Operation

– Indirect inguinal hernia

– Direct inguinal hernia

– Femoral hernia

Surgery is performed with a classic skin incision. The prosthesis / mesh is placed behind the first superficial muscle (external oblique muscle) in the inguinal canal. Attached to the ilio-inguinal ligament.

The main advantage of this technique, is the possibility to perform the procedure under regional anesthesia or under epidural anesthesia. Epidural anesthesia involves an injection into the lower back. Through which the lower part of the body is numbed, but the patient continues to breath on his own without a breathing machine.

This technique is indicated for patients whose general condition does not permit general anesthesia and for patients who refuse general anesthesia.

Epidural anesthesia is not indicated if the patient is taking anticoagulant medication that cannot be stopped.

What is a prosthesis/mesh ?

A prosthesis is made of polypropylene with the following characteristics :

• Non absorbable
• Non carcinogenic
• Non allergenic
• Resistant to mechanical stress

Over time, scar tissue forms through and around the openings in the mesh/prosthesis, causing it to be incorporated into the adjacent tissue. This forms a mechanical barrier against pressure and prevents hernia recurrences.

If the prosthesis infects and does not respond to antibiotic treatment, it may be necessary to remove the prosthesis / mesh.

How long does the procedure take ?

• Unilateral hernia: +/-45 – 60 min
• Bilateral hernia: +/- 90 min

Recurrence of inguinal hernia.

• Open surgery  : 2–3 %.

Hematoma

• Accumulation of blood in the wound.
• Is more frequent in open surgery than in laparoscopy.
• A large hematoma can be painful. Accumulated blood can infect.
• With a large hematoma, puncture or surgery may be necessary to remove the fluid.

Seroma / fluid effusion

If a large hernia is removed from the scrotum or if part of the hernia sac remains in the scrotum, the void left after treatment of the hernia may be filled with abdominal fluid (seroma) and blood.

The fluid collection can be emptied by punctures during the consultation, rarely the fluid has to be removed surgically.

Normal symptoms

In normal circumstances, pain is easily controlled with paracetamol (Dafalgan®) NSAIDs (anti-inflammatories) or morphine (Tradonal®…) and pain symptoms diminish over time :

• Urinary retention may occur in the first hours after the procedure. Temporary placement of a urinary catheter may be necessary.
• Nausea and vomiting (24–48 hours) may occur. Adolescents and especially young women are more affected.
• Hardening and pain at the level of the scar. The wound may feel hard for several weeks.
• Pain is often aggravated by sudden movements of the abdominal wall laughing, coughing, sneezing,…
• Groin or testicular pain disappears after a few weeks.
• Swelling at the site of the hernia after surgery (seroma): Collection of wound fluid and blood that fills the void left after treatment of the hernia.

• Red or purple coloration of the penis or scrotum : Ecchymosis caused by blood and wound fluid penetrating the subcutaneous tissues of the penis and scrotum. The colour slowly recedes spontaneously within 2 week.

Sexual function

You cannot have erectile dysfunction after inguinal hernia surgery. The nerves for erections are not located in the operation area.

If the blood supply to the testicle or the duct that transports sperm from the testicle to the penis is injured, the testicle may become sterile.

Pregnancy

Inguinal hernia surgery does not affect a future pregnancy. In inguinal hernia surgery, the reproductive organs are not in the operation area.

Sport / Physical activity

• After a rest period of 4 to 6 weeks, sports and physical activities can be resumed.