Inguinal Hernia

Surgery

Surgery has generally been recommended for all inguinal hernias to avoid complications such as strangulation, in which a loop of intestine becomes tightly trapped in a hernia, cutting off the blood supply to that part of the intestine. But surgery may not be needed if the hernia is small and you do not have symptoms. Consult with your doctor to decide if you need hernia repair surgery.

If a hernia in an adult can be pushed back (reduced), surgery can be done at the person's convenience. If it cannot be pushed back, surgery must be done sooner.

• During surgery, the hernia sac is removed and occasionally a couple of stitches are used to close the opening of the inguinal canal nearest the abdominal cavity (internal ring).
• Most hernia repairs are done as outpatient surgery. Anesthesia can be local, spinal, or general.
• The use of synthetic patches or mesh for hernia repair is becoming standard for adult surgery. The mesh or patch is used to strengthen the abdominal wall and prevent hernias from recurring. Previously, these were used mostly for hernias that were large or hard to repair.

Laparoscopic hernia surgery may have some advantages over open surgery in certain situations. Studies show that people have less pain after this type of surgery and return to work and other activities more quickly than after open repair. But laparoscopic surgery is more expensive than open repair. And laparoscopic surgery has a higher risk for serious complications.³

The risk of a hernia coming back after surgery varies depending on a surgeon's experience, the type of hernia, if mesh is used, and the person's age and overall health.

• Recurrence rates after hernia repair are lower when experienced surgeons perform the procedure, especially for laparoscopic techniques.⁴
• The chance of a hernia coming back after surgery ranges from 1 to 10 out of 100 surgeries done.^{5, 6}
• Using mesh to repair the weak muscle in the stomach wall makes it up to half as likely that the hernia will come back.⁷

  Should I have surgery for inguinal hernia now, or should I wait?

Surgery in children

In most cases, a child with an inguinal hernia will need surgery to correct it.

Infants 6 months of age and younger who have inguinal hernias have a much higher risk of strangulation than older children and adults. So surgery for inguinal hernias in infants is not delayed like it can be for adults.

• Synthetic patches are not needed to repair an inguinal hernia in an infant.
• Some infants with an inguinal hernia may need to be hospitalized for surgery rather than have it in an outpatient setting. These include infants with lung problems, seizure disorders, or heart diseases from birth or those who were born prematurely.

One of the major decisions concerning infants and children is whether to explore the opposite groin area for a hernia during a hernia repair. A hernia develops in the other side of the groin in about 30% of children who have had hernia surgery.

Issues to consider in deciding whether the other side should be explored include the overall health of the child, the risk of incarceration of a hernia, and the experience level of the surgeon (how many of these surgeries the doctor has performed and his or her recurrence rates).

Surgery Choices

Two types of surgery are done to repair inguinal hernias:

Open hernia repair (herniorrhaphy, hernioplasty)

Laparoscopic hernia repair

What To Think About

The laparoscopic procedure causes less pain and numbness after surgery and generally allows you to return to work and activities sooner. But serious complications such as bladder injury are more likely to occur with a laparoscopic procedure. Also, the success of a laparoscopic surgery depends more on the surgeon's experience, and laparoscopic surgery is more expensive than open surgery.³

Laparoscopic surgery may not be possible for a person who has tissues that have grown together (adhesions) from previous abdominal operations.

Most hernias that will recur do so within 5 years after surgery.

There are some considerations before having inguinal hernia repair surgery. Talk with your doctor so that you make the best decision for your condition.

Recurrent inguinal hernias are more difficult to repair and pose more risks than initial hernia repairs. The risks linked with recurrent hernia surgery are more scar tissue, numbness and pain after surgery, and a greater chance of injury to a testicle or the spermatic cord.

Conditions that might increase the risk of recurrence include abdominal muscles that are not strong or healthy enough to "hold" the stitching (suture) material and bleeding or infection that weaken the repair.

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. Experts don't yet know how often or to what degree this affects a man's ability to father a child.

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Author:	Monica Rhodes	Last Updated: April 29, 2009
Medical Review:	Kathleen Romito, MD - Family Medicine Arvydas D. Vanagunas, MD - Gastroenterology
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