We recommend open hernia surgery using local anaesthetic with sedation for common hernia repairs

• Open surgery allows us to use our pioneering mix of local anaesthetic and sedation. Patients arrive at our clinic and are shown to their room, where they are prepped for surgery ahead of being taken to theatre. The time from admission to getting to theatre can be long or short. We recommend coming with something to read or occupy your thoughts whilst waiting.

• The operation takes no more than an hour

• We perform hernia surgery under a local anaesthetic with sedation. Patients have the area of the hernia blocked so it has no feeling and surgery is comfortable. The sedative makes you feel relaxed and at ease. Some patients stay awake and chat to the staff, others fall asleep. Most do a combination of the above – asleep at times; awake, relaxed and chatty at other times. We can use this to test your repair as we go along.

• By repairing your hernia under local anaesthetic we are blocking the body’s ability to know that you have had an operation. This minimizes the body’s reaction to the operation, which under general anaesthetic manifests as pain, stiffness and feeling unwell. It is expected that with simple pain relief medication you will remain comfortable after surgery.

• Surgery is carried out using a synthetic mesh to repair the hernia. The operation typically lasts for 35-50 minutes. Observations are then carried out in the recovery area before the patient is returned to their room. We wait for you to pass water, which takes up to 90 mins on average, after surgery

• The patient is then discharged and typically walks out of the hospital 2 -4 hours after surgery.

• We like to think of the mesh as the scaffolding for scar tissue to build upon. Mesh technology has evolved faster than mobile phone technology, and what was cutting-edge 20 years ago is now obsolete.

Why do we often advise open surgery rather than keyhole surgery aka laparoscopic hernia repair?

Local anaesthetic repair is not possible in keyhole surgery therefore patients having keyhole surgery must have a general anaesthetic. With general anaesthetic patients often have a longer recovery time and require opioid pain killers with its side effects as described later. The risk of difficulty passing water affects all age groups but is most common after general anaesthetic inguinal hernia repair. Age, frailty and a pre-existing history of possible obstructive symptoms to urine flow increase this risk, often substantially.

The surgical risks are very different between open and keyhole repair. Although open and keyhole surgery have very different risks, they share some that occur in equal proportion between surgery types. Such as hernia recurrence, bruising and wound infection. Open surgery inguinal hernia repairs (most common type) can lead to a small area of altered skin sensation near the scar that in some can be permanent about the size of a 50p piece. Pain due to an inflamed bit of bone in the groin is very rare but slightly more common in open repair than keyhole repair. Conversely, keyhole repair comes with a small but well documented risk of significant bleeding, bladder injury or very rarely, even bowel injury. These risks in keyhole surgery have more serious longer-term consequences than the more frequent but less significant consequence risk of a patch of altered sensation seen in open surgery.

The risks described above regarding inguinal hernia surgery also occur in other types of hernia surgery when using either method to repair hernia.

For umbilical and incisional hernia repairs there is the added risk of serum or fluid collection in the space the hernia occupied. called a seroma. When using keyhole surgery there is also the risk of bowel adhesions causing obstruction at some point in the future because adhesion can form inside the abdominal cavity. Most first-time common hernia types are better suited to open local anaesthetic repair with sedation. This includes one sided first time and recurrent: groin hernias, umbilical, epigastric and smaller incisional hernias. Most hernias that are bilateral or particularly large may need a general anaesthetic.