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Inguinal Hernia Repair

Inguinal hernia repair addresses a common medical condition where tissue, typically part of the intestine, protrudes through a weak point in the abdominal wall, specifically in the groin region. This condition can cause discomfort and, in some cases, lead to severe complications. The repair aims to alleviate symptoms and prevent potential complications by returning the protruding tissue to its rightful place and reinforcing the abdominal wall.

Causes and Risk Factors

Weakness in the Abdominal Wall: This weakness can be congenital, meaning present from birth, or develop due to the natural ageing process.

Increased Pressure in the Abdomen: Activities such as lifting heavy objects, persistent coughing, or straining during bowel movements can exert additional pressure on the abdominal wall.

Combination of Pressure and Pre-existing Weakness: The simultaneous presence of abdominal pressure and a weak spot can lead to the formation of a hernia.

Other Factors: Conditions and situations like pregnancy, chronic cough, and certain medical conditions can also contribute to the development of an inguinal hernia.

Symptoms

Visible Bulge: A noticeable protrusion in the groin or scrotum area is a common sign of an inguinal hernia.

Pain or Discomfort: This can be especially pronounced when lifting objects, during bouts of coughing, or when bending over.

Sensation of Heaviness: Affected individuals may feel a persistent heaviness in the herniated area.

Burning or Aching Sensation: This discomfort can be centred around the bulge.

Diagnosis

Physical Examination: A healthcare professional will conduct a thorough examination to identify the presence of a hernia.

Imaging Tests: Diagnostic tools such as ultrasound or MRI might be employed to confirm the diagnosis and assess the hernia’s size and location.

Treatment Options

Watchful Waiting

In some cases, especially when the hernia is small and doesn’t cause any discomfort, immediate surgical intervention may not be necessary. Here’s what it entails:

Monitoring: Regular check-ups with a healthcare professional are essential to monitor the hernia’s size and any potential symptoms.

Lifestyle Adjustments: Patients are often advised to avoid activities that might exacerbate the hernia, such as heavy lifting.

Symptom Onset: If symptoms begin to manifest or if the hernia increases in size, surgical intervention might be recommended.

Surgery

Surgical repair remains the definitive treatment for inguinal hernias, especially if they are symptomatic or growing in size. There are two primary surgical techniques:

Open Repair (Herniorrhaphy or Hernioplasty):

Advantages: It can be done under local anaesthesia and might be preferred if the hernia is large or if the patient has had previous pelvic surgery.
Recovery: Patients might need to stay in the hospital for a day or two. Full recovery typically takes about six weeks.

Laparoscopic Repair:

Advantages: Smaller scars, reduced pain post-surgery, and a quicker return to normal activities. It might be a preferred option for repairing hernias on both sides of the body (bilateral).
Considerations: Not all hernias are suitable for laparoscopic repair. Factors such as the hernia’s location, size, and any previous surgeries can influence the decision.
Recovery: The recovery period is generally shorter compared to open repair, with most patients resuming normal activities within a few weeks.

Surgical Procedure

Preparation for Surgery

Pre-operative Assessments: A thorough medical history is taken to identify any potential risks or contraindications to surgery.
Fasting Guidelines: Patients are typically instructed not to eat or drink anything (including water) for a specified number of hours before the surgery. This reduces the risk of aspiration during anaesthesia.

Anesthesia Options

General Anaesthesia: The patient is rendered unconscious and will not feel or remember the procedure. A breathing tube (endotracheal tube) is often inserted to assist with breathing.
Regional Anaesthesia: Only a specific region of the body is numbed, such as the lower half. The patient remains awake but will not feel pain in the numbed area.
Local Anaesthesia with Sedation: The surgical area is numbed, and the patient is given sedative medications to relax. The patient remains awake but is often drowsy and may not remember the procedure.

Open Surgery (Herniorrhaphy or Hernioplasty)

Procedure:

An incision, several centimetres in length, is made directly over the hernia or in the groin area.
The herniated tissue is identified, and the protrusion is pushed back into the abdominal cavity.
The defect in the abdominal wall is then sutured closed. If the defect is large or the surrounding tissue is weak, a synthetic mesh may be used to reinforce the area.

Recovery:

The wound is closed with sutures, staples, or surgical glue. Depending on the complexity and the patient’s health, a hospital stay may be required.

Laparoscopic Surgery

Procedure:

Several small incisions (usually three) are made in the lower abdomen.
A laparoscope, equipped with a camera, is inserted through one of the incisions. This provides the surgeon with a clear view of the hernia and surrounding structures on a monitor.
Specialised instruments are introduced through the other incisions to repair the hernia. A synthetic mesh is often placed over the defect for reinforcement.

Recovery:

The incisions are much smaller than those in open surgery, leading to less post-operative pain and a quicker recovery. Most patients can return home the same day.

Post-operative Care

Recovery Timeline

Immediate Recovery: After the surgery, patients are monitored in a recovery room until the effects of the anaesthesia wear off. Vital signs such as blood pressure, heart rate, and oxygen levels are closely observed.

Hospital Stay: Depending on the type of surgery (open or laparoscopic) and the patient’s overall health, a short hospital stay might be required. Most laparoscopic procedures allow for same-day discharge.

Full Recovery: While many patients feel better within a few days, it’s essential to understand that the body still needs time to heal. Full recovery can take several weeks.

Activity Recommendations

Initial Days: Patients are encouraged to engage in light activities like walking to promote circulation and prevent blood clots. However, they should avoid strenuous activities, heavy lifting, or vigorous exercises.

Resuming Activities: Gradually, as the patient feels better, they can return to their regular activities. However, patients should follow the surgeon’s guidelines on when to resume specific activities, especially those that strain the abdominal area.

Potential Complications

While complications are rare, it’s essential to be aware of them and seek medical attention if they arise. These can include:

Signs of infection at the surgical site.
Persistent fever.
Uncontrolled pain.
Nausea or vomiting.
Swelling or discolouration of the scrotum (in men).
Difficulty urinating.
Any unusual symptoms or concerns.

Conclusion

Inguinal hernia repair is a well-established procedure with a high success rate. It offers relief from the discomfort and potential risks associated with hernias. Patients experiencing symptoms or those diagnosed with an inguinal hernia should consult with a urologist to discuss the best course of action tailored to their individual needs.

Dr Lee Fang Jann

Urologist & Renal Transplant Surgeon

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

Bachelor of Medicine and Bachelor of Surgery (Singapore)
Membership of The Royal College of Surgeons (Edin)
Master of Medicine (Surgery) (Singapore)
Fellowship of the Academy of Medicine (Urology)
Clinical fellowship at Oxford Transplant Centre in the UK

Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.