Inguinal (groin) Hernia

This is the side view of your groin and lower abdomen. Toward the top is your belly button. Lower down in the groin is the hernia, which is a hole in your abdominal wall. Over time, the inner layer pushes through the hole. Once the hernia is large enough, a bulge will become noticeable. This bulge usually comes and goes as stuff slips in and out of the hernia. It can become painful, especially with certain activities, or coughing and sneezing. There is a low risk your intestine could get trapped inside the hernia and this could become an emergency. At the time of surgery we bring all that tissue back inside the belly where it belongs. We will place a piece of mesh in between the layers of your abdominal wall to reduce the risk of the hernia returning. 

What is a groin hernia?

A hernia is a hole in your abdominal wall that allows stuff that should stay in your belly to slip out. This may produce a bulge in your groin, and the bulge may extend into the scrotum. Women can develop groin hernias as well. Hernias tend to get larger over time and they can be uncomfortable and even painful.

Hernias occur because of a combination of risk factors and genetics. Lifestyles that involve heavy lifting or smoking, and medical conditions like chronic coughing and constipation can increase the risk of developing a hernia. In many cases though, hernias are just something you’re born with.

Do I need surgery?

Surgery is a complex decision that should be made together with a licensed surgeon. It’s always a matter of balancing risk and benefit. If your hernia doesn’t bother you at all, it may be safe to simply watch it. If your hernia has any negative impact on your life – pain, worry, physical limitations – it is worth considering surgery. If you think you may have a hernia, see your primary care doctor or your local surgeon.

How is the surgery performed?

There are two major options: open repair or minimally invasive (“keyhole”) repair. The open repair can be done with “twilight” anesthesia in some cases, and involves a 1.5 to 3 inch incision in the groin. The “keyhole” approach requires 3 very small incisions higher on your belly, and typically offers less pain after surgery and a faster recovery. It may be performed with robotic instruments. All approaches involve using mesh. For more about robotic surgery, click here.

What is mesh?

Mesh is a piece of flexible material that is used to reinforce your abdominal wall. Without mesh, there is only the weak hernia-prone tissue, and any repair using only weak tissue has a higher risk of failure. The mesh looks like a window screen, and it works like a scaffolding, allowing your body to weave scar tissue all through and around it, creating a barrier of reinforced scar in between the layers of your abdominal wall. Most people don’t feel it at all once it has healed. For more about mesh, click here.

What are the risks of surgery?

There is a roughly 2% risk the hernia could return. Risk of infection: less than 2%. Risk of significant bleeding: less than 2%. If you take blood thinners, this risk is increased. Risk of chronic groin pain: roughly 4%. Most patients with chronic pain after surgery will improve within the first 12 months, though this may require invasive procedures in some rare cases. Risk of injury to testicular structures: less than 1%. In very rare cases, such an injury could require removal of the testicle.

I take blood thinners or heart medication. What should I do?

Many patients take medications to prevent blood clots. Some take aspirin alone, others take aspirin plus clopidogrel (Plavix) or similar, and still others may be taking warfarin (Coumadin), Xarelto, Eliquis, or other similar medications. You may also take medication for your heart rhythm or for high blood pressure. Make sure your surgeon knows which medications you are taking and why, and which doctor prescribes them for you. Your surgeon will coordinate with your Cardiologist or other prescribing physician the best time to stop taking your medication and when to restart it after surgery. If you have any questions about when to stop or start your medication, contact your surgeon.

What can I expect on the day of surgery?

Groin hernia repair is outpatient surgery, so you will not have to stay overnight in the hospital. The procedure itself takes about an hour, but there is additional time for checking you in, getting you off to sleep, getting our equipment set up, and waking up afterward. You will need someone to give you a ride home, and ideally someone to stay with you the first night or check in on you periodically.

What can I expect after surgery?

You will likely have pain and soreness. You may also have bruising and swelling of the groin area. You may find your scrotum is sensitive to pressure – like sitting for long periods, this is normal and usually goes away within two weeks. You may not have a bowel movement in the first few days after surgery – that is OK, don’t try to force it. If you get to 48 hours after surgery and you have not had a bowel movement, take something over the counter like Miralax or Milk of Magnesia to help get things going. If you take Miralax or Milk of Magnesia for 2 days and still do not have a bowel movement, contact your surgeon.

For the first 2 weeks, you should take it very easy. Walking and going up and down stairs is fine even on the day of surgery. After 24 hours, you can shower and drive. Typically, you will follow up with your surgeon about 2 weeks after surgery. Most people can begin increasing physical activities gradually at that point, ramping up over a month. By 6 weeks after surgery most people have no restrictions or limitations. If you are over 60, it may take a few months for your energy levels and appetite to return to normal.