Overview
For open hernia repair surgery, a single long incision is made in the groin. If the hernia is bulging out of the abdominal wall (a direct hernia), the bulge is pushed back into place. If the hernia is going down the inguinal canal (indirect), the hernia sac is either pushed back or tied off and removed.
The weak spot in the muscle wall—where the hernia bulges through—traditionally has been repaired by sewing the edges of healthy muscle tissue together (herniorrhaphy). This is appropriate for smaller hernias that have been present since birth (indirect hernias) and for healthy tissues, where it is possible to use stitches without adding stress on the tissue. But the surgical approach varies depending on the area of muscle wall to be repaired and the surgeon’s preference.
Mesh patches of synthetic material are now being widely used to repair hernias (hernioplasty). This is especially true for large hernias and for hernias that reoccur. Patches are sewn over the weakened area in the abdominal (belly) wall after the hernia is pushed back into place. The patch decreases the tension on the weakened belly wall, reducing the risk that a hernia will recur.
Open surgery is different from laparoscopic surgery for hernia repair in the following ways:
An open surgery requires one larger incision instead of several small incisions. If hernias are on both sides, a second incision will be needed to fix the other hernia. Laparoscopic surgery allows the surgeon to repair both hernias without making more incisions. Open hernia repair can be done under general, spinal, or local anesthesia. Laparoscopic repair requires general anesthesia.
Why it is done
Surgical repair is recommended for inguinal hernias that are causing pain or other symptoms and for hernias that are incarcerated or strangulated. Surgery is always recommended for inguinal hernias in children. Infants and children usually have open surgery to repair an inguinal hernia.
Risks
Adults and children who have a hernia repair are at risk for:
- Reaction to anesthesia (main risk).
- Infection and bleeding at the site.
- Nerve damage, numbness of skin, loss of blood supply to scrotum or testicles resulting in testicular atrophy (all infrequent).
- Damage to the cord that carries sperm from the testicles to the penis (vas deferens), which results in an inability to father children.
- Damage to the femoral artery or vein.
Procedure
A few days before surgery, your surgeon may order a pre-op exam consisting of blood tests, an EKG (electrocardiogram), and a chest X-ray to be sure your heart and lungs are in good condition. You may be instructed to stop taking some over-the-counter medications for a week to 10 days before surgery, such as aspirin or ibuprofen (Advil), which can increase bleeding. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. You may also be given a prescription for pain medication to take after surgery, in case you need it. Fill it before your surgery, so you don’t have to think about it after.
The following people need special preparation before surgery to reduce the risk of complications:
- Those with a history of blood clots in large blood vessels (deep vein thrombosis)
- Smokers
- Those taking large doses of aspirin
- Those taking a medicine (called a blood thinner) that prevents blood clots
- Most inguinal hernia repair surgery on adults of all ages and healthy children is done on an outpatient basis. Outpatient surgery takes about 1 hour.
The day of the Surgery
- You’ll arrive at the hospital the morning of your surgery; you’ll sign consent forms, change into a hospital cap and gown, have your blood pressure taken, and be started on an IV (intravenous line). The area of your hernia may need to be scrubbed and shaved to guard against infection.
- The anesthesiologist will meet with you and review the type of anesthesia you and your surgeon have decided on. You’ll be given medication to relax you
- Next you’ll be taken to the operating room, your anesthesia will be administered and the next thing you know
During the procedure:
- Open: An incision of 3″ to 6″ is made in the abdomen to give the surgeon access to the hernia.
- Tension: The edges of healthy tissue around the hernia are pulled together and sewn with sutures.
- The incision is then closed with dissolving sutures or abdominal adhesive.
This method has been tried and true for decades and may be the only way to repair a very large hernia. The incision tends to be painful and recovery can take as long as five to six weeks. The incision also leaves a scar, although it’s usually very low on the abdomen. Tension repair has a higher recurrence rate than non-tension, or mesh, repair.
Results
Most people who have open hernia repair surgery are able to go home the same day. Recovery time is about 3 weeks. You most likely can return to light activity after 3 weeks. Strenuous exercise should wait until after 6 weeks of recovery. Don’t do anything that causes pain. You’ll probably be able to drive again in about 2 weeks or when you have no pain in your groin. You can have sexual intercourse in about 3 weeks.
Infection: Swelling over the incision is common after hernia surgery. It doesn’t mean that the surgery was unsuccessful. To reduce swelling and pain, put ice or a cold pack on the area for 10 to 20 minutes at a time. Do this every 1 to 2 hours. Put a thin cloth between the ice and your skin.
Call your doctor if you have any of these symptoms:
- The incision is noticeably warm and red.
- A testicle is hard and swollen.
- Your wound is bleeding through your bandage.
- You have a fever.
English
Czech
Hausa
Igbo
Yoruba
