You are having a laparoscopic inguinal hernia repair with mesh.
The Procedure:
This surgery involves the use of three small incisions in the abdominal wall- one at the belly button and two small incisions on each side of the mid-abdomen. The abdomen is inflated with gas and a flap is made in the innermost layer of the abdominal wall (peritoneum). A space is developed here once all the bulging hernia contents are pulled back into the abdomen for the mesh to patch the hernia from the inside. The mesh used is manufactured by Bard and is called 3D Max mesh. This mesh is secured at one spot (Cooper’s ligament) using a dissolvable tack. The innermost layer (peritoneum) that was initially opened is then sewn closed. The surgery is usually around an hour long but more time is needed before and after surgery as you go asleep and wake up from anesthesia.
Anesthesia:
This type of repair requires general anesthesia because the abdominal muscles have to be completely relaxed to allow access to the abdominal cavity. This is the case for all laparoscopic abdominal surgeries.
Why we recommended this surgery:
Whenever possible, we recommend an inguinal hernia repair with mesh placed behind the abdominal wall. We tend to recommend this repair to patients who haven’t had other surgery in the area and who have a little more weight in their low abdomen, making this the best approach for them. This type of repair, in which the hernia is patched by placing mesh on the inside of the hernia hole, results in the lowest possible chance a hernia comes back after surgery – about 1-3%. Commonly,the worst pain after surgery is at the belly button where the incision is slightly larger (just over 1cm) and a stitch is placed in the strength layer to minimize the chance of developing a hernia at this location. Most of the time, patients do not require opioid pain medications after surgery and can get back to work within a few days of surgery so long as they do not have a very physical job.
A note on mesh:
Patients often ask us “Is mesh safe?” The mesh we use has been used millions of times and is well tolerated by patients. There are lawsuits related to a specific type of mesh that was taken off the market several years back. We do not use this mesh. There are other concerns related to where mesh is placed in the groin. In the case of inguinal hernia repair, this usually relates to stitching and placing mesh over the area of the three nerves in the groin. When one of these nerves is inadvertently injured, patients can develop chronic pain. In the case of open preperitoneal inguinal hernia repair, we are placing the mesh on the inside of the hernia hole- this allows us to stay away from the area where most of the nerves course. This is one of the major benefits of repairing a hernia from the inside. Additionally, when using a foreign material like mesh, there is a chance that material becomes infected. Your body can’t defend infection in a foreign material as well as it can in our own bodies. Fortunately, this is very rare (about 1 in 5,000) but can result in the need for the mesh to be removed.
Risks of surgery:
During your appointment, you discussed the risks of surgery. Every surgery comes with risk, but we do everything we can to minimize the chance that you have a complication related to one of these risks.
- Hernia recurrence – 1/100 – Hernias can come back after repair. After open preperitoneal inguinal hernia repair, the risk of recurrence is about 1-3%. This means that 97-99% of patients will not need another operation for their inguinal hernia.
- Infection – 1/200 – If an infection occurs after surgery, it is usually a skin infection and is well treated with a short course of oral antibiotics. If the mesh becomes infected, it can require removal. This is exceedingly rare at ~1/5,000.
- Chronic pain – 1/300 – As mentioned during your consultation, chronic pain is less of a risk when we repair inguinal hernias from the inside, but it is impossible to completely avoid the risk of some discomfort extending beyond the normal recovery period. The risk of chronic pain is less than 1/300. If this happens, we work closely with our patients until they get better. In our experience, this usually resolves by itself and rarely requires surgical intervention to fix.
- Bleeding – 1/400 – The risk of any significant bleeding after inguinal hernia repair is less than 1/400 and this is kept very low risk when patients adhere to activity restrictions in the first couple weeks after surgery.
- Injury to surrounding structures during surgery – 1/500 – Because this operation involves going into the abdominal cavity, there is a risk, though it is very low, of injuring one of the surrounding structures within the abdomen. If injury occurs, other operations can be required or your hernia repair could need to be delayed to another time when it is safer to proceed.
Preparing for surgery:
- Please continue to be as active as you normally are. It is safe to exercise as long as you do not have pain with your activities.
- Make sure you have acetaminophen (tylenol) and ibuprofen (motrin, advil) at home as these medications are typically all that is needed to treat post-operative pain.
- No bowel prep is needed before surgery.
- You may or may not need to have a Covid test within 72 hours before surgery. This is dependent on the policies at the location you are having surgery. Our medical assistants give you instructions on how best to arrange this at the time of your consultation if it is required.
- Depending on what facility you are having surgery in, another step is required prior to surgery:
- Newton-Wellesley Hospital – Our medical assistants will schedule you a pretesting phone appointment and we will contact you regarding the scheduling of this appointment.
- BOSS– You were given a sheet detailing what you need to do to register prior to surgery.
- Surgical Center of NH at Derry – You will receive an email or text from the surgery center itself to register as a new patient.
The day of surgery:
- Please be prepared to leave for the hospital earlier than your planned time and keep an eye on your phone in case someone calls you from the hospital or surgery center. Sometimes we have to start earlier than planned and will call you if so. We really appreciate your flexibility.
- Please arrive promptly at the time you are given as a lot has to happen before you are wheeled into the operating room.
- You will get an IV, meet the team (including the preoperative nurses, the OR nurse, the anesthesiologist or nurse anesthetist), and see your surgeon and physician assistant in preparation for surgery.
- After surgery, you will spend about 1-2 hours in the recovery room before you go home.
After surgery:
- Take acetaminophen and ibuprofen together every 6 hours for the first 2-5 days for pain control.
- Avoid any activity more strenuous than casual walking for two weeks after surgery.
- Remove bandage (if present) 48 hours after surgery.
- Please see these instructions for more details on your post-operative care.
- A note on resuming exercise after the 2 week recovery period: Once you are two weeks out from surgery, you can start testing different activities. Approach activities slowly until you are sure they don’t cause you sharp pain. Any activity that causes sharp pain at the incision should be avoided. If you feel well and are active throughout one day, it is normal to feel more sore the next day while you continue to recover. You didn’t hurt yourself so long as you don’t push through an activity that’s causing you pain while doing it. Ultimately, the goal after you are fully recovered is to get you back to all of your activities without restriction. For most of our patients who have this type of surgery, they are back to most of their pre-op activities about 1 month after surgery.
We hope this information has helped you prepare for your upcoming hernia surgery. If you have any questions about the above information, please call our office to set up a follow up appointment so that we can ensure all of your questions are adequately answered and you feel comfortable prior to your surgery.