Inguinal Hernia Repair (TAPP)

An inguinal hernia is the most common type of hernia that occurs when soft tissue pushes through a weak spot in the lower abdominal muscles, often developing in or around the groin area.  Anybody can develop an inguinal hernia, however, it is seen more frequently in men than women.  If left untreated, it can lead to life threatening complications.

Your doctor is likely to recommend surgery if the hernia is causing pain when you cough, bend over or lift heavy objects.

Causes of an Inguinal Hernia

Inguinal hernias occur most commonly in men, although both adults and children can develop inguinal hernias.  It is thought that inguinal hernias are a result of ageing, as the muscles around your abdomen may become weaker.  Some inguinal hernias may develop as a result of:

• Elevated pressure in the abdomen (stomach)
• Strenuous activity such as heavy lifting or weight lifting
• Repetitive straining during urination or bowel
• Obesity
• Persistent coughing or sneezing
• Pregnancy
• A pre-existing weak spot in the abdominal wall, usually developed from a defect present at birth or in later life
• Previous hernias (the second hernia usually appearing on the opposite side)

Symptoms of an Inguinal Hernia

In some cases, when the hernia is small it can be painless, becoming larger and more painful over time or when coughing, lifting or bending.  Other symptoms of an inguinal hernia include:

• A swelling in the area on either side of your pelvis
• A burning or aching sensation around the swelling
• Soreness or discomfort in your groin
• Weakness, pressure, or aching in your groin
• Sometimes, pain and swelling can be experienced around the testicles due to the protruding intestine descending into the scrotum

You can sometimes gently push the bulging hernia in when you lie on your back.  If you are unable to push the hernia in, it may be trapped in the abdominal wall.  A twisted or trapped hernia can become strangulated, cutting off the blood flow to the trapped tissue and become life threatening if left untreated.  Symptoms of a strangulated hernia may include:

• Nausea and vomiting
• A temperature above 38°C
• Sudden pain that rapidly increases
• A hernia swelling that turns dark red or purple
• Inability to pass gas or empty your bowels

Seek immediate medical assistance if you notice any signs or symptoms of a strangulated hernia

Diagnosis of an Inguinal Hernia

Inguinal hernias can typically be diagnosed by just a physical examination.  Your doctor will assess the groin area to check for any bulging or swelling.  As standing and coughing can make a hernia more noticeable, you will probably be asked to stand and cough or strain during the examination.

Your doctor may organise an imaging test, such as an abdominal Ultrasound, CT scan or MRI scan if a diagnosis cannot be determined by a physical examination alone.

Procedure and Treatment

Surgery is not always essential; however, hernias usually do not improve on their own.  Although there are risks and complications associated with surgery, the prognosis is generally positive.

Inguinal hernia repair is a common surgical procedure that is carried out to push the bulge back into place and strengthen the abdominal wall.  The surgery is usually suggested if the hernia is causing pain, or if any serious complications occur.

The most common laparoscopic (keyhole) surgical technique for inguinal hernia repair is Transabdominal Preperitoneal (TAPP).  This is a minimally invasive procedure and can be useful when the hernia is small and easy to access.

The laparoscopic TAPP technique is performed using a laparoscope (a thin tube with a light and a camera at the tip).  The procedure is carried out under general anaesthetic and usually takes around 30-45 minutes.  Your doctor will make several small incisions and use gas to inflate your abdomen to make the internal organs easier to examine.

Laparoscopy enables your doctor to avoid scar tissue from any previous hernia repair.  A laparoscope is inserted into one of the incisions. Directed by the camera, your doctor inserts tiny medical tools through the other incisions to repair the weak spot in the abdominal wall with synthetic mesh.

This procedure leaves smaller scars than open surgery, and boasts a faster recovery time.

Post-Operative Recovery

Laparoscopic inguinal hernia repair may result in less discomfort and scarring following surgery and a faster return to normal activities.  However, the hernia returning may be more likely with laparoscopic repair than with open surgery.

Inguinal hernia repair is generally carried out as a day care procedure, meaning you can go home the same day (as long as there are no unforeseen complications).  You will be provided with information on how to care for your wound during recovery.  It is important you follow this and maintain a healthy diet.

With laparoscopic surgery, you will usually be able to get back to your normal activities within a few days to a week.  Men may sometimes experience difficulty urinating in the hours after the surgery and a catheter (a tube that drains urine from the bladder), may be offered to help with this.

You will be encouraged to get up and move around after about an hour post-surgery, and take part in regular exercise in the weeks following to help the healing and recovery process.  You do not need to avoid lifting; however, you may find it uncomfortable to lift heavy weights within the first few weeks.

The majority of people will make a full recovery from inguinal hernia repair within 6 weeks.

Risks and Complications

A laparoscopic inguinal hernia repair is a minimally invasive, routine procedure with limited risks.  As with any surgery there are some complications to be aware of:

• Breathing difficulties (following chest or abdominal surgery it may hurt to push air out or breathe in too deeply)
• Bleeding and blood clots
• Allergic reaction to the anaesthetic
• Infection at the wound site
• Scarring

Specific complications to inguinal hernia repair may include:

• Fluid or blood build up in the space left by the hernia (usually recovering without treatment)
• Swelling or bruising of the testicles or at the base of the penis
• Nerves damaged or trapped during surgery and causing pain or numbness
• Prolonged pain at the wound site
• Damage to the vessels supplying blood to the testicles
• Damage to the vas deferens (the tube that transports sperm to the testicles)
• Complications are more likely to develop if you are over the age of 50, are a smoker or suffer from other medical conditions.

Outlook after Inguinal Hernia Repair Surgery

An inguinal hernia is a common condition caused by a weakness in the abdominal wall, which if left untreated can occasionally cause serious complications.  Following a successful operation, you should no longer have the hernia.  The operation should prevent you from having any serious complications that a hernia can cause, but does not prevent the hernia from returning or a new one forming.

Need Help?

At One Ashford Hospital we can book you in to see a leading Consultant General Surgeon, usually within 48 hours, for an initial consultation. We are well placed to see patients from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding areas.

You can use your private medical insurance or pay for your Inguinal Hernia Repair (TAPP) treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

Why One Healthcare

• Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• 0% and low finance options**
• Private, spacious, en-suite rooms
• Specialist Physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

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