Consent: Hernia Repair (Open or Laparoscopic)

Note: This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines.

Overview of Procedure

There are several types of hernias, the most common being inguinal, femoral, umbilical, paraumbilical and Spigelian. This consent is generic for each of these types of hernia (there will be slight variation between each subtype), which can be undertaken both open or laparoscopically.

Fig 1 – Repair of an inguinal hernia.

Intraoperative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Damage to any of the surrounding structures through laparoscopy or blood vessels around the hernia*.
Injury to surrounding structures including bowel, bladder and ureter, liver, spleen A laparoscopy involves assessing all organs, which can be damaged in the process. Decompress the bladder with a catheter
Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

*In chronic liver disease patients with para-umbilical hernias, the bleeding risk is high as any portal hypertension present will cause dilatation of the umbilical veins, alongside any potential coagulopathy, and any damage can be potentially life-threatening

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain* The patient will most likely have a local anaesthetic at the hernia site and require only simple analgesia post-operatively.

For inguinal hernia, (1) avoid suturing through the bone of the pubic tubercle (take the thick connective tissue over it only) and (2) Identify the ilio-inguinal nerve and if it can’t be preserved, resect it proximally so it not at risk of being trapped by a suture.

Bleeding There is a small chance of bleeding and bruising in the abdomen post-surgery.
Infection Superficial wound infection is possible.  An infected mesh is a fortunately rare but serious complication.  It leads to prolonged wound problems and ultimately needs further surgery to remove the mesh. Peri-operative antibiotics will reduce the risk of wound infections
Scarring A midline or transverse incision will result in a scar, which may form a keloid scar, particular in high risk ethnicities. Laparoscopic surgery will minimise this risk
Seroma A swelling of lymphatic fluid may occur in redundant subcutaneous space following surgery.
Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Testicular Atrophy Damage to the blood supply to the testicle can occur in groin hernia repair Identifying and avoiding damage to the spermatic cord and associated vessels
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery

*Patients may have long-standing pain from hernia pre-operatively. Importantly, for inguinal hernias, 1 in 50 patients have severe long-standing groin pain post-operatively and 3 in 50 are symptomatically worse than they were before the operation, hence this is very important to discuss and explicitly consent for.

Late

Complication Description of Complication Potential Ways to Reduce Risk
Adhesions Abdominal surgery may cause adhesions as a reaction to the procedure.
Recurrence There is always a potential for further surgery due to recurrence of the hernia. Rates vary between procedures: for inguinal hernia it is around 1% at 5 years and for para-umbilical it is 10-20% at 5 years. Avoid heavy lifting for 6 weeks

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