Open inguinal hernia repair (herniorrhaphy, hernioplasty)

Surgery 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 (Gore-Tex, Teflon, Dacron, Marlex, or Prolene) are now being widely used to repair hernias (hernioplasty). This is especially true for hernias that recur and for large hernias. Patches are sewn over the weakened area in the abdominal wall after the hernia is pushed back into place. The patch decreases the tension on the weakened abdominal wall, reducing the risk that a hernia will recur.

What To Expect After Surgery

For adults, open surgery for hernia repair usually involves a recovery period of up to 4 weeks before resuming normal strenuous activities. But this varies depending on the individual.

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.

• Children who need to have inguinal hernia repair surgery
• Adults who need to have inguinal hernia repair surgery

How Well It Works

Open surgery for inguinal hernia repair is safe. The recurrence rate (hernias that require two or more repairs) is low when open hernia repair is done by experienced surgeons using mesh patches. Synthetic patches are now widely used for hernia repair in both open and laparoscopic surgery.

The chance of a hernia coming back after open surgery ranges from 1 to 10 out of every 100 open surgeries done.¹

Fertility is usually not affected by an inguinal hernia or hernia surgery. But in males there is a chance that surgery or an incarcerated hernia can cause injury to the vas deferens, the tube that carries sperm from the testicles to the urethra.² It is not known at this time how often or to what degree this affects a man's ability to father a child. In rare cases, surgery or an incarcerated hernia may injure the blood vessels that supply one or both testicles with blood, which may cause the affected testicle to shrink.

Risks

Healthy children who have a hernia repair have few risks. The surgery usually is done on an outpatient basis.

• The surgeon may check to see whether a child younger than 1 year also has a hernia on the other side of the groin. If there is one, it may be repaired during the same surgery to avoid the risks of a second surgery. In males, this practice involves putting both testicles at risk at the same time.
• Males with hydrocele and hernia may have both problems repaired at the same time to avoid the risks of a second surgery.
• Premature babies are at risk for heart and lung complications during surgery.

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), resulting in an inability to father children.
• Damage to the femoral artery or vein.

What To Think About

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 anticoagulation medicines (such as warfarin or heparin)

Most inguinal hernia repair surgery on adults of all ages and healthy children is done on an outpatient basis. This lowers costs (as much as 50% lower than inpatient surgery, which requires a stay in the hospital) and may reduce infection. Outpatient surgery takes about 1 hour.

Inpatient surgery is sometimes recommended for people who have:

• Unusual, recurrent hernias.
• Very large hernias.
• Hernias on both sides (bilateral hernias).
• Severe illnesses (such as heart or lung disease), or who are taking anticoagulant medicines.

Infants with the following conditions may need to be hospitalized for hernia surgery:

• Lung problems, such as bronchopulmonary dysplasia
• Seizure disorders
• Heart disease from birth (congenital heart disease)
• Premature birth or the need for a breathing machine (ventilator)

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Author:	Monica Rhodes	Last Updated: May 16, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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