Recovery after inguinal hernia repair: what is normal and when to return to work

Recovery varies from person to person. It depends on the method (open repair through a single cut, or laparoscopic surgery through several small cuts), the size of the hernia, the type of anaesthetic, age and general health. The outline below is a guide and describes the most common course after a planned operation without complications.

• Day of surgery: the patient stays under observation until they have recovered from the anaesthetic, and gets up and walks when the medical staff allow it. Pain around the wound is expected and is relieved with medicines prescribed by the doctor. The surgeon decides how long the hospital stay will be. If you go home the same day, someone else should drive you, and after a general anaesthetic or sedation it is advisable to have someone with you for the first 24 hours.
• The first few days: pain and discomfort are at their worst, especially when getting up, coughing and sneezing. Short walks around the house several times a day help recovery.
• Weeks one and two: pain gradually eases, and bruising and swelling begin to settle. The first check-up with the surgeon usually takes place during this period. Most people can then return to lighter tasks and desk work.
• Weeks three and four: most everyday activities become easier, and walks can be longer. Lifting heavier objects is still avoided.
• After four to six weeks: with the surgeon's agreement, physically demanding work, exercise and sport are gradually resumed.

If your recovery is a little slower than this outline, it does not necessarily mean there is a problem. Discuss it with the surgeon at your check-up, and see the signs that mean you should get in touch sooner further down this page.

Pain around the wound is worst in the first few days and usually eases day by day. When coughing, sneezing or getting up, it helps to gently support the wound with your hand or a small pillow. Take painkillers as stated in your discharge summary, and ask a doctor before taking any other medicine.

Bruising and swelling around the wound are common. They may spread lower down to the genital area, and in men to the scrotum. This can look unpleasant, but it usually settles within about two weeks, and a larger bruise can last longer. Sometimes a slight firmness or soft bulge can be felt at the site of the operation, for example from a collection of fluid, which often goes down gradually. Show any new bulge to the surgeon at your check-up, and without delay if it is hard, red, painful or growing quickly.

The skin below the wound and in the groin may feel numb or unusually sensitive. This usually improves gradually, although a small numb area sometimes remains. After laparoscopic surgery, bloating and shoulder pain may occur in the first few days, caused by the gas used during the procedure. A little blood or fluid on the dressing in the first two days is common.

Walking is part of recovery. Moving from the first days reduces stiffness and helps circulation, and the length of your walks should be increased gradually. Lying down all day is not advised. For wound care and everyday habits, the following usually applies, together with the instructions in your discharge summary:

• Keep the wound clean and dry. Showering is usually allowed after a few days, with a waterproof dressing.
• Wait until the wound has fully healed before taking a bath or swimming in a pool or the sea, usually about two weeks.
• Stitches or clips are removed by the surgeon or a nurse at a check-up, when the surgeon judges that the wound is ready. If dissolvable stitches were used, they do not need to be removed.
• A diet with plenty of fibre and enough fluids helps keep stools soft, as straining on the toilet is uncomfortable in the first few days.
• A hernia belt is usually not needed after the operation. Comfortable, close-fitting underwear that supports the groin can ease discomfort and swelling in the first few days. The surgeon will tell you what is needed in your case.
• Smoking slows wound healing and increases the risk of the hernia coming back, so recovery is a good time to stop.

Returning to your usual activities depends mainly on the type of work you do and how quickly the pain eases. As a guide:

• Desk work and lighter tasks at home: usually after one to two weeks.
• Work involving lifting, long periods of standing or strenuous physical effort: usually after four to six weeks, sometimes later.
• Driving: do not drive for at least 24 hours after the operation, whatever type of anaesthetic you had, and have someone else drive you home. After that, you can drive when you can put on a seatbelt, brake suddenly and look over your shoulder without pain, and when you are not taking medicines that make you drowsy.
• Gym, sport and heavy lifting: usually after four to six weeks, gradually and with the surgeon's agreement.
• Sex: when you feel ready and are not in significant pain. If you are unsure, ask the surgeon at your check-up.

The international guidelines for the treatment of inguinal hernia (HerniaSurge, 2018) state that there is no evidence that restricting activity after surgery reduces the risk of the hernia coming back, and advise returning to normal activities as soon as the patient feels well enough. Even so, many surgeons advise avoiding heavy lifting and strenuous effort for a few weeks as a precaution. After laparoscopic surgery, some patients return to lighter tasks slightly sooner than after open repair, but this also depends on the size of the hernia and general health. This is why advice from different surgeons sometimes differs. What applies to you is what the surgeon writes in your discharge summary or tells you at your check-up.

In Serbia, sick leave (temporary incapacity for work) is issued and extended by your GP (izabrani lekar), the doctor you are registered with under compulsory health insurance. In the discharge summary and at the check-up, the surgeon gives an opinion on how much time off work is needed, but the decision on sick leave is made by your GP. If sick leave needs to last longer than the period the law allows the GP to approve, an extension is decided by the medical board of the Republic Health Insurance Fund (RFZO).

The length of sick leave usually depends on the type of work: shorter for desk work and longer for physically demanding work. Before the operation, ask your GP which documents you need to bring. Keep your discharge summary and check-up reports together and bring them to every appointment.

Some signs are not part of a normal recovery. Contact the surgeon without delay if you notice any of the following:

• A temperature of 38 °C or higher, shivering or feeling generally unwell.
• Redness, warmth, increased swelling or pus at the wound, or bleeding from the wound that does not stop.
• Swelling or bruising in the groin or scrotum that grows quickly, becomes hard and increasingly painful.
• Pain that gets worse instead of better, or swelling and pain in the abdomen.
• Difficulty passing urine or pain when passing urine.
• Nausea or vomiting lasting longer than 24 hours after the operation.
• Pain, swelling or cramping in the calf.

If you cannot reach the surgeon, for example outside working hours, go to the nearest emergency medical service or emergency department. If you cannot pass urine at all, or if you have difficulty breathing, chest pain or are coughing up blood, call an ambulance on 194 or go to the nearest emergency department without delay.

The appointment for the first check-up after surgery is usually arranged when you are discharged. At the check-up, the surgeon examines the wound and assesses how recovery is progressing, and stitches are removed if needed. It is a good opportunity to ask about work, driving, sport and sick leave, so write your questions down in advance.

In the Maja Hospital general surgery price list, the first post-operative check-up, the surgeon's follow-up examination and stitch removal are listed as separate items. What is included in the price of the operation itself is explained at the consultation with the surgeon. Consultations and check-ups are booked by phone.