AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION Groin : Inguinal and Femoral Repair

Many patients become symptomatic after The Condition the first 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. or urinary symptoms. help you be better informed about Any part of the 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. Benefits—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, difficulty passing urine, continued pain, Hernia Location Education is provided on: and swelling of the testes or groin area. 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 Your Recovery Expectations and Discharge...... 6 Femoral Before your operation—Evaluation Pain Control...... 7 Inguinal 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. The day of your operation—You will Surgical Procedure not eat or drink for 6 hours before the Open hernia repair—An incision is operation. Most often you will take your made near the site and the hernia is normal medication with a sip of water. You SAMPLErepaired with mesh or by suturing will need someone to drive you home. (sewing) the muscle closed. Your recovery—If you do not have Laparoscopic hernia repair—The hernia complications you usually will go home is repaired by mesh or sutures inserted the same day. through instruments placed into small Call your surgeon—If you have severe incisions in the abdomen. pain, stomach cramping, chills, or a high Nonsurgical Procedure fever (over 101°F or 38.3°C), odor or increased drainage from your incision, Watchful waiting is a safe and acceptable or no bowel movements for 3 days. option for adults with inguinal 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 Inguinal and The Condition, Symptoms, Femoral Repair and Diagnostic Tests

Keeping You Informed Inguinal canal Groin Hernia Fat Who Gets Hernias? Muscle There may be no cause for a hernia. Some risk factors are: • Older age—muscles become weaker Hernia with intestine • Obesity—increased weight places Spermatic cord pressure on abdominal muscle • Sudden twist, pulls, or strains • Chronic straining Symptoms • Family history Femoral The most common symptoms are: • Connective tissue Inguinal 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 ●●Mild pain or pressure at the hernia site.2 during pregnancy.2 The Condition ●● Numbness or irritation due to pressure 2 Other medical The Hernia on the nerves around the hernia. ●● Sharp abdominal pain and vomiting disorders An occurs when the intestine can mean that the intestine has slipped that have symptoms bulges through the opening in the muscle through the hernia sac and is strangulated. similar to hernias include in the groin area. A reducible hernia can be This is a surgical emergency and enlarged lymph nodes, pushed back into the opening. When intestine immediate treatment is needed. cysts, and testicular or abdominal tissue fills the hernia sac and problems such as cannot be pushed back, it is called irreducible scrotal hydrocele.2-4 or incarcerated. A hernia is strangulated if the intestine is trapped in the hernia pouch Common Tests and the blood supply to the intestine is History and Physical exam2 decreased. This is a surgical emergency.2 The site is checked for a bulge. ThereSAMPLE are two types of groin hernias. Other tests may include (see glossary): An inguinal hernia appears as a bulge in the groin or scrotum. Inguinal hernias account for ●●Digital exam 75% of all hernias and are most common in men.2 ●●Blood tests A femoral hernia appears as a bulge in the groin, ●●Urinalysis upper thigh, or labia (skin folds surrounding ●●Electrocardiogram (ECG)—for patients the vaginal opening). Femoral hernias are ten over 45 or if high risk of heart problems times more common in women.2 They are always ●●Ultrasound repaired because of a high risk of strangulation.1-3 ●●Computerized tomography (CT) scan Herniorraphy is the surgical repair of a hernia. Hernioplasty is the surgical repair of a hernia with mesh.

2 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation Groin Hernia Inguinal and Surgical and Femoral Repair Nonsurgical Treatment

Laparoscopic Repair Open Repair Muscle Inguinal ring Muscle Spermatic cord Port Inguinal ring Sutured muscle Spermatic cord Nerve and genital Mesh branch of nerve Nerve and genital branch of nerve Mesh repair

●● For an open mesh repair: The hernia sac is removed. Mesh is placed over the hernia site. The mesh is attached using sutures Port sites will vary sewn into the stronger tissue surrounding Inguinal ring the hernia site. Mesh plugs can also be Trusses or belts can help manage Mesh plug placed into the inguinal or femoral hernia the symptoms of a hernia by space. The mesh plug fills the open site and applying pressure at the site. A is sutured to the surrounding tissue. An truss requires correct fitting and additional mesh patch is applied and may complications include testicular or may not be sutured.2 Mesh is often used nerve damage and incarceration for large hernia repairs and may reduce the may result.4 risk that the hernia will come back. The site is closed using sutures, staples, or surgical glue. Laparoscopic Hernia Repair Keeping You Surgical Treatment The surgeon will make several small punctures The type of operation depends on hernia size or incisions in the abdomen. Ports (hollow Informed and location, and if it is a repeat hernia. Your tubes) are inserted into the openings. The health, age, anesthesia risk, and the surgeon’s abdomen is inflated with carbon dioxide gas Open vs. Laparoscopic expertise are also important. An operation to make it easier to see the internal organs. Incisional Repair Surgical tools and a laparoscopic light are is the only treatment for incarcerated/ A laparoscopic repair of inguinal placed into the ports. The hernia is repaired with strangulated and femoral hernias. hernia may result in less pain mesh and sutured or stapled in place. The repair and numbness, lower infection Your hernia can be repaired either as is done as a TransAbdominal PrePeritoneal rate, and faster return to normal an open or laparoscopic approach. (TAPP) procedure, which means the activity when compared with open The repair can be done by using sutures (the sac that contains all of the abdominal surgery.6 Laparoscopic repair may only or adding a piece of mesh. organs) is entered, or the repair is done as a SAMPLE2-4 lengthen the operative time and Totally ExtraPeritoneal (TEP) procedure. Open Hernia Repair may cost more.5 A recurrence from The surgeon makes an incision near a previous open hernia repair is the hernia site and the bulging tissue Nonsurgical Treatment best repaired laparoscopically is pushed back into the abdomen. because you avoid scar tissue from 7 Most inguinal hernia repairs use mesh Watchful waiting is an option if you have previous incisions. Laparoscopic 1 to close the muscle.5 An open repair an inguinal hernia with no symptoms. repair of a bilateral (both sides can be done with local anesthesia. Hernia incarceration occurred in 1.8 per of the groin) inguinal hernias 1,000 men who waited longer than 2 years also resulted in earlier return ●●For a suture-only repair: The hernia to have a repair.2 Femoral hernias should to work than open repairs. 8 sac is removed. Then the tissue along always be repaired because of the high risk The risk of complications the muscle edge is sewn together. (400 of 1,000) of incarceration and bowel increases for both the open and This procedure is often used for strangulation within 2 years of diagnosis.2 strangulated or infected hernias or laparoscopic procedure if the 9 small defects (less than 3 cm.). hernia extends into the scrotum. 3 Groin Hernia Inguinal and Femoral Repair Risk of this Procedure

RISKS WHAT CAN HAPPEN KEEPING YOU INFORMED

Long-term pain 75 of 1,000 of patients reported chronic pain of the leg or Pain may be less with laparoscopic procedures than groin lasting at least 3 months.10 The rate of pain was 60 of open procedures.2 Pain is reported as mild and 1,000 for the group and 90 of 1,000 for open continues to decrease over time.11 Pain can be treated repair. with nonsteroidal anti-inflammatory medications.

Recurrence Recurrence is reported in 37 of 1,000 patients. Recurrence There is no difference in recurrence between mesh plugs, flat (hernia comes occurs half as often when mesh is used versus nonmesh mesh, and open mesh.2 Laparoscopic repair is recommended back) repair. 2 for recurrent hernias because the surgeon avoids previous scar tissue. There is a higher rate of recurrence in older men with laparoscopic repair.

Urinary Having trouble urinating occurs in 22 of 1,000 patients General or regional anesthesia, older age and enlarged retention receiving general or regional anesthesia and 4 of 1,000 prostate are associated with urinary retention. A patients for local anesthesia.9-12 temporary urinary catheter may be inserted. 2-4

Seroma A seroma (collection of clear/yellow fluid) can occur in Seromas can form around the former hernia site. Most disappear 80 of 1,000 mesh repairs and 31 of 1,000 for nonmesh on their own. Removal of fluid with a sterile needle may be procedures. required.2-4

Injury to Injury can be caused by instruments inserted with For bladder injury, a Foley catheter remains in place to drain internal organs: laparoscopic repair. Bowel/bladder injury is reported as the urine until the bladder is healed, or surgical repair may be bowel, bladder, 1 of 1,000 and blood vessel injury is less than 1 of 1,000. 9-12 needed. For bowel injury, the site is repaired and/or a nasogastric vas deferens, The risk of (vas deferens) spermatic cord damage is rare.13 tube is placed to keep the stomach empty. Any injury to a blood blood vessels vessel is repaired.2-4

Infection Wound infection occurs in an average of 1-2 of 1,000 open Antibiotics may be given for inguinal or femoral hernia repair.15 repairs and 1 of 1,000 laparoscopic repairs.14 Smoking and having other diseases can increase the infection rate. 2

Hematoma Hematoma, (collection of blood in the wound site or Hematomas are treated with anti-inflammatory medications, scrotum) occurs in 22 of 1,000 mesh procedures and 70 of elevation, and rest. Rarely blood replacement or further testing 1,000 when mesh is not used.9-12 for a blood vessel injury is needed.4

Testicular pain/ Testicular pain is reported in 8 of 1,000 patients for mesh Postoperative testicular swelling (orchitis) may be due to swelling repair. Less than 1 of 1,000 men reported decreased libido manipulation of the veins near the testes. The swelling often following repair.9-12 appears 2-5 days after the operation and can last 6 to 12 weeks. Treatment includes anti-inflammatory medications.2

Hernia at Hernia at the site where the laparoscopic trochar (tube) was This risk is reduced with the use of smaller trochars and endoscopic site inserted occurs in less than 4 of 1,000. 4 instruments. 2-4

Nerve pain— Tingling and numbness in the groin or scrotum is reported Pressure, staples, stitches or a trapped nerve in the surgical area tingling or less after laparoscopic procedures (74 of 1,000) than for can cause nerve pain. Inform your doctor if you feel severe, sharp, numbness open procedures (107 of 1,000). A nerve getting trapped at or tingling pain in the groin and leg immediately after your the site is reportedSAMPLE in 2 of 1,000 patients.9-12 procedure. An operation may be required if the nerve is trapped. 2 Heart/breathing There are no reports of heart or breathing complications Problems with your heart or lungs (breathing) may be aggravated related specifically to a hernia operation. by general anesthesia. Your anesthesia provider will suggest the best anesthesia option for you.

Elderly risks Complications related to general anesthesia may be higher If general anesthesia is a concern, an open surgery with local because of a health problem such as high blood pressure anesthesia may be recommended.7 and shortness of breath in those 80 years and older.16

Death No deaths are reported directly related to elective inguinal Stopping smoking and being at the ideal body weight and femoral hernia repair. Death can occur after treatment before surgery reduces the risks of complications. Your of a strangulated hernia or in exceptionally high-risk surgical team is prepared for all emergency situations. patients.

The data has been averaged per 1,000 cases

4 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation Groin Hernia Inguinal and Expectations: Preparation Femoral Repair for Your Operation

What to Bring Questions Preparing for Your Operation ●● Insurance card and identification to Ask Home Medication ●●Advance Directives About my operation Bring a list of all of the medications and vitamins that you are taking. Your medication may have ●●List of medicines • What are the risks to be adjusted before your operation. Some ●●Loose-fitting, comfortable clothes and side effects of medications can affect your recovery and response general anesthesia? ●Slip-on shoes that don’t require that to the anesthesia. Most often you will take your ● you bend over • What technique will morning medication with a sip of water. be used to repair the ●●Leave jewelry and valuables at home Anesthesia hernia—laparoscopic or open; mesh or Let your anesthesia provider know if you have What You Can Expect with sutures? allergies, neurologic disease (epilepsy, stroke), heart An identification (ID) bracelet and allergy bracelet disease, stomach problems, lung disease (asthma, with your name and hospital/clinic number will • Ask your surgeon emphysema), endocrine disease (diabetes, thyroid be placed on your wrist. These should be checked how frequently they conditions), or loose teeth; if you smoke, drink by all health team members before they perform perform laparoscopic alcohol, use drugs, or take any herbs or vitamins; or any procedures or give you medication. Your hernia repairs? if you have a history of and vomiting with surgeon will mark and initial the operation site. anesthesia. • What are the risks Fluids and Anesthesia of this procedure? If you smoke, you should let your surgical team know An intravenous line (IV) will be started and you should plan to quit. Quitting before your • Will you be to give your fluids and medication. surgery can decrease your rate of respiratory and performing the entire wound complications and increase your chances of For general anesthesia, you will be asleep and procedure yourself? staying smoke-free for life. Resources to help you pain free. A tube will be placed down your throat quit may be found at www.facs.org/patienteducation to help you breathe during the operation. For • What level of pain or www.lungusa.org/stop-smoking. spinal anesthesia, a small needle with medication should I expect and how will it Length of Stay will be placed in your back near your spinal column. You will be awake and pain free. be managed? If you have local anesthesia, you will usually go home the same day. You may stay overnight if After Your Operation • How long will it be before I can return to you had a repair of a large or incarcerated hernia, You will be moved to a recovery room where your my normal activities— laparoscopic repair with a longer anesthesia time, heart rate, breathing rate, oxygen saturation, work, driving, lifting? postanesthesia issues such as severe nausea and blood pressure, and urine output will be closely vomiting, or you are unable to pass urine. watched. Be sure that all visitors wash their hands. The Day of Your Operation Preventing Pneumonia and Blood Clots SAMPLEMovement and deep breathing after your ●● Do not eat or drink for at least 6 hours before operation can help prevent postoperative the operation. complications such as blood clots, fluid in ●●Shower and clean your abdomen and groin your lungs, and pneumonia. Every hour area with a mild antibacterial soap. take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. ●●Brush your teeth and rinse your mouth out with mouthwash. When you have an operation, you are at risk of getting blood clots because of not moving during ●●Do not shave the surgical site; your surgical team will clip the hair nearest the incision site. anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and, for high risk patients, taking a medication that thins your blood. 5 Groin Hernia Inguinal and Femoral Repair Your Recovery and Discharge

Your Recovery Keeping You and Discharge Informed Thinking Clearly High-Fiber Foods If general anesthesia is given, or if you are Foods high in fiber include beans, taking narcotic pain medication, it may Handwashing Steri-strips bran cereals and whole-grain cause you to feel different for 2 or 3 days, breads, peas, dried fruit (figs, have difficulty with memory, and feel more Wound Care fatigued. You should not drive, drink alcohol, apricots, and dates), raspberries, ●● Always wash your hands before and after or make any big decisions for at least 2 days. blackberries, strawberries, touching near your incision site. sweet corn, broccoli, baked Nutrition potatoes with skin, plums, pears, ●●Do not soak in a bathtub until your stitches, apples, greens, and nuts. ●● When you wake up from the anesthesia, Steri-strips, or staples are removed. You may you will be able to drink small amounts take a shower after the second postoperative of liquid. If you do not feel sick, you can day unless you are told not to. begin eating regular foods. ●●Follow your surgeon’s instructions on when ●●Continue to drink about 8 to 10 glasses of to change your bandages. water per day. ●●A small amount of drainage from the incision ●●Eat a high-fiber diet so you don’t strain is normal. If the dressing is soaked with while having a bowel movement. blood, call your surgeon. Activity ●●If you have Steri-strips in place, they will fall off in 7 to 10 days. ●● Slowly increase your activity. Be sure to get up and walk every hour or so to ●●If you have a glue-like covering over the prevent blood clot formation. incision, just allow the glue to flake off on its own. ●●Patients usually take 2 to 3 weeks to return comfortably to normal activity.7 ●●Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for ●● You may go home the same day after a them to heal. simple repair. If you have other health conditions or complications such as ●●Protect the new skin, especially from the sun. nausea, vomiting, bleeding, or difficulty The sun can burn and cause darker scarring. passing urine, you may stay longer. ●●Your scar will heal in about 4 to 6 weeks and ●●Persons sexually active before the will become softer and continue to fade over operation reported being able to return the next year. to sexual activity in 14 days (average). Bowel Movements SAMPLEWork and Return to School Avoid straining with bowel movements by ●● You may return to work after 1 to 2 weeks increasing the fiber in your diet with high- after laparoscopic or open repair, as fiber foods or over-the-counter medicines Do not lift anything long as you don’t do any heavy lifting. (like Metamucil and Fibercon). Be sure you are over 10 pounds. Discuss the timing with your surgeon. drinking 8 to 10 glasses of water each day. A gallon of milk ●●Do not lift items heavier than 10 pounds Pain weighs 9 pounds. or participate in strenuous activity for at The amount of pain is different for each least 4 to 6 weeks. person. The new medicine you will need ●●Lifting limitation may last for 6 months after your operation is for pain control, and after complex or recurrent hernia repairs. your doctor will advise how much you should take. You can use throat lozenges if you have sore throat pain from the tube placed in your throat during your anesthesia.

6 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation Groin Hernia Inguinal and Femoral Repair

Non-narcotic pain medication—most When to Contact non-opioid analgesics are classified as non- steroidal anti-inflammatory drugs (NSAIDs). Your Surgeon They are used to treat mild pain and OTHER INSTRUCTIONS: Contact your surgeon if you have: inflammation or combined with narcotics ●●Pain that will not go away to treat severe pain. Possible side effects of NSAIDs are stomach upset, bleeding in the ●●Pain that gets worse digestive tract, and fluid retention. These ●●A fever of more than 101°F or 38.3°C side effects usually are not seen with short- term use. Let your doctor know if you have ●●Continuous vomiting heart, kidney, or liver problems. Examples ●●Swelling, redness, bleeding, or bad- of NSAIDs include ibuprofen, Motrin, Aleve, and Toradol (given as a shot). smelling drainage from your wound site FOLLOW-UP APPOINTMENTS ●●Strong or continuous abdominal pain or Pain Control without Medicine WHO: swelling of your abdomen Distraction helps you focus on ●●No bowel movement by 2 to 3 days after other activities instead of your pain. the operation Listening to music, playing games, or DATE: other engaging activities can help you cope with mild pain and anxiety.

Pain Control Guided imagery helps you direct and PHONE: Everyone reacts to pain in a different way. A control your emotions. Close your eyes and scale from 0 to 10 is used to measure pain. At gently inhale and exhale. Picture yourself in a “0,” you do not feel any pain. A “10” is the the center of somewhere beautiful. Feel the worst pain you have ever felt. Following a beauty surrounding you and your emotions laparoscopic procedure, pain is sometimes felt coming back to your control. You should in the shoulder. This is due to the gas inserted feel calmer. into your abdomen during the procedure. Moving and walking helps to decrease the gas and the right shoulder pain.2-3 Keeping You Extreme pain puts extra stress on your body Informed at a time when your body needs to focus on healing. Do not wait until your pain has Pain after Inguinal reached a level “10” or is unbearable before Hernia Repair telling you doctor or nurse. It is much easier to control pain before it becomes severe. Pain that continues one year after Guided imagery inguinal hernia repair is reported Common Medicines to Control Pain as 110 of 1,000 patients, with Narcotics or opioids are used for severe moderate/severe pain reported pain. Possible side effects of narcoticsSAMPLE are in 17 of 1,000. 80% of patients sleepiness, lowered blood pressure, heart with severe groin pain had pain rate, and breathing rate; skin rash and itching; before the operation. The pain constipation; nausea; and difficulty urinating. decreased by 50% in one year. Some examples of narcotics include morphine The incidence of pain is higher in 11 and codeine. women than in men. Pain was higher when heavy versus light- weight mesh was used.11 Most studies don’t report a difference in chronic pain between open versus laparoscopic repair.

7 Groin Hernia Inguinal and Glossary of Terms and Femoral Repair More Information

For more information, please go to the American College of Surgeons Patient Education website at www.facs.org/patienteducation. For a complete review of hernia repair, consult Selected Readings in , “Hernia” 2012 Vol. 37 No. 8 at www.facs.org/Publications/SRGS. GLOSSARY REFERENCES Advance Directives: Documents Incarceration: The protrusion or The information provided in this report is chosen from recent articles based on relevant signed by a competent person constriction of an through clinical research or trends. The research below does not represent all that is available for your giving direction to health care the wall of the cavity that normally surgery. Ask your doctor if he or she recommends that you read any additional research. providers about treatment choices. contains it. 1 Fitzgibbons RJ, Giobbie-Hurder A, Gibbs JO et al. Watchful waiting vs. repair of inguinal hernia in minimally symptomatic men. JAMA. 2006:295(3):285-292. Computerized tomography (CT) Local anesthesia: The loss of scan: A diagnostic test X ray and sensation only in the area of the 2 Malangoni MA, Rosen MJ. Hernias. In: CM Townsend, RD Beauchamp, et al. Sabiston a computer to create a detailed, body where an anesthetic drug is Textbook of Surgery, Philadelphia, PA: Elsevier, 2012:chap 46. three-dimensional picture of your applied or injected. 3 Sarosi G, Yongliang W, Gibbs J, Reda D, McCarthy M, Fitzgibbons R, Barkun, J. A clinician’s abdomen. A CT scan is commonly guide to patient selection for watchful waiting management of inguinal hernia. Annals used to detect abnormalities or Nasogastric tube: A soft plastic of Surgery, 2011;253(3):605-610. tube inserted in the nose and down disease inside the abdomen. It is 4 Fitzgibbons RJ Jr., Filipi CJ, Quinn TH. Inguinal Hernias. In: FC Brunicardi, DK Andrson, et to the stomach which is used to sometimes used to find a hernia not al. Principles of Surgery (8th edition). New York: McGraw Hill, 2005. obvious during the physical exam. empty the stomach of contents and gases to rest the bowel. 5 Gould, J. Laparoscopic versus open inguinal hernia repair. Surgical Clinics of North Digital exam: The examiner will America. 2008;88(5):1073-1081 Seroma: A collection of serous place their gloved index finger 6 Abbas AE, Noaman N, Amin M, Patient-perspective quality of life after laparoscopic and gently into the scrotal sac and feel (clear/yellow) fluid. open hernia repair: A controlled randomized trial. Surgical Endoscopy. 2012;26:2465- up to the inguinal ring in the groin. Strangulation: Part of the intestine 2470. Then the patient is asked to strain. or fat is squeezed in the hernia sac 7 Takata MC, Duh QY. Laparoscopic inguinal hernia repair, Surgical Clinics of North America. Electrocardiogram (ECG): Measures and blood supply to the tissue is 2008;88(1):157-178 the rate and regularity of heartbeats cut off. 8 Mahon D, Decadt M, Rhodes M. Prospective randomized trial of laparoscopic and any damage to the heart. Ultrasound: Sound waves are used (transabdominal preperitoneal) vs. open (mesh) repair for bilateral and recurrent to determine the location of deep inguinal hernia. Surgical Endoscopy. 2003;17:1386-1390. General anesthesia: A treatment structures in the body. A hand 9 Schwab JR et al. After 10 years and 1.903 inguinal hernias, what is the outcome for the with certain medicines that puts roller is placed on top of clear gel laparoscopic repair? Surgical Endoscopy. 2002;16:1201-1206. you into a deep sleep so you do and rolled across the abdomen. An 10 Matthews R, Anthony T, Kim LT, Wang J, Fitzgibbon R, Giobbie-Hurder A, Reda D, not feel pain during surgery. ultrasound may be used to find a Itani K, Neumayer L. Factors associated with postoperative complications and hernia hernia that is not obvious during recurrence for patients undergoing inguinal hernia repair. The American Journal of Hematoma: A collection of blood Surgery. 2007;194:611–617. that has leaked into the tissues of the physical exam. the skin or in an organ, resulting Urinalysis: A visual and chemical 11 Inaba T, et al. Chronic pain and discomfort after inguinal hernia repair. Surgery Today. from cutting in surgery or the examination of the urine, most 2012;42:825-829 blood’s inability to form a clot. often used to screen for urinary 12 Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs. tract infections and kidney disease. Lichtenstein and other open mesh techniques for inguinal hernia repair. A meta-analysis of randomized controlled trials. Surgical Endoscopy. 2002;16:1201-1206. 13 Gulino, et al. Urological complications following inguinal hernioplasty. Archivo Italiano di DISCLAIMER Urologia, Andrologia. 2012;84(3):105-110. This information is published to educate you about your specific surgical 14 Neumayer L, Giobbie-Hurder A, Jonasson O et al: Open mesh versus laparoscopic mesh procedures. It is not intended to take the place of a discussion with a qualified repair of inguinal hernias. New England Journal of Medicine. 2004;350:1819-1827. surgeon who is familiar with your situation.SAMPLE It is important to remember that each 15 Sanabria A, Domínguez LC, Valdivieso E, Gómez G. Prophylactic antibiotics for mesh individual is different, and the reasons and outcomes of any operation depend inguinal hernioplasty; A meta-analysis. Annals of Surgery. 2007;245(3):392-396. upon the patient’s individual condition. 16 Turrentine FE, Wang H, Simpson VB et al. Surgical risk factors, morbidity and mortality in The American College of Surgeons (ACS) is a scientific and educational elderly patients. The American Journal of Surgery. 2006;203:865-877. organization that is dedicated to the ethical and competent practice of surgery; it was founded to raise the standards of surgical practice and to improve the quality Revised May 2013 by: Nancy Strand, MPH, RN of care for the surgical patient. The ACS has endeavored to present information for David Feliciano, MD, FACS prospective surgical patients based on current scientific information; there is no Mary Hawn, MD, FACS warranty on the timeliness, accuracy, or usefulness of this content. Originally Reviewed 2009 by: Robert Fitzgibbons, MD, FACS Mark Malangioni, MD, FACS Kathleen Heneghan, RN, MSN

8 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation