Introduction to surgical complications
While most hernia operations are straight forward both keyhole and open surgery have risks and complications. Most of the risks are similar for both types of approach but there are some differences. eg. keyhole surgery requires a general anaesthetic while local anaesthesia can be used in high risk patients who are having an open repair,
Below are some of the risks and complications of hernia surgery.
The risk of recurrence
The most important risk is whether the hernia is going to be cured and not come back. All hernia repairs have a recurrence rate (RR). None can offer a 100% long term garrantee, although they get pretty close.
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The recurrence rate between surgeons and units varies and are difficult to compare. This is due to the different operations, the intensity and duration of follow up and differing patients. A 'good' operation done poorly will not get good results.
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Inguinal Hernia
very low RR
The RR for open inguinal hernia repair varies from 3 - 15 %. I am likely to tell you the best figure.
The RR for the modern keyhole repair of a similar inguinal hernia is comparable. I suspect the Keyhole operation will prove to have the best long term cure rate for inguinal hernia. But only if done well. The RR for a well repaired inguinal hernia should be around 3 %.
Recurrent hernia from both techniques can occur early, even in the first few days, if a hernia has been missed or the repair was not solid. However most recurrences occur after several years.
A surgeon skilled in one operation is likely to get better results than with a new operation that he has less experience with. There is often a big learning curve for a new operation.
Post repair pain syndrome
Post repair pain syndrome
A small number of men, following groin hernia surgery, have ongoing post operative pain that is difficult to treat. It can be pretty uncomfortable and can interfere with daily activities. It is likely to be due to nerve entrapment due to scarring, sutures or staples. It can happen after open or keyhole surgery and can be partly avoided by reducing operative trauma and not damaging small nerves in the operative field.
The good news is that it nearly always gets better but this can take many months.
Bruising / Haematoma / Seroma
Some bruising is common. Inguinal hernia can develop a large bruise deep in the inguinal canal due to the surgery. This can occur with open and keyhole surgery. This can be felt as a firm lump in the groin. Most will settle and absorb and not need draining. The bruising may descend into the scrotum as this is the most dependant part.
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Fluid can collect under wound or in the inguinal canal especially if some of the hernia sac has been left behind, forming a seroma. These almost always settle but can be drained if needed.
Damage to the testes
Both open surgery and keyhole groin surgery can damage the testes. This is not common and prevention depends on a good identification of the testicular vessels. The TEPP keyhole operation is safer as the testicular blood supply and vas deferens can be left untouched. Testicular damage is more likely in large complicated groin hernia that have been present for a long time.
Urinary retention
Not being able to pass urine after a groin hernia operation is common in older men who have a large prostate. It may require a cather.
Infection
Bacterial wound infection is rare after hernia surgery. Minor wound infection is easily treated and surprisingly, mesh infection is very uncommon.
MESH
Mesh has received a lot of recent bad publicity and a Google search will show pending class legal actions. Mesh can cause significant problems however many are due to inappropriate use of mesh. Reactions to mesh requiring it to be removed are rare but can occur. You should discuss this risk with your surgeon.