Inguinal hernia in a nutshell: Laparoscopic vs open surgery and other considerations

In the second part of his deep dive into inguinal hernia (first part here), renowned consultant general and colorectal surgeon Mr Daniel Baird explains when an inguinal hernia needs to be repaired, open surgery vs laparoscopic and the possible risks or complications.

When should I get my inguinal hernia repaired?

The decision regarding the timing of inguinal hernia repair is influenced by several factors, all of which will be discussed during your consultation with Mr Baird. Here are key considerations:

Symptoms and discomfort

If you're experiencing significant pain, discomfort, or other bothersome symptoms associated with the hernia, surgical intervention may be necessary. Symptoms include pain, noticeable bulging, and difficulties with daily activities.

Size of the hernia

Larger hernias may pose a higher risk of complications, such as incarceration or strangulation. Repairing them can prevent further enlargement and mitigate these potential risks.

Complications

In the event of incarceration or strangulation, where the hernia becomes trapped or its blood supply is cut off, immediate surgical intervention is vital.

Quality of life

If the hernia is significantly affecting your quality of life or impeding daily activities, surgery can often provide relief and improve your overall well-being.

Underlying health conditions

Your overall health is a crucial factor in determining the timing of hernia repair. Mr Baird will consider any other medical conditions you may have that could affect the risks associated with surgery.

Remember, seeking medical advice promptly is essential, especially if you suspect complications like incarceration or strangulation, as they require immediate attention and often surgical intervention.

Which is better, keyhole (laparoscopic) or open hernia repair?

The choice between laparoscopic and open inguinal hernia surgery depends on various factors, including your health and the characteristics of the hernia. Both approaches have their own advantages and considerations:

Open inguinal hernia surgery:

• Involves a larger incision directly over the hernia, allowing the surgeon to repair it by pushing the protruding tissue back into place and reinforcing the abdominal wall with stitches and synthetic mesh.
• Well-established and suitable for almost all types of hernias, and may be preferred for particularly larger or more complex ones.
• Not usual to do bilateral (both sides) with an open approach.

Laparoscopic inguinal hernia surgery:

• Utilises a minimally invasive approach, involving several small incisions through which a camera and specialised instruments are inserted, allowing the surgeon to repair the hernia while viewing internal structures on a monitor.
• Generally associated with a quicker recovery and less postoperative pain. This could mean a quicker return to normal activities.

Ultimately, the decision between the two approaches should be made on an individual basis after a thorough discussion with Mr Baird, considering factors such as patient preferences, hernia characteristics, and overall health.

What are the risks of an operative hernia repair?

While inguinal hernia surgery is generally safe, like any surgery, it carries some risks and potential complications. It's important to note that the likelihood of complications varies among individuals and can be influenced by factors such as overall health, other medical conditions, and the specific surgical technique used. Most patients will not suffer any complications. However, possible complications include:

• Pain: Some pain is to be expected after surgery. Patients can take oral painkillers, and most will stop taking them between 2 and 14 days postoperatively.
• Infection: Infections at the surgical site are possible, though they are relatively uncommon. Antibiotics will be given on the day of surgery to minimise this risk.
•  Bleeding: Bleeding during or after surgery is a rare complication.
• Haematoma: Accumulation of blood outside blood vessels (haematoma) at the surgical site may occur, leading to swelling and discomfort
• Seroma: A collection of clear fluid in the surgical area (seroma). In most cases, the body reabsorbs the fluid, but draining may be necessary in some instances.
• Nerve damage may occur, leading to temporary or persistent numbness, tingling, or pain, though rare. If a skin nerve is close to the mesh, I will deliberately amputate the nerve to reduce the chronic pain risk. If there is a patch of numb skin the sensation will usually settle a few weeks after surgery.
• Chronic pain at the surgical site can occur but typically diminishes with time. For most, it does not interrupt activities of daily living or quality of life. In rare cases, patients may need to see a pain specialist for further treatments.
• Recurrence of hernias is possible, albeit less common with mesh repairs.
• Mesh-related complications, urinary retention, and risks of deep vein thrombosis and pulmonary embolism are also potential concerns, though measures are taken to minimise these risks.
• Accidental injuries to internal organs or the cord running to the testicles are rare but possible.

Mr Baird will thoroughly discuss these potential risks and complications with you both before the procedure during your outpatient consultation and on the day of surgery, ensuring you are fully informed and prepared.

Mr Daniel Baird is an esteemed consultant general and colorectal surgeon based in West Sussex. If you would like to book a consultation with Mr Baird, you can do so today via his Top Doctors profile.