Inguinal hernia repair: what happens, risks and recovery

The inguinal canal is a passage through the lower abdominal wall in the groin. When part of the bowel or fatty tissue squeezes through a weak spot there, it shows as a lump that often appears on standing or coughing and settles on lying down. It is much more common in men, but women can have one too.

A repair is aimed at symptoms and at avoiding trouble later. The NHS explains that surgery is recommended when the hernia is painful or limiting, and to prevent the bowel becoming blocked or its blood supply being cut off, which is called strangulation. A Hull NHS trust leaflet frames the decision as a balance between waiting and having a planned operation, because a hernia left alone can enlarge or end up needing emergency surgery, which carries greater risk.

A small hernia that you barely notice may reasonably be watched. This is sometimes called watchful waiting, and it is a legitimate choice rather than a delay. You would be asked to report changes: a lump that grows, becomes painful or can no longer be pushed back.

There is no medicine that closes a hernia, and a support truss only relieves discomfort for some people. If you choose to wait, it helps to know the warning signs below so that a sudden change is acted on quickly.

Pre-assessment usually covers your medical history, medicines, allergies and fitness for the anaesthetic. Follow the written fasting advice you are given for the day. If you smoke, stopping before surgery is worth discussing, because the Guy's and St Thomas' hernia guidance advises avoiding smoking for at least 4 weeks before a hernia repair.

• Arrange for an adult to take you home; most trusts also ask that someone stays with you for the first night.

• Bring loose clothing that will not rub the groin, and any regular medicines in their boxes.

• Tell the team about blood-thinning tablets, which may need adjusting.

• Plan time off and ask about a fit note before you leave hospital.

In open surgery the surgeon makes a cut over the groin large enough to find the weakness, returns the bulging tissue and reinforces the wall, commonly with a mesh patch that the Hull leaflet describes as being stitched or stapled in place. In keyhole surgery the same leaflet describes several small cuts of about 1cm or less, with gas used to inflate the abdomen so the surgeon has room to work. A Milton Keynes leaflet describes three small cuts and a mesh fixed with staples for its laparoscopic repair.

Which route suits you depends on whether the hernia is on one side or both, whether it has come back after earlier surgery, your general health and the surgeon's own experience. Keyhole surgery generally needs a general anaesthetic. Open repair can sometimes be done with local anaesthetic, with or without sedation.

The NHS lists wound infection, the hernia coming back, bruising, numbness, blood clots, and, uncommonly, damage to nearby organs. The Hull leaflet adds scarring and a collection of fluid called a seroma as common problems, and groin-specific ones: injury affecting the testicle, difficulty passing urine and long-lasting pain. Bowel injury is described as rare.

None of the pages used here gave dependable percentages that can be quoted, so none are given; ask your surgeon for figures based on their own results and your circumstances. A keyhole repair may be followed by a short period needing a urinary catheter, according to the Milton Keynes leaflet.

Walking is encouraged from the start. Different NHS sources give different lifting limits, from about 10 days to 6 weeks, which is one reason to follow the sheet from your own hospital. Most people take at least a week or two off work, longer for heavy jobs. Driving is a judgement about control: you should be able to brake hard without pain, and you should check your insurer's terms.

A week-by-week view is on the linked recovery timeline for this operation.

Contact NHS 111, or the ward number on your discharge sheet, for a wound that becomes red, hot or leaking, a fever, worsening groin swelling or pain, vomiting that does not settle, or leg pain. Call 999 for breathlessness, chest pain or coughing up blood, which can mean a clot has reached the lungs. A hernia that becomes very painful, firm and cannot be pushed back, particularly with vomiting, is an emergency in its own right.

The operation is the same whichever way it is funded. The usual differences are the wait, how much choice you have over the surgeon and date, and who handles follow-up if a problem arises, so ask what a private package includes beyond the first appointment.

• Is my repair open or keyhole, and why that choice?

• Will mesh be used, and which type?

• What is your own recurrence and chronic-pain experience?

• Which lifting and driving rules does this hospital use?