Inguinal Hernia

An inguinal hernia is a protrusion of a loop of intestine into the groin or scrotum through a defect in the lower abdominal wall. It is common in baby boys and older men and relatively uncommon in women. It produces a soft lump in the groin or scrotum, which can usually be pushed back into the abdomen. It usually occurs on on one side but can occur on both sides either at the same time or at different times. The lump can vary in size from a 'golf ball' to a 'grapefruit' and sometimes even bigger.

The risks of not repairing the hernia include continuing discomfort, increase in size of the hernia, obstruction and strangulation. The latter two complications are serious and can result in peritonitis and death.

Our aim is to successfully treat your hernia using the most effective modern techniques, with the minimum of discomfort and the best cosmetic result.

Options include:

• Do nothing. This is usually because of extreme frailty associated with a very large hernia. Most hernias will require to be repaired surgically.
• An open repair, either under local or general anaesthetic.
• A laproscopic or 'keyhole' repair. My current policy is to offer laparoscopic repairs to those patients who have bilateral or recurrent inguinal heniae. The advantages in terms of early mobility, fewer complications and less pain are significantly in favour of the keyhole method.

Inguinal Hernia - Open

An incision is made through the skin at the site of the hernia and the hernia repaired. Further reinforcement is obtained by placing a very fine nylon mesh in the tissues. This technique is now well established and used by most surgeons.

Depending on facilities available, patients requirements and suitability ( age, social circumstances and general health), the procedure can be undertaken under local anaesthetic and as a Day Case i.e. you are admitted to hospital and discharged within 24 hours.

Sometimes it may be necessary for you to spend a couple of nights in hospital. If this is the case you will have been advised of this.

tension free mesh technique

This technique is eminently suitable for single herniae.

Inguinal Hernia - Laparoscopic

CO2 gas is used to insufflate (blow up) the abdominal cavity and the hernia is then repaired from the 'inside'.

The procedure is undertaken under general anaesthetic ( i.e. you are asleep) and a mesh is placed in much the same way as in the open technique.

It is undertaken as a Day Case procedure (i.e. out of hospital the same day), recovery is quick and post-operative mobility is good.

The greatest advantage appears to occur when the laparoscopic technique is used to repair bilateral (double) or recurrent herniae.

This is a relatively new (15 years old) technique which is now established as routine in most countries. However, extensive studies have not demonstrated a significant, consistent advantage over the 'open' technique for single herniae.

Other Abdominal Wall Herniae

There are many different types of abdominal wall herniae. All are repaired using either 'open' or laparoscopic techniques.

• Para-umbilical:

  Usually a day case procedure, either under local or general anaesthetic.

• Femoral:

  Usually a day case procedure, either under local or general anaesthetic.

• Incisional:

  These herniae occur at the site of a previous incision where the abdominal wall has given way. They can vary form small to enourmous. Surgery and repair should not be under-estimated and there are many complex (eg component layer separation, laparscopic) techniques described for repair.

Hernia - Other Information

You may find the following of interest and can be viewed or printed at your convenience.

Peri-operative Information Sheet - open repair (pdf)

Peri-operative Information Sheet -laparascopic repair (pdf)

Giving Consent to an Operation (pdf)

The British National Institute for Clinical Excellance (NICE) has issued guidance (to both surgeons and patients) pertaining to the repair of inguinal herniae and you may find the section Patient Information useful.

Medline® - more about herniae.