Open Inguinal Hernia Repair (Herniorrhaphy, Hernioplasty)
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 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
Most people who have open hernia repair surgery are able to go home the same day. Recovery time is about 3 weeks.
You most likely can return to light activity after 3 weeks. Strenuous exercise should wait until after 6 weeks of recovery.
Don't do anything that causes pain. You'll probably be able to drive again in about 2 weeks or when you have no pain in your groin. You can have sexual intercourse in about 3 weeks.
Swelling over the incision is common after hernia surgery. It doesn't mean that the surgery was unsuccessful. Placing an ice pack on the incision during the first 24 hours helps reduce swelling. Call your doctor if you have any of these symptoms:
- The incision is noticeably warm and red.
- A testicle is hard and swollen.
- Your wound is bleeding through your bandage.
- You have a fever.
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.
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
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)
- 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. Outpatient surgery takes about 1 hour.
Open surgery is different from laparoscopic surgery for hernia repair in the following ways:
- An open surgery requires one larger incision instead of several small incisions.
- If hernias are on both sides, a second incision will be needed to fix the other hernia. Laparoscopic surgery allows the surgeon to repair both hernias without making more incisions.
- Open hernia repair can be done under general, spinal, or local anesthesia. Laparoscopic repair requires general anesthesia.
- Harmon JW, Wolfgang CL (2007). Hernias of the groin and abdominal wall. In NH Fiebach et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 1673–1681. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
- Society for Surgery of the Alimentary Tract (2006). SSAT patient care guidelines: Surgical repair of groin hernias. Available online: http://www.ssat.com/cgi-bin/hernia6.cgi.
Last Revised: January 12, 2012
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