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Definition

This is an operation to treat a hernia , which develops when the abdominal wall weakens, bulges, or tears. This causes the inner lining of the abdomen to protrude and form a sac, or hernia. The most common site of a hernia is the groin (an inguinal hernia), but hernias can also occur in the navel, at the site of a surgical incision, in the upper-middle abdomen, between the abdomen and thigh, or where the esophagus joins the stomach at the diaphragmatic hiatus ( hiatal hernia ). A hernia occurs where any part of the body abnormally protrudes into any other area.

Inguinal Hernias

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Parts of the Body Involved

Most commonly, the groin or abdomen and abdominal cavity.

Reasons for Procedure

Hernia repair is performed to correct the hernial defect. If a hernia is “strangulated” (pinched so the blood supply is cut off), emergency surgery is required. When the hernia is not strangulated, hernia repair surgery is elective. Without surgery the hernia will not heal, and the amount of pain you feel and the size of the hernia will likely increase over time.

Risk Factors for Complications During the Procedure

A risk factor is something that increases your chance of having complications during your procedure. Risk factors for complications during a hernia repair include:

  • Having neurological, cardiovascular, or respiratory conditions
  • Age: older than 70 years
  • Obesity
  • Smoking
  • Any active infection

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Blood tests
  • Urine tests
  • Electrocardiogram (EKG, ECG) —a test that records the heart’s activity by measuring electrical currents through the heart muscle
  • Instruct you to stop some medications before surgery, including aspirin, to avoid interactions with anesthetics and abnormal bleeding
  • Check with your doctor if you are taking any cardiac medications or medications for diabetes

The days before and the day of your procedure your doctor may recommend that you:

  • Follow a special diet.
  • Take antibiotics.
  • Shower the night before your procedure using antibacterial soap.
  • Arrange to have someone drive you to and from the procedure and for help at home after your procedure.
  • The night before, eat a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor.
  • Wear comfortable clothing.

Anesthesia

Depending on your surgeon’s preference, your age, your state of health, and the difficulty of your procedure, you will receive local anesthesia (the area is numbed) or general anesthesia .

Description of the Procedure

In a conventional hernia repair , the surgeon makes an incision over the site of your hernia. Next, your surgeon moves the protruding tissue back into the abdominal cavity and/or removes the sac that has formed. The surgeon sews the muscle around the hernia together to repair the hole or weakness in the abdominal wall. If the hernia is large, or if it is in the groin, a piece of mesh is inserted to cover the hole or to repair weakness without sewing together the muscle.

In a laparoscopic hernia repair , several small keyhole-type incisions are made in the abdominal cavity. The surgeon inserts a laparoscope, which contains a tiny camera and light, into one of the incisions and views the hernia from within the peritoneal cavity on a TV monitor. The surgeon repairs the hernia with tiny instruments inserted through the other incisions.

After the procedure is complete, your surgeon closes the incision(s) with stitches or staples and applies a sterile dressing.

After Procedure

You will be moved to a recovery area, where you may receive fluids and pain-relieving medications through an intravenous (IV) line.

How Long Will It Take?

The surgery typically takes less than two hours.

Will It Hurt?

Anesthesia prevents pain during surgery. Patients typically experience pain during recovery but receive pain medication to relieve the discomfort.

Possible Complications

  • Damage to neighboring organs or structures such as the intestine or bladder
  • Infection
  • Bleeding
  • Scarring
  • Pneumonia and other risks of general anesthesia, if general anesthesia is required

Average Hospital Stay

In most cases, hernia repair is performed on an outpatient basis, so no overnight hospital stay is required. You may receive IV fluids and pain-relieving medications for a few hours in the hospital.

Postoperative Care

You will receive instructions on when and what you can eat, and how you need to restrict your activity. During the first few days after surgery, you will be able to ease back into normal activities. You may be prescribed pain medication. You may be restricted from driving for a few days and/or from sexual activity for 1 to 2 weeks. You should avoid excessive strain (eg, vigorous exercise, lifting) for 6 to 8 weeks after surgery.

Outcome

The outcome of your hernia repair depends on your overall health, age, the severity and size of your hernia, and the strength of your abdominal tissues. Hernia repair can permanently fix a hernia, but there is some risk the hernia will recur. You can reduce the risk of hernia recurrence by:

  • Maintaining a healthy weight
  • Strengthening your abdominal muscles
  • Treating chronic constipation, allergies, or chronic coughing
  • Consuming a high-fiber diet

Call Your Doctor If Any of the Following Occurs

It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occurs, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Excessive tenderness or swelling
  • Severe or increasing pain