Patient education: Groin hernia repair (The Basics)

What are groin hernias? — A hernia is an area in a layer of tissue that is weak or torn. Often, when there is a hernia, other tissues that are normally held in by the damaged layer bulge or stick out through the weak or torn spot.

Hernias can happen in different parts of the body. When they happen in the groin (where the thigh and body meet), they are called "inguinal" or "femoral" hernias (figure 1). Either type of hernia can balloon out and form a sac. In some cases, the sac holds a loop of intestine or a piece of fat that is normally tucked inside of the belly.

What is groin hernia repair? — This is a way to fix a hernia with surgery. Not all hernias need repair, but many do.

Doctors can repair groin hernias in a few ways. The best surgery for you depends on your preferences and your surgeon's experience. It also depends on the type and size of your hernia, whether this is the first time it is getting repaired, and your overall health.

Groin hernia repair can be done in 2 ways:

●Open surgery – During an open surgery, the doctor makes 1 large cut near the hernia to repair it.

●Minimally invasive surgery – "Minimally invasive" surgery allows the doctor to make smaller cuts in the skin. They insert long, thin tools through the cuts. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery).

You might be able to return to normal activities sooner if you had minimally invasive surgery than if you had an open surgery.

How do I prepare for groin hernia repair? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might order tests, such as:

●Lab tests

●Electrocardiogram ("ECG") – This test measures the electrical activity in your heart.

●CT scan – A CT scan is a special kind of X-ray.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Fasting – This means not eating or drinking anything for a period of time. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything that you do not understand.

What happens during groin hernia repair? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia used for groin hernia repair include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain. If you get this type of anesthesia, you will also get medicines called "sedatives." These will help you relax and feel sleepy.

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you will get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctor might put a thin, flexible tube called a "catheter" into your bladder. This is to drain urine during the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make an incision (cut) near the hernia:

•If you are having minimally invasive surgery, you will have 3 small incisions. The doctor will put a laparoscope with a tiny camera through 1 of the small incisions to look at the tissue that is stuck in the hernia. The doctor will put small tools through the other incisions to do the procedure.

They will also use carbon dioxide gas to inflate your belly during the surgery. This makes it easier for them to see and use the tools.

•If you are having open surgery, you will have just 1 incision.

●The doctor will look at the tissue that is stuck in the hernia. If it is healthy, they will gently push it back into place. Sometimes, a piece of tissue needs to be removed.

●Next, the doctor will sew the layers of tissue back together, so that nothing can bulge through. In most cases, they will also patch the area with a piece of mesh. The mesh takes some of the strain off of the area. That way, the hernia is less likely to happen again.

●The doctor will close your incisions and cover them with clean bandages.

What happens after groin hernia repair? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Usually, people can go home the same day that they have their procedure. But in some cases, you might need to stay overnight in the hospital.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a catheter in your bladder, it will be removed.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of groin hernia repair? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●Bleeding

●Damage to the bladder or testicle

●Urinary retention – This is when you are unable to pass urine.

●Lung infection

●Chronic pain – This is pain that lasts longer than 3 to 6 months.

●Problems with the mesh, if you got mesh – These can include the mesh moving to the wrong place in the body, breaking down, or becoming infected. If this happens, you will need another surgery to remove the mesh.

●Problems with sex or pain when having sex

●Heart attack, stroke, or a blood clot in your lungs

What else should I know? — In some cases, a hernia might come back even after surgery. You can help lower the chance of this happening if you:

●Maintain a healthy weight.

●Keep other health conditions, like diabetes, under control.

●Avoid lifting heavy objects after your surgery.

More on this topic

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Patient education: Groin hernias (The Basics)
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