Strenuous activities like sports etc. should also be avoided for at least 6 weeks.
Risks Involved in Inguinal Hernia Repair
- Spasm in the sphincter of the bladder may cause difficulty in passing urine
- The scrotum and testicles may swell or the penis may be bruised, in most cases, these are resolved as time passes
- Chances of infections that require further treatment and anti-biotics
- Bleeding may occur
- Any of the nerves traversing the groin area may be cut or caught during stitching causing pain and discomfort
- Postoperative scarring may cause chronic pain
- The position of the testicle within the scrotum may be little higher than earlier
- The scar may become thick, red or may pain
- A hernia may recur
- Intake of blood thinning medications prior to surgery may cause thinning of blood
- Obese, diabetic or patients who smoke are at a greater risk for infection in the chest or the wound or complications of the heart and legs
- In uncommon cases, there are chances of heart attack or stroke, a blood clot in the legs causing swelling. There may occur a rare occasion where the tube carrying the sperms from the testicles to the prostrate may be severed which may result in partial vasectomy and fertility issues.
- Bleeding may occur after surgery. There are chances that blood may collect in the space where a hernia was present. This is a condition called Hematoma and will resolve eventually with time and warm compresses.
- Infection may occur in the mesh or the incision. Urinary infections have also been reported though on rare occasions. These are treated with antibiotics.
- Some patients experience retention of urine for which catheter is inserted for passing urine for few days.
- Severe or chronic pain may sometimes occur post surgery
- Any of the nerves in the groin region may be damaged, injured and may cause pain or discomfort
- On rare occasions, the vas deferens may be traumatized causing discomfort or infertility
- Seroma or temporary collection of fluid in the region of a hernia may occur. This may last for several months but are mostly absorbed. In some cases, management operation of seroma may be required for those lasting more than 4-6 months.
- Gastrointestinal Issues may develop post surgery and most patients recover within 24 hours. If these persist, the doctor must be informed.
- Postoperative constipation is common and is usually managed with laxatives.
- Patients may experience shoulder pain which is usually self-limiting and gets corrected within 3 days.
Factors affecting Cost of Inguinal Hernia Repair Surgery
- Cost of Material such as Mesh etc. used in surgery
- Cost of the fee of the surgeon – Depending on the choice of the surgeon, the fee for the surgery may vary accordingly
- Any complications may increase the cost of surgery