It has been determined that you have an Inguinal Hernia. Because of your current symptoms and/or findings, and the potential for complications arising from the presence of this hernia, surgical repair has been recommended. An Inguinal Hernia occurs due to a weakness, gap or opening in the muscles or tendons of the abdominal wall in the groin area, resulting in a bulge of intra-abdominal contents and/or pain or discomfort. This pain and discomfort is the result of nerves in this area being irritated or stretched as the surrounding tissue is also stretched. If these hernias are left untreated, they may enlarge. Intestine may then become trapped within the hernia leading to intestinal blockage or damage ( Strangulation or Incarceration). This is an emergency surgical situation.
Surgery involves repair of the area of weakness and return of the abdominal contents back into their normal position. We utilize a plastic screen or mesh made from non-reactive polypropylene to reinforce the area in repairing the overwhelming majority of inguinal hernias (both primary and recurrent hernias). The decision on what type, size, and specific manufacturer of mesh to be utilized will be made by your surgeon during surgery based on the operative findings. Surgical repair of hernias is called a HERNIORRHAPHY.. Muscle is not cut, nor sewn together under tension in our technique, and the defect is repaired with mesh. This technique is therefore called an open, TENSION FREE HERNIORRHAPHY REPAIR.
In most adults, surgery will be performed under local anesthesia. What this means is that although you are lightly or mildly sedated by our Department of Anesthesia, you will not be "put to sleep". Rather, the surgical area will be numbed with the use of several injections of a Novocaine-like medication. You will be kept fully relaxed, comfortable and pain-free during the short procedure. After surgery, you will be observed in our ambulatory surgery area where you will be active and able to walk, and offered a light snack. Virtually all patients are discharged on the day of surgery, safely and comfortably. A prescription for pain medication will be provided, or you will be instructed in taking over-the counter pain medication.
We have extensive experience in the repair of Inguinal Hernias, performing over 750 inguinal hernia repairs annually. The surgeons of the North Penn Hernia Institute have received dedicated education and training in hernia repair, and truly "Specialize" in this field of surgery. This permits us to provide you, our patients, with the safest, most advanced and most effective hernia repair available. As such, our success rates are extremely high, equal to or better than the National Average. Additionally, our complication rate is therefore extremely low; again comparable to or below that seen nationally.
. While there are risks with any surgery, Inguinal hernia repair is the most common, and SAFEST procedure performed today. When performed by the experienced Hernia Specialists at North Penn Hernia Institute moreover, who have extensive expertise in all facets of hernia repair, any risks are significantly reduced well below the nationally reported averages. Our use of Sedation and local anesthesia for the overwhelming majority or inguinal hernia repairs, rather than full general anesthesia, is a major component of our "Patient Safety and Quality First", risk-reduction strategy.
So that you may be fully informed as required by law, we have listed below the possible major complications of Inguinal Hernia surgery, based on both reported published national averages and our personal experience. Again, we believe our success is better than these averages, but they are listed below for your information.
- Recurrence of the Hernia.......About 0.5% or 1 in 200 (for Primary or 1st time repairs)
- This 1/2% recurrence (1 in 200 patients) occurs most often in obese patients or in those with large or long neglected hernias
- Infection of Incision........................Less than 1/2% or 1 in 200
- Bleeding (fully controlled in OR)............Less than 1% or 1 in 100
- Swelling and Black/Blue(temporary and usually mild)..............About 5% or 1 in 20
- Injury to Bladder or Bowel .............Extremely rare (less than 1/4% or less than 1 in 400)
- Actual or Perceived change in testicular size/function
- 0.5% for Primary repairs (1 in 200, usually in large scrotal or long-neglected hernias)
- 1 to 5% for Recurrent repairs
- Injury to the vas deferens...............................About 0.3% or less
- Infertility, directly caused by inguinal hernia surgery is extremely rare. This would occur only if both sides (left and right) were repaired and both vas deferens or testicular injury occurred
- Numbness and/or Chronic Incisional Pain*...............................2-3%
- (*Generally mild, non-debilitating and resolves over time)
- Patients considering hernia repair can now use a free app for mobile devices, designed by a leading surgeon, which can help predict their chances of experiencing chronic pain and discomfort after an operation. The app for both Android and I-phone, is called CeQOL, which stands for Carolinas Equation of Quality of Life, is already available for download. It is aimed at men, who comprise the majority of hernia patients.
- 1. HERNIA, Nyhus and Condon, 5th Edition, 2002
- 2. Retrospective NPHI Patient Analysis
- 3. HERNIA, Journal of the American and European Hernia Societies (Multiple Volumes)
- 4. Wantz, G.E.(1993) Testicular atrophy and chronic residual neuralgia as risks of inguinal hernioplasty. Surg Clin North Am. 1993;73:571–581
- 5. Rutkow, I.M., (2003), Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am. 2003 Oct;83(5):1045-51, v-vi.
All surgical incisions may be associated with some local numbness, as virtually invisible nerves within the skin and lower layers are divided during the incision process., Most of this will be temporary, however a small area of residual numbness around the incision may persist. This is generally well tolerated, minimally noticeable and creates no functional problems.
This mild numbness may be located in a small area of skin below the incision or incision or slightly into the scrotum (men) and upper thigh. Again, this is generally non-problematic, and frequently not noticeable.
Chronic incisional pain or discomfort occurs in approximately 1-2% of all hernia repair techniques. With our method this rare occurrence is generally mild and usually temporary, lasting 2-3 months. More chronic pain is less likely. Severe and long lasting pain at the area of the incision can occur, but is extremely rare (less than 1/2%).
If your hernia is being repaired for the second or more time, the chance of recurrence and other complications listed above are a bit higher, including infection and change in testicular size postoperatively. We also have extensive experience in the repair of multi-recurrent and large hernias which have been especially referred to us. We will take every available precaution and use contemporary technique to reduce these complications for you.
The incidence of complications listed previously (page 2), is based upon national averages. With our experience and expertise, our complication and recurrence rates are less than national averages. Moreover, by decreasing the generally accepted recurrence rate in the general population from 10% to 15% seen with older, less contemporary repairs and their variants, to the base less than 0.5% rate with our tension-free approach, re-operative surgery, with its increased risk of complications, prolonged recovery, etc. is thereby minimized.
While the over-whelming majority of Inguinal hernias are both safely and effectively repaired using just local anesthesia and mild sedation (over 95% of our patients here at NPHI), on extremely rare occasions, because of hernia complexity, multiple recurrence, extreme obesity and even patient comfort, conversion to a safe, light form of mild general anesthesia under the supervision of a Board Certified Anesthesiologist may be required. This need can at times be anticipated on initial physical examination. Our Anesthesiologist, therefore, must reserve the right to such a conversion during surgery if in his/her opinion, patient safety and surgical quality and efficacy so dictates.
I hereby attest that I have read in their entirety, and understand to my satisfaction the four (4) pages presented here. I have been informed and understand the risks and complications associated with Inguinal Hernia Repair, as well as the alternatives to surgery and the risks of non-operative management. I understand the nature of my problem, based on the discussion with my physicians/surgeons and the above information. Additional questions and/or concerns that I previously had have been addressed and answered to my satisfaction, and I agree to the surgery as planned.
PRINT FULL NAME (Patient)_________________________________
Print Witness' Full Name Please______________________________
North Penn Hernia Institute
Medical Arts Building @ Lansdale Hospital
125 Medical Campus Drive, Suite 310
Lansdale, PA 19446-7205
215.368.1122 fax 215.368.3569