JAMA PATIENT PAGE | Hernia

Groin Hernia Repair by Open Surgery

There are 2 surgical approaches to hernia repair: open surgery and laparoscopic surgery.
The approach to fixing a groin hernia depends on multiple factors,
Open surgery for groin hernia
including previous surgery, size of the hernia, whether abdominal
contents are stuck (incarcerated), and general health.
After a patient receives medication to relax him or her and pre-
ventpain,anopenherniarepairiscarriedoutbyasurgeonwhomakes
Ilioinguinal
a 2- to 4-in incision near the groin hernia and identifying the abdomi- Surgical nerve
incision
nal contents that protrude through the weak area of the abdomen.
These contents are contained in a structure called the hernia sac. The
Hernia sac Spermatic
hernia sac is separated from important structures such as the sper-
Spermatic cord
maticcordandthenreturnedbackintotheabdomenthroughthegroin cord Hernia sac
hernia. The hernia defect is repaired by bringing the groin tissues back Hernia
together. In most circumstances, a prosthetic (man-made) mesh is defect

placed over the hernia defect to decrease the chance that the hernia
The hernia sac is separated from the
recurs. The incision is closed with small staples that are later re- spermatic cord and ilioinguinal nerve
and pushed back into the abdomen.
moved or with stitches (sutures) that dissolve on their own over time.
The wound is then covered with a dressing.
Most patients undergoing an elective or nonemergent groin her-
nia repair will go home the same day as the surgery once their pain
is controlled, they have urinated, and they are able to tolerate food
Internal
or liquids without nausea or vomiting. oblique muscle

Postsurgery Care at Home External

oblique muscle
Most patients can expect soreness over the first 1 to 2 days after sur- Inguinal
ligament
gery. Take pain medication as prescribed by your surgeon. Some pa-
tients may experience bruising (ecchymosis) in and around the groin
area. This is normal. However, if there is significant swelling in the groin,
you should contact your surgeon. You should walk every day but limit MESH
strenuous activity such as running and lifting anything over 5 to 10 lb IMPLANT

(the equivalent of a gallon of milk) until evaluated by your surgeon at

your postoperative visit 1 to 2 weeks after surgery. In general, if an ac-
tivity hurts, it shouldn’t be done. Constipation and straining during A prosthetic mesh implant is
placed over the hernia defect and
bowel movements increases pressure on the repair and should be secured between muscle layers
to strengthen the abdominal wall.
avoided; eat a high-fiber diet and use stool softeners if needed.
Contact your surgeon if you experience fever higher than
100.4°F, shaking chills, pain that gets worse over time, inability to
urinate, inability to eat without feeling nauseous, or redness or pus SURGICAL AREA
draining from the incision(s). CROSS SECTION

FOR MORE INFORMATION

• Mayo Clinic Mesh implant
www.mayoclinic.org/diseases-conditions/inguinal-hernia/home covering hernia defect
/ovc-20206354
The external oblique muscle layer is
• National Library of Medicine closed over the hernia repair, and the
medlineplus.gov/hernia.html skin incision is sewn or stapled shut.

Authors: D. Brock Hewitt, MD, MPH; Karen Chojnacki, MD
Conflict of Interest Disclosures: The authors have completed and submitted the
ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Source: Beadles CA, Meagher AD, Charles AG. Trends in emergent hernia repair in the
United States. JAMA Surg. 2015;150(3):194-200.
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