Hernia – Part 3

The region of the hernia repair is commonly affected by hardness, swelling and bruising which are related to the clotted blood and fluid under the wound, the stitches pulling the wound together and finally by scar tissue formation. These difficulties all settle over time as the area heals. The genitals can be affected by bruising and then they can become black and blue. This is because downwards is the obvious direction for any bleeding to track after the hernia repair.



Sometimes bruising can be very extensive. Occasionally bleeding from a small blood vessel under the skin or near the repair can produce a collection of blood, visible as a bulge under the wound, called a haematoma. This may settle slowly on its own but sometimes needs to be let out by a further operation. If bleeding spreads down into the scrotum some swelling may remain around the testicle for a long time.



During the operation a small nerve which travels across the incision line may be cut through, causing a minor area of numb feeling at the inner end of the incision. To do the operation well this nerve has to be cut but because the numb area gets smaller with time and is hidden under the pubic hair it does not normally cause any problems. A chronic pain problem over the area of the repair can develop in one in twenty patients and can be a significant problem. Nerve stretch as the operation is being done or the nerve becoming tethered as the healing proceeds are possible reasons for this pain. A pain killer can be injected into the painful area to reduce the pain but in some cases the surgeon will need to re-explore the area to find the trapped nerve and release it.



During the operation all the structures close to the hernia, including the tube carrying sperms, the vein and the artery, are all at risk of damage. In recurrent hernia surgery the risk to these structures is greater. Damage to the artery can result in ischaemic damage to the testicle and it may then shrivel and need to be surgically removed. Damage to the tube carrying sperms means that the ability to be fertile will depend on sperm from the remaining testicle which is usually plenty. In older patients the removal of the testicle can be advised before repairing a recurrent hernia to get the best outcome.



An infection in the hernia wound is a risk but not common and antibiotics are prescribed if the wound gets red or inflamed. If an infection worsens and starts producing pus then the surgeon may need to re-open the wound and clean it out to release the infection. The risk of a hernia recurring increases with the presence of infection. Infection of the mesh means it will need to be removed and once the infection has settled the repair will need to be repeated. There is a degree of risk of a deep vein thrombosis (DVT) but this is not common. Getting up and about walking again and keeping the legs and feet moving regularly are helpful to keep the circulation going and prevent DVT.



The risk of getting a recurrent hernia is less than 1 in 20 overall after a primary repair of a hernia. There are some risks involved in having a general anaesthetic which increase if the patient has a long-term medical condition. There are temporary side effects, occurring 1 in 10 to 1 in 100 times, which include pain in the injection sites, bruising, sickness and blurred vision, side effects which are treatable and go off quickly.



Complications which can occur but less commonly (approximate risk of one to 100 to one to 10,000) are headaches, short term breathing and speaking difficulties, sore throat, lip, tongue and teeth damage and muscle pains. Much more serious complications are extremely rare and occur at less than once in ten thousand times. These include blood vessels and nerve damage, lung injury, eye damage, brain damage, severe allergy reactions and death, liver/kidney failure and injury to the larynx. The likelihood of these complications occurring depends on what other medical conditions the patient is suffering from.



Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Glasgow visit his website.