Patient Information leaflet - About Your Groin Hernia Repair

What is a hernia?

A hernia is a bulge due to bowel or fat from inside the abdomen protruding out through a weak area. It can be caused by the muscles of the body wall being weak from birth or weakening with the passing of time. Sometimes the body wall is over- strained by coughing, heavy work or sport etc. In your case, the hernia is in the groin and is called an inguinal hernia. This can occur on just one or on both sides. Hernias are very common and are easily treated.

What does a hernia repair involve?

A cut of about 4 inches long is made above the ligament in the groin. The bulge is pushed back or is cut off. The weak part is strengthened by placing a sheet of mesh over it. The cut in the skin is then stitched up.

A hernia can be repaired either under a general or local anaesthetic. We usually give a general anaesthetic so that you will be asleep. This is given by injection into your arm or vein in your hand.

Sometimes it is better to just freeze the area with injections and for you to stay awake during the operation. The doctors will discuss this with you.

Some surgeons use a telescopic method to repair hernias ('keyhole surgery'). This is particularly useful for double hernias (one on each side) or for recurrent hernias (ones being repaired for the second or third time). We have a separate information sheet for patients having these sort of repairs.

What are the alternatives?

Simply waiting to see if you have more trouble may not be a good idea. If left untreated, the hernia could get bigger, cause pain or even cause a blockage in the bowel (although this is rare).

A truss can be used to hold the hernia back in place until you have the operation. It can also be helpful if you do not like the idea of having an operation or if you are not fit enough for one.

Preparing for your operation

You will need to come into hospital on the day of your operation. You should have nothing to eat for 6 hours and nothing to drink for 2 hours before the operation.

After the operation

Going home

This depends on how fit you are, whether you have someone at home with you and how comfortable you are after the operation. We aim to get most patients home the same day of operation, but there will always be some who have to stay in overnight.

Pain and painkillers

People vary a lot in the amount of pain they feel after a hernia repair. Some get very little discomfort, but it is common to have pain during the first 3 or 4 days, particularly when getting up from lying or sitting, and when returning to a chair or bed. This is because the muscles that have had stitches put into them are active and pulling at those times.

Painkilling tablets should easily control this discomfort. If not, we can give pain-killing injections. By the end of a week, the wound itself should be virtually pain free.

Mobility

You will be expected to get out of bed as soon as possible, despite any discomfort. You will not do the wound any harm, and the exercise is good for you. With the new type of mesh repairs that we use, it is safe to do any physical activity you wish as soon as you like. Most patients, relatives, friends and even GPs find this impossible to believe but it really is true! Although we are not saying it will be possible to dig the garden after a few hours (because there will be discomfort which prevents you), nonetheless it would be safe to do so. Patients who 'get going' quickly and try to be as physically active as they can, do much better than those who take the opportunity for a prolonged rest.

You are likely to get aching and pulling as you become more active during the first month, as the tissues are stretched and become supple again.

In 2-3 weeks time, you should be able to return completely to your usual level of activity.

Washing

You can wash, bathe, or shower as soon as you like. The dressing will get wet, which doesn't really matter, but you may find it will get less soggy and dry quicker if you shower rather than bathe. Soap and tap water are quite alright.

It is probably wise to avoid swimming for about 10 days after the operation.

Constipation

It is quite normal for the bowels not to open for a day or so after operation. If you have not opened your bowels after two days and you feel uncomfortable, a laxative may be a good idea.

Stitch removal

Some surgeons use stitches whilst others use skin clips or no sutures. If you have had stitches or skin clips, these will need removing after 6-8 days. You will need to make an appointment with the practice nurse at your local surgery to have this done.

Lifting

At first, discomfort in the wound will probably prevent you from lifting anything too heavy, although it would be safe to do so. After a couple of weeks, you should feel comfortable enough not to need to restrict yourself in any way. Direct physical trauma is not advisable for the first few weeks so avoid contact sports during this time!

Driving

You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 7 days.

Sex

You can resume sexual relations within a week or two, when the wound is comfortable enough.

Work

You should be able to return to a light job after about a week and any heavy job with in 2-3 weeks.

What problems can occur after a hernia operation?

Bruising, swelling and hardness in the wound area are common particularly if the hernia was large. Sometimes the bruising may go down into the penis and scrotum. The swelling and bruising will improve in 2-3 days and will all settle down in time.

Very occasionally, bleeding from a small blood vessel near the repair can produce a large collection of blood, which looks like a bulge under the wound. This may settle slowly on its own, but sometimes needs to be let out by a needle or a further operation. However this is rare.

A small area of numbness in the skin is common just below the inner end of the wound. This is caused by the division of a nerve, which crosses the area of the hernia. The nerve is often divided during the repair. The area of numbness will get smaller. As it is small and lies under the pubic hair it is not usually noticeable.

Infection of the wound is a rare problem and usually settles down with antibiotics.

The chance of the hernia coming back after a hernia repair is small (i.e. less than 1 in 100).

What are the risks?

There is a small risk that the tube, which carries sperms, or the artery that goes to the testicle could be damaged during the operation. If the tube carrying sperms is damaged, then fertility will rely on the sperms from the other testicle (which are usually quite enough). If the artery is damaged, then the testicle may shrivel up or may need to be removed. These risks are higher during surgery for a recurrent hernia.

Very occasionally, a painful area may persist in the groin after a hernia repair. This is probably due to one of the nerves being scarred. This often responds to a special painkilling injection. A very small number of people (about 2%) can have a degree of chronic pain following a mesh hernia repair. Only in exceptional cases would this necessitate removal of the mesh or another operation.

Deep vein thrombosis is a possible problem after hernia repair, but is rare. If you are at particular risk, we can take precautions to reduce the risk. Moving your legs and feet as soon as you can after the operation and walking about early, all help to prevent thrombosis.

What should I do if there is a problem?

To save time and trouble, we will not usually give you an appointment to visit the Out Patient Department for a follow-up.

However, if you have

persistent severe pain

persistent bleeding

fever or

an inflamed or discharging wound

please contact your family doctor.

If your GP cannot help, please feel free to call the ward or your Consultant's secretary at the North Devon District Hospital (01271 322577) who will be happy to advise you.


About your groin hernia repair
Other formats If you need this information in another format such as audio tape or computer disk, Braille, large print, British Sign Language or translated into another language, please telephone 01271 311575.
What is a hernia? A hernia is a bulge due to bowel or fat from inside the abdomen protruding out through a weak area. It can be caused by the muscles of the body wall being weak from birth or weakening with the passing of time. Sometimes the body wall is over- strained by coughing, heavy work or sport etc. In your case, the hernia is in the groin and is called an inguinal hernia. This can occur on just one or on both sides. Hernias are very common and are easily treated. What does a hernia repair involve? A cut of about 4 inches long is made above the ligament in the groin. The bulge is pushed back or is cut off. The weak part is strengthened by placing a sheet of mesh over it. The cut in the skin is then stitched up. A hernia can be repaired either under a general or local anaesthetic. We usually give a general anaesthetic so that you will be asleep. This is given by injection into your arm or vein in your hand. Sometimes it is better to just freeze the area with injections and for you to stay awake during the operation. The doctors will discuss this with you. Some surgeons use a telescopic method to repair hernias ('keyhole surgery'). This is particularly useful for double hernias (one on each side) or for recurrent hernias (ones being repaired for the second or third time). We have a separate information sheet for patients having these sort of repairs. What are the alternatives? Simply waiting to see if you have more trouble may not be a good idea. If left untreated, the hernia could get bigger, cause pain or even cause a blockage in the bowel (although this is rare). A truss can be used to hold the hernia back in place until you have the operation. It can also be helpful if you do not like the idea of having an operation or if you are not fit enough for one. Preparing for your operation You will need to come into hospital on the day of your operation. You should have nothing to eat for 6 hours and nothing to drink for 2 hours before the operation. After the operation Going home This depends on how fit you are, whether you have someone at home with you and how comfortable you are after the operation. We aim to get most patients home the same day of operation, but there will always be some who have to stay in overnight. Pain and painkillers People vary a lot in the amount of pain they feel after a hernia repair. Some get very little discomfort, but it is common to have pain during the first 3 or 4 days, particularly when getting up from lying or sitting, and when returning to a chair or bed. This is because the muscles that have had stitches put into them are active and pulling at those times. Painkilling tablets should easily control this discomfort. If not, we can give pain-killing injections. By the end of a week, the wound itself should be virtually pain free. Mobility You will be expected to get out of bed as soon as possible, despite any discomfort. You will not do the wound any harm, and the exercise is good for you. With the new type of mesh repairs that we use, it is safe to do any physical activity you wish as soon as you like. Most patients, relatives, friends and even GPs find this impossible to believe but it really is true! Although we are not saying it will be possible to dig the garden after a few hours (because there will be discomfort which prevents you), nonetheless it would be safe to do so. Patients who 'get going' quickly and try to be as physically active as they can, do much better than those who take the opportunity for a prolonged rest. You are likely to get aching and pulling as you become more active during the first month, as the tissues are stretched and become supple again. In 2-3 weeks time, you should be able to return completely to your usual level of activity. Washing You can wash, bathe, or shower as soon as you like. The dressing will get wet, which doesn't really matter, but you may find it will get less soggy and dry quicker if you shower rather than bathe. Soap and tap water are quite alright. It is probably wise to avoid swimming for about 10 days after the operation. Constipation It is quite normal for the bowels not to open for a day or so after operation. If you have not opened your bowels after two days and you feel uncomfortable, a laxative may be a good idea. Stitch removal Some surgeons use stitches whilst others use skin clips or no sutures. If you have had stitches or skin clips, these will need removing after 6-8 days. You will need to make an appointment with the practice nurse at your local surgery to have this done. Lifting At first, discomfort in the wound will probably prevent you from lifting anything too heavy, although it would be safe to do so. After a couple of weeks, you should feel comfortable enough not to need to restrict yourself in any way. Direct physical trauma is not advisable for the first few weeks so avoid contact sports during this time! Driving You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 7 days. Sex You can resume sexual relations within a week or two, when the wound is comfortable enough. Work You should be able to return to a light job after about a week and any heavy job with in 2-3 weeks. What problems can occur after a hernia operation? Bruising, swelling and hardness in the wound area are common particularly if the hernia was large. Sometimes the bruising may go down into the penis and scrotum. The swelling and bruising will improve in 2-3 days and will all settle down in time. Very occasionally, bleeding from a small blood vessel near the repair can produce a large collection of blood, which looks like a bulge under the wound. This may settle slowly on its own, but sometimes needs to be let out by a needle or a further operation. However this is rare. A small area of numbness in the skin is common just below the inner end of the wound. This is caused by the division of a nerve, which crosses the area of the hernia. The nerve is often divided during the repair. The area of numbness will get smaller. As it is small and lies under the pubic hair it is not usually noticeable. Infection of the wound is a rare problem and usually settles down with antibiotics. The chance of the hernia coming back after a hernia repair is small (i.e. less than 1 in 100). What are the risks? There is a small risk that the tube, which carries sperms, or the artery that goes to the testicle could be damaged during the operation. If the tube carrying sperms is damaged, then fertility will rely on the sperms from the other testicle (which are usually quite enough). If the artery is damaged, then the testicle may shrivel up or may need to be removed. These risks are higher during surgery for a recurrent hernia. Very occasionally, a painful area may persist in the groin after a hernia repair. This is probably due to one of the nerves being scarred. This often responds to a special painkilling injection. A very small number of people (about 2%) can have a degree of chronic pain following a mesh hernia repair. Only in exceptional cases would this necessitate removal of the mesh or another operation. Deep vein thrombosis is a possible problem after hernia repair, but is rare. If you are at particular risk, we can take precautions to reduce the risk. Moving your legs and feet as soon as you can after the operation and walking about early, all help to prevent thrombosis. What should I do if there is a problem? To save time and trouble, we will not usually give you an appointment to visit the Out Patient Department for a follow-up. However, if you have persistent severe pain persistent bleeding fever or an inflamed or discharging wound please contact your family doctor. If your GP cannot help, please feel free to call the ward or your Consultant's secretary at the North Devon District Hospital (01271 322577) who will be happy to advise you. Further information If you are worried or unclear about any aspect of your hernia repair, please ask the doctors or nurses for more details when you come into hospital. They are never too busy to do this.
PALS The Patient Advice and Liaison Service (PALS) ensures that the NHS listens to patients, relatives, carers and friends, answers questions and resolves concerns as quickly as possible. If you have a query or concern, please visit them in the Information Centre on Level 2 at North Devon District Hospital or contact them on 01271 314090. Have your say Northern Devon Healthcare NHS Trust aims to provide high quality services. However, please tell us when something could be improved. If you have a comment or compliment about a service or treatment, please raise your comments with a member of the ward staff in the first instance. Please also take the time to complete a comment card 'Tell us what you think', so we can make improvements. If you would like to make a formal complaint, please contact the Customer Relations Manager on 01271 322334 or put your concerns in writing to the Chief Executive, Northern Devon Healthcare Trust, Raleigh Park, Barnstaple, EX31 4JB. Tell us what you think If you have any suggestions to improve this leaflet, please contact the Communication Department on 01271 311575.
North Devon District Hospital Raleigh Park, Barnstaple Devon EX31 4JB Tel. 01271 322577 www.northdevonhealth.nhs.uk © NDHT