Open Inguinal Hernia Repair , Procedure & Recovery

Overview

A hernia is the protrusion of the abdominal tissue through a weak spot in the abdominal muscles. This protrusion is called an inguinal hernia when it develops in the inguinal region. Hernias do not generally cause any symptoms. They may pain and become more prominent when you cough, sneeze, bend or lift heavy objects. Hernias do not go away on their own. They may develop complications if left untreated for a long. Surgery is the only form of treatment for hernias. Your surgeon will assess your condition and recommend a surgery best suited to your needs.

What Is A Hernia?

A hernia is a sac formed by the peritoneum (lining of the abdominal cavity). This sac protrudes out of the places where the abdominal muscles are weak. The type of hernia depends upon the location of the protrusion-

• Inguinal Hernia- Bulge in the groin, more common in men.
• Femoral Hernia-Bulge in the upper thigh, just below the groin. 
• Hiatal Hernia-Bulge in the diaphragm. The stomach pushes out into the chest.
• Umbilical Hernia-Bulge around the belly button. This hernia is seen when the belly button does not close well after birth.
• Incisional Hernia- Bulge through the scar of previous abdominal surgery.

How Are Hernias Managed?

Surgery is the only treatment method that can be used for hernias. The surgery usually consists of-

• Herniorrhaphy-Pushing the contents of the abdomen back inside and closing the opening with sutures.
• Hernioplasty-Placing abdominal cavity and a mesh so the herniation does not recur.

This repair surgery may be of two types-

• Open surgery- This is done under general or local anesthesia. The surgeon cuts open your abdomen and does the necessary repair work. This surgery leaves you with big scar tissue.
• Minimally Invasive Surgery- This surgery is generally laparoscopic and robotics-assisted. Several small incisions will be made on your abdomen, and the hernia is repaired laparoscopically.

What Is An Open Inguinal Hernia Repair?

Open inguinal hernia repair is an open surgery to treat an inguinal hernia. This surgery is done under general or local anesthesia. The repair work is done in 2 steps.

• The surgeon will push the protruding parts back into the abdominal cavity and closes the weak spot in the groin by sewing the ends of the healthy muscles together. This is known as Herniorrhaphy.
• The surgeon then places a synthetic mesh over the hernia's opening. The mesh is then sewn together with the healthy abdominal muscles. This mesh repair is known as Hernioplasty and is preferred when the hernia is large and the opening in the abdominal wall is huge. Hernioplasty is very helpful in decreasing the chances of recurrence.

When Is An Open Inguinal Hernia Repair Recommended?

A hernia usually does not produce symptoms. Once a diagnosis is confirmed, the hernia is left alone if it is very small. If the hernia can be pushed back inside by manual compression, it indicates that surgery can wait.
However, there are certain conditions where getting operated on as soon as possible is advisable.

• Incarceration- This is a condition where the abdominal tissue gets trapped inside the hernia.
• Strangulation- When the hernia gets strangulated, the tissue trapped inside loses its blood supply and eventually begins dying. This causes permanent damage and is a surgical emergency.
• Necrosis- The tissue trapped inside the hernia may get infected and decay. This is a critical situation, and the hernia must be operated upon immediately.
• Symptomatic Hernia- Any hernia causing pain and discomfort must be surgically removed immediately.
• An inguinal hernia is kids an indication for immediate surgery.

What Happens Before An Open Inguinal Hernia Repair?

An open inguinal hernia repair is a surgical procedure to fix an inguinal hernia. This surgery is performed under general or local anesthesia. It involves pushing back the bulge and keeping it in place by using a mesh. Open surgery for an inguinal hernia usually leaves a large, visible scar.

• Discuss your medical history and the medications that you are currently taking with your surgeon. You will need to:
  • Inform your doctor if you are allergic to any medications.
  • Inform your doctor if you are pregnant so that the doctor can decide on the treatment modality.
  • Stop medications such as blood thinners (medications taken to prevent blood clots) a few days before the procedure, as these can cause excess bleeding during and after the surgery.
  • Inform your doctor about any dietary supplements which you may be taking.
• Your surgeon will conduct a physical examination to evaluate your hernia. The lump is checked for any tenderness, hardness, and mobility to rule out tumors. You will be asked to stand and cough to check the lump (since it becomes prominent on standing, coughing, or sneezing).
• Routine tests, like blood tests, urine examinations, ECG (electrocardiogram), and chest X-ray, will be advised before the surgery. At times, other imaging tests such as ultrasounds, CT Scans or MRIs may be required: 
• You will be asked to quit smoking immediately and avoid alcohol 3 to 4 weeks prior to the surgery,  as it might delay your healing process and also may increase your risk of developing infection post-surgery.
• You will need to fast (no solid or liquids) for a period of about 8 -12 hours before the surgery or your doctor might suggest an enema (a method that stimulates stool evacuation) to empty the contents from your rectum.
• A day before the procedure, your surgeon may ask for certain tests like blood tests, urine examinations, ECG (electrocardiogram), chest X-ray, CT scan (computed tomography scan), MRI (magnetic resonance imaging), etc. 
• Open inguinal hernia repair is a daycare procedure so you can go home the same day after surgery. You will have to arrange for a family member to drive you home as you cannot drive due to the effects of anesthesia.
• At times, your surgeon may advise you to stay in the hospital for a day or two for observation.

What Happens During An Open Inguinal Hernia Repair?

• On the day of the surgery, you will be administered general or local anesthesia as decided by your surgeon.
• A large surgical cut will be made on your groin to access the hernial sac.
• The surgeon will locate the hernia and separate it from the surrounding tissue.
• The hernia will be gently pushed back into the abdomen or cut off, depending on the condition of the herniated tissue.
• The weakened abdominal muscles will be sewn with sutures. A mesh will be placed to support the abdominal wall and prevent hernia recurrence. Hernia or surgical mesh is a flat, sterile sheet of plastic or biological material used to cover the hernia. The mesh also aids in decreasing the operative time and speeding up recovery time.
• The opening will be stitched closed with sutures.
• Drains may be placed to facilitate the flow of lymphatic fluids and blood post-surgery.

What Happens After An Open Inguinal Hernia Repair?

After the procedure, you will spend 1-2 hours in the recovery room, where your vitals (body temperature, pulse rate, respiratory rate, and blood pressure) will be monitored. Before you go home, your doctor will give you the necessary instructions to follow during recovery and prescribe medications such as painkillers and antibiotics (medications to prevent bacterial infections). Complete recovery is seen 2-3 weeks after the surgery.

After the open inguinal hernia surgery, you will experience pain for a few days. To speed up post-surgery recovery, follow these do’s and don’ts at home:

• Rest whenever you feel tired, nauseated, or feverish.
• You may shower 24 to 48 hours after the surgery. Check this with your doctor since he/she might recommend keeping the incision dry for a few more days.
• You should avoid moving too much or strenuous physical activity until the hernia is repaired completely. Discuss with your doctor when you can resume physical activities (exercises or sports). Heavy exercises and strenuous activities must be avoided for at least 4 weeks. 
• You will be advised to consume lots of fiber and drink adequate water to prevent constipation. You can continue with your normal diet. Try and eat bland, low-fat foods for a few days.
• You should drink plenty of water and use a laxative or stool softener (after consulting your doctor) to avoid constipation.
• You should understand all guidelines from your surgeon about how to take care of the dressing over the incision.

What Are The Benefits And Risks Of Open Inguinal Hernia Repair?

Surgery is the only available treatment method for fixing a hernia. If your doctor recommends surgery, you should get it done at the earliest possible date. Any unnecessary delay could lead to undesirable consequences.
As with all surgeries, open hernia repair has its share of benefits and risks.

Benefits of Open Inguinal Hernia Repair

• It is a safe procedure with very low chances of repeat surgery being required.
• The chances of hernia recurrence are very low with open inguinal hernia repair.
• The cost of this surgery is lower compared to laparoscopic surgery.
• Open inguinal hernia repair ensures good long-term benefits and a low risk of complications.

Risks Of Open Inguinal Hernia Repair

• Infection of the surgical site.
• Damage to the nerves and blood vessels supplying the scrotum and testes, leading to testicular atrophy.
• Damage to the cord that carries sperm from the testes to the penis.
• Damage to the femoral artery

The risks of open inguinal hernia repair are greatly minimized if the surgery is performed by a skilled and experienced surgeon.

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