What are the monitoring and follow-up protocols for an open inguinal hernia repair?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Answer

With the routine use of mesh for hernia surgery, the recurrence rate has fallen to less than 1%. Although some recurrences occur early, cases may be reported many years later. A thorough clinical evaluation, a high degree of suspicion, and appropriate follow-up are advised for keeping track of recurrences. A follow-up visit is routinely scheduled for 1 week after the procedure. Thereafter, follow-up is scheduled on an as-needed basis.

Although the postoperative course is generally uncomplicated, patients must be routinely instructed to recognize certain signs and symptoms that can alert them to potential complications. [1, 40]

Patients with chronic groin pain, postoperative neuralgia, paresthesias, neurapraxia, or hypoesthesia for more than 6 months after surgery should be referred for further evaluation, surgical exploration, and, if required, excision of the involved nerve. A multidisciplinary approach at a pain clinic is an option for the treatment of chronic postherniorrhaphy pain. Surgical means of treating specific causes of such pain include the following:

  • Resection of entrapped nerves
  • Mesh removal (in mesh-related pain)
  • Removal of fixating sutures
  • Burying the nerve endings in the internal oblique muscle

Large-scale studies examining the convalescence period after elective inguinal hernia repair convincingly demonstrated that the median length of absence from work was 7 days when patients were advised by their surgeons to limit the recuperation period and to resume normal activities within 1 day after the procedure. [1, 53]  Moreover, these studies confirmed that the risk of recurrence was not increased by early resumption of activities. Thus, with adequate analgesia, patients can safely return to their daily duties.


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