Groin
What is a Hernia?
  • Lump in the groin caused by weakness of muscles
  • Loop of intestine can push into the lump causing pain and discomfort
cause
What causes a Groin Hernia?
  • Heavy strain on the abdominal wall
  • Ageing
  • Weakness present from birth
surgery
How is the procedure performed?
  • Open Surgery
    • Incision made over the lump to dissect the hernia and identify the defect
    • The defect is repaired with surgical mesh
  • Laparoscopic Surgery (TEP)
    • Laparoscopic instruments inserted through holes in the abdomen
    • Any defect is then repaired using surgical mesh
What is a Hernia?
  • A hernia occurs when the layers of the abdominal muscle have weakened, resulting in a bulge or tear causing the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a sac.
  • This can allow a loop of intestine or abdominal tissue to push into the sac to cause symptoms of discomfort, pain or occasionally other potentially serious problems that could require emergency surgery.
What causes a Groin Hernia?
  • One potential area of such weakness is in the groin which allows structures such as the spermatic cord to pass to the testes in men and the round ligament of the uterus in females.
  • Hernias can develop in these areas due to heavy strain (coughing/difficulty with bowel movements or urination) on the abdominal wall, ageing or a weakness present from birth.
  • The groin hernias can be
    • Inguinal which are more common.
    • Femoral which is more common in females and usually present as an emergency.
Will I need Surgery?
  • Asymptomatic hernia in the elderly do not need any surgical treatment.
  • If symptomatic, we do recommend surgical repair as they can get bigger over time and have the potential to cause a medical emergency by trapping bowels.
Am I a suitable candidate for laparoscopic (keyhole) surgery?
  • Laparoscopic surgery is not suitable for everyone, particularly if you have had previous abdominal surgery or you have underlying medical conditions.
  • The National Institute for Clinical Excellence (NICE) has reviewed this procedure and recommends that laparoscopic surgery can be used as one of the treatment options for the repair of inguinal hernia. You can obtain more detailed information about this procedure from their website www.nice.org.uk.
  • Factors that may increase the possibility of choosing or converting to the “open” procedure may include
    • Obesity
    • History of prior abdominal surgery causing dense scar tissue
    • Bleeding problems during the operation
    • Very large hernia
What are the advantages and disadvantages of laparoscopic surgery over “open”surgery?
  • One of the benefits of laparoscopic hernia surgery over “open” hernia surgery is that you can usually return to work and normal activities more quickly.
  • There may also be a lower risk of developing persistent numbness and pain in the groin after surgery and a smaller incidence of wound infection.
  • The disadvantage of laparoscopic surgery is that there is a slightly higher risk of injury to surrounding structures (such as the bowel, bladder and blood vessels inside the abdomen) than there is in traditional “open” surgery.
How is the procedure performed?

Surgical procedures are done in one of two fashions:

  • Open Surgery-The open approach is done from the outside through a three to four-inch incision over the lump in the groin. A small of surgical mesh is used to repair the defect or hole.
  • Laparoscopic Surgery (TEP)-The laparoscopic hernia repair is done through 3 tiny separate incisions below the umbilicus to view and repair the hernia and secure the defect it with a small piece of surgical mesh which maybe fixed in place using absorbable staples or adhesive sealant.
  • The relevant technique and along with its risks and benefits for each individual will be explained in detail during the consent process.
How long will I be in hospital?

Most patients will come into hospital on the day of their operation, and will be able to go home later the same day (day stay). If there is any issue with pain control or ability to pass urine, you may be kept in overnight.

What complications can occur?

Surgery for groin hernias is usually a routine with very few risks.

  • Early Complications
    1. Bleeding and infection, which are uncommon with laparoscopic hernia repair.
    2. Injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle (rare).
    3. Urinary retention- may require placement of a catheter (tube) to drain the bladder after surgery.
    4. Bruising and swelling of the scrotum, is common but will resolve over time.
    5. Rarely your intestines can get blocked by getting caught in scar tissue if you have had a laparoscopic repair causing intestinal obstruction which might need surgery.
  • Delayed Complications
    1. Recurrence rate is low is around 2-3% and is slightly lower with laparoscopic repair.
    2. 10% of people experience groin pain after groin hernia surgery due to trapping of nerves in the scar tissue during the healing process. In majority of the patients this resolves with time but in tiny fraction it can be debilitating