Groin Hernia Repair

What Is a Groin Hernia?

A groin hernia occurs when tissue pushes through a weak spot in the muscle wall of the groin, creating a lump or discomfort. It can develop on one or both sides and is more common in men, but women can be affected as well. Groin hernias do not improve on their own and tend to slowly get worse over time. Surgery is recommended to relieve symptoms and reduce the risk of serious problems like bowel obstruction or strangulation.

Types of Groin Hernias

There are two main types of groin hernias that may require surgical repair:

• Inguinal hernias: These are the most common type of groin hernia and can be classified as direct or indirect. They occur in the inguinal canal and are more common in men.

• Femoral hernias: These are less common but have a higher risk of becoming trapped (incarcerated) or strangulated. For this reason, they are typically repaired soon after diagnosis.

Surgical Options

Surgery is the only way to permanently fix a groin hernia. There are three main approaches: open, laparoscopic (keyhole), and robotic-assisted. All are effective and safe. Your surgeon will recommend the most suitable method based on your health, hernia type, and previous surgeries. Mesh is used in nearly all repairs unless there is active infection or contamination.

Open repair involves making a small incision over the hernia, pushing the tissue back in, and placing a mesh to reinforce the area. This is often done under general anaesthetic, but some patients may have spinal anaesthetic if needed.

Laparoscopic (keyhole) repair is performed under general anaesthetic through several small incisions. A camera and instruments are inserted to repair the hernia from inside. Mesh is placed over the defect. There are two main techniques:

• TAPP (Transabdominal Preperitoneal): the abdominal cavity is entered and mesh placed from inside.

• TEP (Totally Extraperitoneal): mesh placed without entering the abdominal cavity. This is our preferred technique

Robotic-assisted repair is similar to laparoscopic TAPP but done with robotic equipment. This can improve precision, especially in complex or recurrent cases, but is less commonly used.

Advantages of Laparoscopic Repair Over Open Repair

Laparoscopic surgery offers several benefits over traditional open surgery:

• Smaller incisions and reduced postoperative pain

• Faster recovery and earlier return to work

• Lower risk of wound infection

• Better option for bilateral hernias (both sides can be repaired at once using the same cuts)

• Preferred for recurrent hernias after previous open repair

• May reduce the risk of chronic postoperative pain due to mesh placement away from major sensory nerves

• May lower recurrence rates when performed by experienced surgeons

• Allows for detection and repair of all hernia openings in the groin on that side, reducing the chance of developing a femoral hernia later

When Laparoscopic Repair May Not Be Suitable

Laparoscopic surgery may not be suitable in the following situations:

• If general anaesthesia is not safe for you

• If you are on blood-thinning medications that cannot be stopped

• In cases of very large or complex hernias

• If you have had major abdominal surgery with dense scar tissue (TAPP technique may not be suitable, though TEP might still be possible)

• If you have had previous prostate cancer surgery (open, laparoscopic, or robotic), which can make laparoscopic repair more risky

• If laparoscopic equipment or surgical expertise is not available

We will carefully assess your case and advise you on the safest and most effective approach.

Use of Mesh in Hernia Surgery

Mesh is used to strengthen the abdominal wall and reduce the risk of recurrence. It acts as a scaffold, allowing your body to heal around it. The mesh is permanent and usually well tolerated. Some patients notice a firm area or tight sensation, but this often settles as healing progresses.

Anaesthetic Options

Most hernia operations are done under general anaesthetic. In some high-risk patients undergoing open repair, spinal or epidural anaesthetic may be used instead. Your anaesthetist will discuss the best option with you.

Preparation for Surgery

Before surgery, please follow these instructions to help ensure a smooth and safe experience:

• You will be advised when to stop eating and drinking before the operation.

• Shower at home on the morning of your surgery.

• Do not shave the surgical site — this will be done in hospital if needed, as shaving at home can increase the risk of infection.

• Inform your doctor about all your current medications, including prescription drugs, blood thinners, and herbal supplements. Some may need to be paused or adjusted before surgery.

• You can still take your heart and blood pressure medications with a small sip of water on the day of surgery.

• If you are diabetic, inform us and anaesthetist. You will be given specific instructions regarding your medications.

• Stop smoking for at least 4 weeks before your surgery. Smoking increases the risk of complications.

• Avoid alcohol for 24 hours before your surgery.

• In general, avoid smoking and alcohol in the days leading up to surgery.

What to Expect on the Day of Surgery

On the day of surgery, most people are treated as day cases and go home the same day. The operation usually takes around one hour, depending on complexity. You’ll receive pain relief and wound care instructions before discharge.

Recovery After Surgery

Recovery varies between individuals, but most people are walking the same day and resume light activity within a few days. Desk-based work is usually fine after one week. You should avoid heavy lifting for 4–6 weeks to allow proper healing. Swimming can resume after two weeks, and sexual activity once you feel comfortable.

For male patients, we recommend wearing supportive underwear such as a new pair of briefs rather than boxer shorts. This provides support to the testes and helps reduce drag, discomfort, and swelling during the early stages of recovery.

Driving After Surgery

You can drive again once your strength and reaction time are back to normal, and you are no longer taking strong pain medicine. After laparoscopic repair, this is often after one week. For open surgery, allow two weeks. If you’re unsure, check with with us and your insurer.

Bowel and Bladder Function

It’s important to monitor bowel and bladder function after surgery. You must be able to pass urine before leaving hospital. Some men may have temporary difficulty urinating, which usually resolves with time. Constipation is common in the first few days. Drinking plenty of water and using a gentle laxative or fibre supplement can help.

Wound Care

Wound care is straightforward. Your wound will have dissolving stitches and be covered by Steristrips and a waterproof dressing. You can shower the next day, pat the area dry, and remove the waterproof layer after a few days. The paper strips will fall off on their own. Avoid applying any creams or powders unless directed by your doctor. Contact us or your GP if the wound becomes red, swollen, or starts to leak fluid.

Common Symptoms After Surgery

Some common symptoms after surgery include bruising, swelling, and a firm or tight feeling in the groin. A lump may be felt at the repair site—this is usually a fluid collection (seroma) and not a hernia recurrence. Mild numbness or tingling is also common and often settles over time. These symptoms are part of the normal healing process.

Risks and Complications

Groin hernia surgery is generally very safe, but like all operations, it does carry some risks. Most are mild or temporary, but some can be more serious.

Common or Minor Risks:

• Bruising and swelling in the groin or scrotum — usually resolves within weeks

• Tightness or pulling sensation — due to mesh or scar tissue

• Seroma — soft swelling caused by fluid build-up, usually temporary

• Numbness or tingling — often improves but may persist

• Keloid or hypertrophic scar — raised or thickened scar tissue at the incision site

• Wound infection — more common in open surgery, may need antibiotics or drainage

• Urinary retention — may require temporary catheterisation

• Bleeding or haematoma — rare, but can cause swelling or bruising

Rare or Serious Risks:

• Chronic groin pain (inguinodynia) — nerve pain lasting more than 3 months

• Recurrence — uncommon when mesh is used, but still possible

• Injury to nearby structures — including blood vessels, nerves, vas deferens

• Injury to bowel or bladder — rare, more likely with prior surgery or adhesions

• Mesh-related complications — including discomfort, rejection, or infection

• Testicular complications — such as swelling (orchitis) or impaired blood supply

When to Seek Medical Attention

Please contact your GP or surgeon if you experience:

• Increasing redness, swelling, or pain at the wound site

• Fever > 38.3 or feeling generally unwell

• Nausea, vomiting, or difficulty passing urine

• Foul smelling or creamy discharge from incision

Long-Term Outcomes

Most people recover fully and enjoy long-lasting results. The recurrence rate is low, especially when mesh is used and postoperative advice is followed. Maintaining a healthy weight and avoiding heavy lifting during recovery are key to a good outcome.

Follow-Up

You will usually see your surgeon again 2–4 weeks after surgery to check the wound and discuss your progress. Avoid strenuous activity until your surgeon gives you the all-clear.