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Groin Hernia Repair: Inguinal and Femoral

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AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION Groin Hernia Repair Inguinal and Femoral Many patients become symptomatic after The Condition the fi rst 1 to 2 years and crossover to surgery Patient Education A hernia occurs when tissue bulges out due to increased pain on exertion, chronic 3 This educational information is to through an opening in the muscles. constipation or urinary symptoms. help you be better informed about Any part of the abdominal wall can your operation and empower you weaken and develop a hernia, but with the skills and knowledge the most common sites are the groin Benefits and Risks needed to actively participate in (inguinal), the navel (umbilical) and of Your Operation your care. a previous surgical incision site. B e n e fi t s — An operation is the only way Keeping You Common Symptoms to repair a hernia. You can return to ● Visible bulge in the scrotum or groin your normal activities and in most cases Informed area, especially with coughing will not have further discomfort. or straining Information that will help you Possible risks include—Return of the further understand the operation ● Pain or pressure at the hernia site hernia; infection; injury to the bladder, and your role in your recovery. blood vessels, intestines or nerves, Groin Hernia Location diffi culty passing urine, continued pain, Education is provided on: and swelling of the testes or groin area. Hernia Repair Overview .................1 Risks of not having an operation—Your Condition, Symptoms, Tests .........2 hernia may cause pain and increase in size. Treatment Options….. ....................3 If your intestine becomes trapped in the hernia pouch you will have sudden pain, Risks and vomiting, and need an immediate operation. Possible Complications ..................4 Preparation and Expectations .............................5 Femoral Your Recovery Expectations and Discharge ....................................6 Before your operation—Evaluation Inguinal Pain Control.............................................7 may include blood work and urinalysis. Glossary/References ........................8 Your surgeon and anesthesia provider will discuss your health history, home Treatment Options medications, and pain control options. Surgical Procedure The day of your operation—You will Open hernia repair—An incision is not eat or drink for 6 hours before the made near the site and the hernia is operation. Most often you will take your repaired with mesh or by suturing normal medication with a sip of water. You (sewing) the muscle closed. will need someone to drive you home. Laparoscopic hernia repair—The hernia Your recovery—If you do not have is repaired by mesh or sutures inserted complications you usually will go home through instruments placed into small the same day. incisions in the abdomen. Call your surgeon—If you have severe pain, stomach cramping, chills, or a high Nonsurgical Procedure fever (over 101°F or 38.3°C), odor or Watchful waiting is a safe and acceptable increased drainage from your incision, option for adults with inguinal hernias or no bowel movements for 3 days. that are not uncomfortable.1-2 This first page is an overview. For more detailed information, review the entire document. AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation Groin Hernia Repair The Condition, Symptoms, Inguinal and Femoral and Diagnostic Tests SAMPLE Keeping You Inguinal canal Informed Fat Groin Hernia Who Gets Hernias? Muscle There may be no cause for a hernia. Some risk factors are: • Older age—muscles Hernia with intestine become weaker • Obesity—increased Spermatic cord weight places pressure on abdominal muscle • Sudden twist, pulls, or strains • Chronic straining Femoral • Family history Symptoms Inguinal • Connective tissue The most common symptoms are: disorders ● Bulge in the groin, scrotum, or • Pregnancy—1 in abdominal area that often increases 2,000 women in size with coughing or straining. develop a hernia The Condition ● Mild pain or pressure at the hernia site.2 during pregnancy.2 The Hernia ● Numbness or irritation due to pressure on the nerves around the hernia.2 Other medical A groin hernia occurs when the intestine disorders bulges through the opening in the muscle ● Sharp abdominal pain and vomiting in the groin area. A reducible hernia can be can mean that the intestine has slipped that have symptoms pushed back into the opening. When intestine through the hernia sac and is strangulated. similar to hernias include or abdominal tissue fills the hernia sac and This is a surgical emergency and enlarged lymph nodes, cannot be pushed back, it is called irreducible immediate treatment is needed. cysts, and testicular or incarcerated. A hernia is strangulated if problems such as the intestine is trapped in the hernia pouch scrotal hydrocele.2-4 and the blood supply to the intestine is Common Tests decreased. This is a surgical emergency.2 History and Physical exam2 There are two types of groin hernias: The site is checked for a bulge. An inguinal hernia appears as a bulge in the groin or scrotum. Inguinal hernias account for Other tests may include (see glossary): 2 75% of all hernias and are most common in men. ● Digital exam A femoral hernia appears as a bulge in the groin, ● Blood tests upper thigh, or labia (skin folds surrounding ● Urinalysis the vaginal opening). Femoral hernias are ten Electrocardiogram (ECG)—for patients times more common in women.2 They are always ● over 45 or if high risk of heart problems repaired because of a high risk of strangulation.1-3 ● Ultrasound Herniorraphy is the surgical repair of a hernia. Computerized tomography (CT) scan Hernioplasty is the surgical repair of a hernia ● with mesh. 2 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation Groin Hernia Repair Surgical and Inguinal and Femoral Nonsurgical Treatment Open Repair Laparoscopic Repair Muscle Inguinal ring Inguinal ring Mesh plug Spermatic cord Mesh Port Open Mesh Nerve and genital branch of nerve Surgical Treatment Suture Only Muscle The type of operation depends on hernia size Inguinal ring and location, and if it is a repeat hernia. Your Port sites will vary health, age, anesthesia risk, and the surgeon’s Spermatic cord expertise are also important. An operation Sutured muscle is the only treatment for incarcerated/ Nerve and genital strangulated and femoral hernias. branch of nerve Mesh repair Your hernia can be repaired either as an open or laparoscopic approach. The repair can be done by using sutures Laparoscopic Hernia Repair only or adding a piece of mesh. The surgeon will make several small punctures Open Hernia Repair or incisions in the abdomen. Ports (hollow The surgeon makes an incision near tubes) are inserted into the openings. The the hernia site and the bulging tissue abdomen is inflated with carbon dioxide gas Keeping You is pushed back into the abdomen. to make it easier to see the internal organs. Most inguinal hernia repairs use mesh Surgical tools and a laparoscopic light are Informed 5 placed into the ports. The hernia is repaired with to close the muscle. An open repair Open vs. Laparoscopic can be done with local anesthesia. mesh and sutured or stapled in place. The repair is done as a TransAbdominal PrePeritoneal Incisional Repair ● For an open mesh repair: The hernia sac (TAPP) procedure, which means the peritoneum A laparoscopic repair of inguinal is removed. Mesh is placed over the hernia (the sac that contains all of the abdominal site. The mesh is attached using sutures hernia may result in less pain organs) is entered, or the repair is done as a and numbness, lower infection sewn into the stronger tissue surrounding Totally ExtraPeritoneal (TEP) procedure.2-4 the hernia site. Mesh plugs can also be rate, and faster return to normal placed into the inguinal or femoral hernia activity when compared with open 6 space. The mesh plug fills the open site surgery. Laparoscopic repair may and is sutured to the surrounding tissue. Nonsurgical Treatment lengthen the operative time and 5 An additional mesh patch is applied Watchful waiting is an option if you have may cost more. A recurrence from and may or may not be sutured.2 Mesh an inguinal hernia with no symptoms.1 a previous open hernia repair is is often used for large hernia repairs Hernia incarceration occurred in 1.8 per best repaired laparoscopically and may reduce the risk that the hernia 1,000 men who waited longer than 2 years because you avoid scar tissue from 7 will come back. The site is closed using to have a repair.2 Femoral hernias should previous incisions. Laparoscopic sutures, staples, or surgical glue. always be repaired because of the high risk repair of a bilateral (both sides ● For a suture-only repair: The hernia (400 of 1,000) of incarceration and bowel of the groin) inguinal hernias sac is removed. Then the tissue along strangulation within 2 years of diagnosis.2 also resulted in earlier return to work than open repairs. 8 the muscle edge is sewn together. Trusses or belts can help manage the symptoms This procedure is often used for of a hernia by applying pressure at the site. A The risk of complications strangulated or infected hernias or truss requires correct fitting and increases for both the open and small defects (less than 3 cm). complications include testicular nerve laparoscopic procedure if the 9 damage and incarceration may result.4 hernia extends into the scrotum. 3 Groin Hernia Repair Risks of this Procedure Inguinal and Femoral SAMPLE Risks Based on the ACS Risk Calculator Open and Laparoscopic Inguinal and Femoral Hernia Surgery from the ACS Risk Calculator—July 17, 2018 Percent for Risks Keeping You Informed Average Patient Wound Infection: Infection at the Open 0.3% Antibiotics and drainage of the wound may be needed. area of the incision or near the organ Laparoscopic 0.2% Smoking can increase the risk of infection.
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