What are the other Names for the Procedure?
- Bassini Repair
- Cooper’s or McVay Repair
- Inguinal Herniorrhaphy
What is Inguinal Hernia Repair surgical procedure?
- An Inguinal Hernia Repair is a procedure that involves repairing an abnormal defect or weakness, within the abdominal wall of the groin, through which a piece of tissue or a loop of bowel may protrude
- In general, a hernia refers to the protrusion of a tissue or organ through a structure that contains it, due to a defect or weak muscles at the region
What part of the Body does the Procedure involve?
An Inguinal Hernia Repair involves the abdominal wall and sometimes, the intestines or urinary bladder.
Why is the Inguinal Hernia Repair surgical procedure Performed?
Inguinal Hernia Repair is done to reduce the patient's risk of a future surgical emergency. If the repair is not performed, hernia may reduce, or may become irreducible, obstructed, or strangulated.
- A reducible hernia occurs, when a hernia can be pushed back into the abdomen, either spontaneously or with manipulation. This is the most common type of inguinal hernia and is usually painless
- An irreducible hernia occurs, when a hernia becomes stuck. This can cause pain and a feeling of illness
- An obstructed hernia occurs, when a part of the intestine enters the hernia sac and gets blocked causing an intestinal obstruction
- A strangulated hernia occurs, when a hernia blocks blood supply to part of the bowel. If the herniated bowel has its blood supply diminished because of pressure from other nearby organs or structures, the affected tissue can die and be invaded by bacteria. This is a life-threatening surgical emergency
What are some Alternative Choices for the Procedure?
- For incarcerated and strangulated hernia, there are no real alternative choices, apart from surgical procedures
- For small, reducible, asymptomatic inguinal hernia, some surgeons may elect to observe and repair the hernia should it become symptomatic
What are the Recent Advances in the Procedure?
- Minimally invasive (laparoscopic approach) is a recent advancement in Inguinal Hernia Repair
- Single incision laparoscopic approach, or single incision minimally invasive approach with robot, are some of the recent advances as well
What is the Cost of performing the Inguinal Hernia Repair surgical procedure?
The cost of Inguinal Hernia Repair procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Inguinal Hernia Repair procedure and what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
Prior to Inguinal Hernia Repair surgical procedure:
How is the Inguinal Hernia Repair surgical procedure Performed?
There are two kinds of Inguinal Hernia Repair: Open repair and laparoscopic repair
- An incision is made in the groin
- The skin, underlying fat, and muscles, are divided
- The hernia sac is identified and separated from the tissues around it
- The sac is then pushed back into the abdomen, or it is removed
- The defect is then obliterated, either by approximation of the adjacent tissue with sutures, or by placement of a prosthetic mesh
- In case of an incarcerated hernia, the sac is opened and its contents examined for viability
- In cases of a compromised bowel, use of a mesh is contraindicated, due to the increased risk of mesh infection. The segment of the bowel compromised is resected and the two ends are connected together
- Using a narrow tube-like instrument (cannula), the surgeon enters the abdomen in the area of the belly button (TAPP – Trans Abdominal Pre Peritoneal approach), or in-between the 2 muscle layers of the abdominal wall (TEP – Totally Extra Peritoneal approach)
- A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a television screen
- Other cannulas are inserted, which allow the surgeon to delicately separate the sac from the adjacent tissues
- Once the sac is separated, the defect is identified and covered with a piece of prosthetic mesh
- Laparoscopic repair is not performed in cases of strangulated hernia, where the bowel viability is compromised
Where is the Procedure Performed?
- An Inguinal Hernia Repair procedure is usually performed in an out-patient surgery center facility, or a hospital. Normally, the individual can go home once the procedure is completed
- However, the physician may keep the patient for overnight observation, if necessary
- However, in some cases the patient may be kept under observation for a certain period of time, under advice by the physician
- If the patient is present with incarcerated or strangulated hernia, the procedure is performed in a hospital. The patient is admitted, and after the procedure, is discharged, as per the instruction of the physician
Who Performs the Procedure?
A general surgeon or a physician trained in general surgery, performs an Inguinal Hernia Repair procedure.
How long will the Procedure take?
The procedure to repair an inguinal hernia, may take anywhere between 1 to 2 hours.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Inguinal Hernia Repair procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Inguinal Hernia Repair surgical procedure?
Prior to an Inguinal Hernia Repair procedure, the patient may need to undergo certain tests, such as:
- Routine blood and urine analysis
- Abdominal X-ray
- Chest X-ray
- Electrocardiography (ECG)
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is an Inguinal Hernia Repair procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is there an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place, during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- What are the costs involved?
During the Inguinal Hernia Repair surgical procedure:
What kind of Anesthesia is given, during the Procedure?
Local anesthesia with sedation, spinal anesthesia, or a general anesthesia is administered, prior to the procedure.
How much Blood will you lose, during the Procedure?
- The procedure requires only a small incision, hence the amount of blood loss is very minimal
- If the procedure is under laparoscopic (minimally-invasive) approach, there is little blood loss involved
- If complications arise during the procedure, it could lead to a further loss of blood
What are the possible Risks and Complications during the Inguinal Hernia Repair surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders, chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the surgery are:
- Excessive bleeding
- Infection in the surgical wound
- Formation of blood clots
- Anesthetic complications
- Accidental injury to the neighboring tissues
What Post-Operative Care is needed at the Healthcare Facility after the Inguinal Hernia Repair surgical procedure?
At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.
After the Inguinal Hernia Repair surgical procedure:
What are the possible Risks and Complications after the Inguinal Hernia Repair surgical procedure?
Post Inguinal Hernia Repair procedure, the following complications may arise:
- Excessive bleeding, resulting in blood clot accumulation at the surgery site (hematoma)
- Loss of bowel/bladder function
- Accidental damage to the intestinal tract
- Signs of an infection
- Recurrence of the hernia
- Impotence; especially when male reproductive structure (vas deferens) is damaged on both sides, during bilateral Inguinal Hernia Repair
- Chronic groin pain (inguinodynia) secondary to nerve damage, or nerve entrapment at the time of surgery
What is the Prognosis after the Surgery?
- The outcome of an elective Inguinal Hernia Repair is usually very good. The recurrence rate is also low
- Emergency repair carries a greater morbidity and mortality rate; this is directly proportional to the degree of bowel compromise
- Other co-existing medical conditions also influence outcome
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain and swelling around the surgical wound
- Bleeding or fluid drainage from the surgical wound
- Signs of an infection
- Feeling sick
- Muscle aches
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Inguinal Hernia Repair surgical procedure?
At home, the following post-operative care is recommended, after an Inguinal Hernia Repair:
- Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
- Avoid all activities that are physically strenuous for about 6 weeks after surgery
- Avoid forcing bowel movements and urination
- Use a heat pad or warm compress to relieve pain due to the incision
- Resume showering and keep the wound clean and dry. Softly wash the surgical wound with soap
- Replace the dressings on the surgical wound, as needed
- Complete the course of prescribed medication, as advised by your physician
- Take stool softeners to prevent constipation, under advice by the physician
- Take antibiotic medication to help combat or prevent infection, under advice by the physician
- Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, as necessary
- Resume driving, when advised by your physician
- Avoid sex till complete healing has taken place (or follow physician’s advice)
How long does it normally take to fully recover, from the Procedure?
It may take anywhere between 4 to 6 weeks, to recover completely from the procedure.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed, as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Inguinal Hernia Repair surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility, physician’s office or hospital
- An anesthesiologist (if anesthesia was administered)
- A pathologist (if the tissue was sent for analysis)
- A general surgeon
The patient is advised to inquire and confirm the type of billing, before the Inguinal Hernia Repair is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA