Surgery for Inguinal Hernia

The information in this webpage is in a simple Q & A format, it aims to provide some common questions and answers that patients have about inguinal hernia and the treatment options available. Please consult your doctor if you require more information.

1. What is an inguinal hernia?
2. What are the complications of hernia?
3. Will the hernia heal by itself?
4. What are the surgical options for hernias?
5. What is laparoscopic surgery?
6. How is laparoscopic surgery carried out?
7. What are the risks of laparoscopic surgery?
8. How can I prepare for surgery?
9. How long do I need to be warded?
10. When can I resume my usual daily activities?

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1. What is an inguinal hernia?

   An inguinal hernia is a hernia in the groin. It is a protrusion of the internal lining of the abdomen (often the intestines or other parts of the bowel) through a weakness in the abdominal wall in the groin. Externally, it usually appears as a bulge, and patients may/may not feel discomfort. Daily activities and normal working abilities may be limited due to the hernia. Men are far more likely to develop a hernia than women (98% of people who develop a hernia in their groin are male). As many as 30% of people who get a hernia on one side of their groin, will develop another hernia on the opposite side.

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2. What are the complications of hernia?

   Hernias can occasionally be life-threatening if the bowel within the bulge becomes obstructed. This is known as a strangulated hernia and may require an emergency operation.

   

   Obstructed hernia (bowels)

   
   
   

   Strangulated hernia (bowels)

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3. Can a hernia heal by itself?

   Unfortunately, hernias cannot get better or heal on their own. If left untreated, hernias can develop complications. The only way to repair a hernia is through Hernia Repair Surgery, a common surgery done today.

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4. What are the surgical options for hernias?

   For patients with first-time hernias of the groin, doctors usually recommend that they go for elective repair of inguinal hernia using mesh (presently established worldwide as the procedure of choice. Mesh can be inserted by conventional (open) or laparoscopic surgery. However, for cases where hernias recur or are on both sides of the body, laparoscopic surgery has significant advantages such as less post-operative pain, earlier return to normal lifestyles, and lower incidence of chronic pain.

   

   Open Surgery for Hernia Repair (without mesh)

   
   
   

   Open Surgery for Hernia Repair (with mesh)

   Patients with unilateral hernia (hernia on one side of the body) who are concerned about post-operative pain or who wish to return to their normal lifestyles and work quickly should also consider a laparoscopic approach. When laparoscopic surgery is undertaken for hernias in the groin, the Totally Extraperitoneal (TEP) procedure is preferred.

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5. What is laparoscopic surgery?

   Laparoscopic surgery, often referred to as “keyhole” surgery, is a method of carrying out an operation without having to make a large incision (as is the case with conventional surgery). Instead, small cuts (between 5mm - 10 mm) are made in the patient‘s abdomen through which special viewing and surgical instruments are passed through to perform the surgery.

   Many conventional operations can now be carried out using laparoscopic surgery. Compared to conventional surgery, patients who undergo laparoscopic surgery can have reduced hospital stays, less post-operative pain and side-effects, and better cosmetic results.

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6. How is laparoscopic surgery carried out?

   After small incisions are made in the abdomen, a harmless gas is pumped in to create space for the surgeon to operate. Viewing equipment (comprising of a camera connected to a TV monitor) and surgical instruments are then inserted through the incisions into the newly formed space. With a clear image of the operating field projected onto the monitor, the surgeon then carries out the hernia repair operation. A prosthetic mesh is then used to reinforce the weakened area of the abdominal wall to prevent recurrence of the hernia.

   

   There are three main Endo-laparoscopic approaches for the inguinal hernia repair. In all cases the surgery is performed covering the hernia defect with a piece of mesh.

   Types of hernia surgeries include:

   • IntraPeritoneal Onlay Mesh repair (IPOM). By this technique the hernia is repaired using an intra-abdominal approach and the mesh is fixed by stapling technique.
   • Transabdominal Preperitoneal (TAPP) Hernia Repair involves treating the hernia through the space on the inside of the abdomen and once the mesh is fixed to cover the defect, the peritoneum is then closed over the mesh.
     

     TAPP: Schematic picture of intraoperative view of TAPP

   • The Totally Extraperitoneal (TEP) approach is the one of the favoured laparoscopic techniques today. In this method, the hernia is accessed without reaching the abdomen cavity (pre-peritoneal space) and the mesh is fixed to cover the weakened area. TEP may decrease the risk of damage to internal organs and vascular injuries.

     

     TEP: Intraoperative picture of direct and indirect hernia

     
     
     

     Mesh is fixed over the hernia defect

7. What are the risks of laparoscopic surgery?

   As with any surgery, there are risks of infection, bleeding and damage to the surrounding internal structures. However, their incidence is very low in laparoscopic repairs.

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8. How can I prepare for surgery?

   The night before your surgery, a nurse will inform you of the pre-operation procedures.

   Please note the following to ensure that your surgery can proceed as scheduled:
   • On the day before your surgery, do not eat or drink from midnight onwards.
   • On the morning of your surgery, do not smoke, chew tobacco or gum.

9. How long do I need to be warded?

   Most patients can be discharged on the same day of the operation. As the effects of anaesthesia may take some time to wear off, it is advisable that you arrange for someone to accompany you home after discharge.

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10. When can I resume my usual daily activities?

    You should be able to return to work and your usual routines in about one to two weeks after your operation. However, take care not to lift heavy loads for a few weeks after surgery to allow the wound to heal completely.

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Information in this webpage is given as a guide only and does not replace medical advice from your doctor. Please seek the advice of your doctor if you have any questions related to the surgery, your health or medical condition.

Information is correct at time of publishing (October 2003).