Groin hernia: repair with a mesh (Lichtenstein)

Types

• Indirect hernia (through the inguinal canal)
• Direct hernia (through the weak back wall)

What is the problem

In the groin the belly wall has a natural weak spot, the inguinal canal. A hernia is a pouch of the inner lining of the belly, often with fat or bowel inside, that pushes through this weak spot. It shows as a bulge that grows when you cough, stand or lift, and goes back when you lie down.

Why an operation

A hernia does not close by itself and usually gets bigger. Rarely, bowel gets trapped in it: this is painful and an emergency. In most people the operation closes the weak spot for good. In men, a small hernia without complaints can sometimes be watched; in women an operation is usually advised. Your surgeon will discuss this with you.

How the operation is done

Through a cut of about 5 to 7 cm above the groin crease, the surgeon pushes the hernia back into the belly. Then a thin plastic mesh is laid over the back wall of the canal and stitched in place, with a small slit for the cord. The mesh strengthens the wall, and your own tissue grows into it. It usually takes about an hour.

Anaesthesia and the hospital stay

The operation can be done with you asleep, with the lower body numbed (spinal anaesthesia), or with local anaesthesia. Many people go home the same day or the next day.

Possible risks

• Bruising and swelling of the groin or scrotum — common, settles within a few weeks
• Numb patch of skin near the scar — common, often improves over months
• Groin pain that lasts longer than three months — about 1 in 10, mostly mild; about 2 in 100 have pain that limits daily life
• The hernia comes back — about 1 to 3 in 100
• Wound infection; infection of the mesh — about 1 in 100; mesh infection is rare
• Difficulty passing urine right after the operation — a few in 100, mostly short-lived
• Problems with the blood supply of the testicle — rare, less than 1 in 100

After the operation

You may walk the same day and eat normally. The groin hurts for one to two weeks; normal painkillers help. Let the pain guide you: most people go back to light work and everyday activities within one to two weeks, and to heavy work and sport as soon as it feels comfortable, often after two to four weeks. Drive when you can brake hard without pain.

Questions people often ask