Inguinal hernia repair in Niš

An inguinal (groin) hernia develops when part of the contents of the abdomen, usually fatty tissue or part of the bowel, pushes through a weak spot in the abdominal wall in the groin. From the outside it usually looks like a soft lump. The lump usually gets bigger when standing, coughing or straining, and smaller when lying down. Inguinal hernias are more common in men, but they also occur in women.

In adults, a hernia does not go away on its own. A hernia belt (truss) can ease the symptoms, but it does not close the opening in the wall. During the operation, the surgeon pushes the contents of the hernia back into the abdomen and strengthens the weakened part of the wall. This is usually done with a mesh, a medical device that stays in the body and that the surrounding tissue grows into over time. The medical name for the procedure is hernioplasty.

The information on this page applies to adult patients.

The decision to operate is made by the surgeon after an examination. The diagnosis is usually made from the examination alone, and sometimes the doctor also asks for an ultrasound scan.

Surgery is usually recommended when a hernia causes symptoms, when it gets bigger over time or when it makes work and everyday activities difficult. For men with a small hernia that causes no symptoms, the doctor sometimes suggests monitoring the hernia and examining it again later. In women, surgery is usually advised earlier, because in their case an inguinal hernia is harder to tell apart from a femoral hernia (a hernia at the top of the thigh), which is more likely to become trapped.

An urgent examination is needed if the hernia becomes hard, painful or tender to the touch and cannot be pushed back, if the skin over it turns red or dark, or if the hernia is accompanied by sudden severe abdominal pain, nausea, vomiting, bloating or being unable to pass wind or stools. These can be signs of a trapped (incarcerated) hernia. In that case, do not wait for a booked appointment: call the emergency medical service on 194 or go to the nearest emergency department.

The Maja Hospital price list includes items for inguinal hernia repair under local and under general anaesthetic, for laparoscopic surgery on one side or on both sides, for surgery for a complex hernia and for repeat surgery. There are two main surgical methods: open and laparoscopic.

Open (conventional) surgery: the surgeon makes a cut a few centimetres long in the groin, pushes the hernia contents back and places a mesh. This is usually done under local or general anaesthetic, and sometimes under a spinal anaesthetic.

Laparoscopic surgery: through several small openings in the abdomen, and with the help of a camera, the surgeon places a mesh on the inner side of the abdominal wall. This is usually done under general anaesthetic. This method is often considered for a hernia on both sides, for a hernia that has come back after open surgery, and for women.

A complex (inguinoscrotal) hernia in men extends down into the scrotum and usually requires more extensive surgery. If a hernia comes back after a previous operation, the surgeon usually recommends repeat surgery (reoperation). Sometimes the old mesh then needs to be removed and the wall strengthened again.

Which method is more suitable depends on the size and type of hernia, whether the hernia is on one side or both, any previous operations, general health, and the assessment of the surgeon and the anaesthetist.

Before the operation, the surgeon reviews the test results and agrees the type of anaesthetic with the patient. For a general or spinal anaesthetic, and for sedation, the patient is also examined by an anaesthetist. The patient is told when to arrive and from what time they must not eat or drink.

On the day of the operation, the patient arrives for admission at the agreed time. The surgeon explains the procedure and its possible risks once more, and the patient signs a consent form for the operation. The side of the hernia is usually marked before the patient goes into the operating theatre. After the operation, the patient is monitored by medical staff until the anaesthetic wears off and they are able to get up, walk and pass urine on their own.

Before discharge, the patient receives a discharge summary with instructions on wound care, pain relief and the follow-up appointment. When the patient can go home is decided by the surgeon. After an anaesthetic, the patient must not drive themselves, so they need to arrange for someone to accompany them and, after a general anaesthetic, for someone to stay with them for the first 24 hours.

As with any operation, this one carries certain risks. The most common are bruising, swelling or a build-up of fluid around the wound, and in men also in the scrotum, which usually settle on their own within a few weeks. Less common are wound infection, bleeding or a larger painful collection of blood (haematoma), difficulty passing urine after the anaesthetic, numbness of the skin below the cut, and groin pain lasting longer than three months.

Rarely, there may be damage to the nerves, blood vessels or the tube that carries sperm (vas deferens) in the groin, pain or swelling of the testicle, injury to the bowel or bladder, mainly with laparoscopic surgery, or a blood clot in the veins of the leg, which can travel to the lungs. The hernia can come back, but this is not common.

The patient discusses the risks related to their own health with the surgeon and the anaesthetist before the operation.

When an inguinal hernia comes back after a previous operation, it is called a recurrent hernia. A repeat operation (reoperation) is then usually needed. It is usually more demanding than the first one, because the surgeon works in the area of the scar and the previously placed mesh. Sometimes the old mesh is removed and the wall is reinforced again with new mesh.

The Maja Hospital price list has two items for reoperation of an inguinal hernia with removal of the mesh and a new repair: under local anaesthetic with sedation or spinal anaesthetic, and under general anaesthetic. Whether a repeat operation is needed, which method is used and which anaesthetic, is decided by the surgeon after an examination, and the type of anaesthetic by the surgeon and the anaesthetist. Please bring the discharge letter and results from the previous operation, if you have them.