Patient Journey

Once the initial appointment request is made, our office staff will contact you to request some basic information, such as insurance and reason for appointment. You will be emailed a link to a secure website, which you can complete at your convenience. This will save you time during the office visit.

Should you be interested in a virtual appointment rather than an in-person one, our physicians can perform an initial video visit. Depending on your problem, an in-person visit may still be required later on, especially if surgery is to be scheduled.

In general, an initial visit to our office will include:

• Initial greeting by one of  our friendly office staff
• Completion of a demographic and history form (unless already performed at home)
• Full consultation from one of our surgeons
• A meeting with our insurance and scheduling liason

(where pertinent- please bring to the office visit with you any old operative reports or other records and any imaging (ultrasound, CT scan, MRI etc. – both images on CD’s and reports).

Preparation for surgery will be discussed on an individualized basis and will depend on your history and current condition.

Some of the preparation may potentially require:

• Additional imaging
• Consults with other specialists
• Medical clearance
• Cardiology clearance
• Holding certain medications you currently take to minimize bleeding complications
• Special preoperative diets. We put particular emphasis on preoperative nutrition, especially prior to abdominal wall reconstruction for large incisional hernias. Our surgeons will discuss with you the need for preoperative immunonutrition supplementation and its benefits in achieving a faster recovery.
• Weight loss: Clinically severe obesity can be associated with higher rates of hernia recurrence. In certain circumstances, your surgeon may create an individualized short-term weight loss program, to help you lose weight prior to hernia repair. This may include anorectic medication or an endoscopic or laparoscopic weight loss procedure.

There are many types of hernias and many types of hernia repair operations.  We perform them all, but the right operation for you will depend on many factors.  All operations should be individualized to meet your specific goals and expectations.

• Inguinal Hernia Repair
• Indirect or Direct Hernias
• Femoral Hernia Repair
• Ventral, Incisional, and Umbilical Hernia Repair
• Complex Abdominal Wall Reconstruction
• Hiatal Hernia Repair
• Parastomal Hernia Repair
• Recurrent Hernia Repair
• Diastasis Recti

“A must-read educational tool for all patients undergoing an inguinal hernia repair”

There are two types of laparoscopic inguinal hernia repairs – TEP (total extraperitoneal) and TAPP (transabdominal extraperitoneal). Both repairs, in general, consist of the 1) hernia dissection, 2) insertion of hernia mesh, and 3) mesh fixation (some surgeons do not use any additional mesh fixation). Both of these repairs carry similar risks, and these risks include, but are not limited to: incisional complications, infections, bleeding, bladder and urinary complications, acute and chronic pain complications, spermatic cord complications, seromas, recurrences, GI complications, and complications related to general anesthesia.

Fortunately, most of these risks are very uncommon, but patient education is very important to us.

Bleeding– Your TEP laparoscopic inguinal hernia surgery will be performed through three small incisions including a single ½-inch incision beneath the belly button, and two additional ¼-inch incisions below this along the lower midline. Likewise, a TAPP laparoscopic inguinal hernia surgery will also use a single ½ inch belly button incision, but the other two ¼-inch incisions will be on the sides of your abdomen. Always, hemostasis (assurance there is no bleeding) is assured at the end of each case, however mild bleeding can occur after the surgery is complete. This has the potential to result in a hematoma (collection of blood) in the space where the hernia was. While this is extremely rare, it is a known complication. Should it occur, applying warm compresses and time will usually allow full resolution. If any of these cuts bleed after surgery, this can cause the area to become black and blue. This may take up to 3-4 days to appear and a couple weeks to fade. In men, the black and blue skin (will look like a bruise) may also involve the penis and the scrotum (in women, the thigh or vulva). It is self-limiting, but should be brought to your surgeon’s attention.

Infections of the incisions or mesh after a laparoscopic inguinal hernia repair are almost non-existent (they are very rare). Despite its rarity, you will receive a single dose of antibiotics before the surgery begins. Incision infections are treated by opening the incisions and by sometimes providing you with an antibiotic. Mesh infections should be treated with mesh removal.

Bladder and Urine – Some patients (less than 5%) experience urinary retention (they have trouble initiating a urinary stream) after a laparoscopic inguinal hernia repair. If this occurs, the treatment may include a temporary insertion of a urinary catheter which is usually removed after one to three days. All patients eventually regain their baseline control of initiating a urinary stream. Bladder injury during the surgery is extremely rare. If you have had prostate surgery in the past, you should discuss this risk with your surgeon. Urinary infections are extremely rare, but have been reported.

Acute and Chronic Pain – It is very important to tell your surgeon if you have any groin pain or leg pain BEFORE the operation. The typical recovery after a laparoscopic inguinal hernia repair is associated with mild to moderate incisional pain and mild groin discomfort. This may last anywhere from 2 – 14 days, but is almost always gone by the 3rd or 4th week after surgery. The groin discomfort may be secondary to the gas used during surgery, the dissection, or rarely the mesh material or tacks (if used). There are a variety of mesh fixation materials that surgeons may choose to use, and all have a rare, but possible association with causing groin pain. These fixation options include (staples, permanent tacks, absorbable tacks, or glues). Some surgeons do repair without using mesh fixation materials at all.

Acute severe groin pain – Groin pain that is severe immediately after surgery should be brought to your surgeon’s attention, as this can be due to direct irritation from surgical material and could warrant return to the operating room to remove the foreign material or tack (if used). Fortunately, this risk is extremely rare. Should it occur, however, acute nerve injury could increase the risk of developing chronic pain.

Chronic groin pain (can be mild or severe) is defined as the presence of pain, discomfort, or hypersensitivity (not present before surgery) existing for more than 3 months after surgery. According to one national database, even a healthy male with no previous history of groin pain has as high as a 6% risk of developing chronic discomfort after undergoing any type of inguinal hernia repair. While the general risks of developing this chronic discomfort exist, our group’s experience has kept this complication at an absolute minimum.

There are 6 nerves in the groin that your surgeon is aware of and will avoid harm to.

Lateral femoral cutaneous nerve – This nerve is the most lateral nerve in the groin, innervates the upper lateral thigh skin, and in the past was the most common nerve irritated during a laparoscopic repair. If irritated, there may be pain or hypersensitivity experienced along the lateral thigh.

Genitofemoral (GF) nerve (both the femoral branch and the genital branch) – This nerve and its terminal branches are not routinely dissected out during a routine laparoscopic repair, but are well known to exist in the region just medial to the psoas muscle and lateral to the external iliac vein. The location of the two terminal branches varies. The trunk or either branch, however, can be potentially irritated or injured by the dissection, a tack, or by the mesh material. By limiting the use of tacks near its known location, injury to it can be minimized. The genital branch runs in the inguinal canal, under the spermatic cord in men and round ligament in women, and innervates the inner thigh and the lateral scrotal skin in men, and the labia majora in women. Its irritation is usually perceived by a hypersensitive scrotum in males and hypersensitive labia majora in females. The femoral branch innervates the anterior thigh, and irritation can lead to pain or hypersensitivity of the upper anterior thigh.

Femoral nerve (and its anterior cutaneous branches) – Like the GF nerve above, this nerve is not routinely identified during routine laparoscopic hernia dissection, but it does exist just lateral to the psoas muscle and entering the leg lateral to the femoral artery. Rather rarely, it at risk to be irritated or injured by use of a tack below the ileopubic tract. Even rarer, mesh can irritate this nerve. By limiting the use of tacks near its known location, injury to it can be minimized. If irritated or injured, leg muscles may feel heavy or weak, or pain along the leg may result.

Iliohypogastric nerve – This nerve may only be injured during a laparoscopic repair if a tack were to penetrate through the muscle and into the nerve. The incidence of irritation during a laparoscopic repair is extremely rare. Pain or hypersensitivity to the suprapubic region or groin may occur.

Ilioinguinal nerve – this nerve may be injured during a laparoscopic inguinal hernia repair only if your surgeon uses tacks and these tacks penetrate through muscle into this nerve. Its injury during a laparoscopic repair is extraordinarily rare. Irritation causes pain or hypersensitivity to the medial thigh, shaft of the penis, or groin.

Paravasal nerve fibers (tiny nerves along the vas deferens in a male) – irritation of these may cause temporary testicular discomfort.

Spermatic Cord Vas Deferens – very rarely, the vas deferens (tube that carries sperm from the testicle to the penis) in men may be irritated or even traumatized. This can cause testicular discomfort, infertility, or be completely asymptomatic. Women do not have a vas deferens, and instead have a round ligament that can be divided without consequence.

Spermatic Cord Artery and Vein – If the arterial supply to the testicle is divided, the testicle may become ischemic. This can be a serious complication, but is fortunately extremely rare. If the venous blood supply from the testicle is potentially compromised, this can lead to vague testicular discomfort or a varicocele.

Seroma – one of the more common side effects of a laparoscopic inguinal hernia repair (up to 12%). After the repair, patients can develop a temporary fluid collection in the same space where the hernia used to be. If it develops, it occurs about one week after surgery, and can last for months. They can become as large as the hernia. Some may mistake it for a recurrent hernia. Almost all reabsorb with time. Very rarely, persistent large seromas lasting beyond 4-6 months will require an operation as management. Percutaneous drains can be attempted with caution as they do risk converting a sterile seroma into an abscess.

Recurrence – All hernia repairs are subject to a very low, but definite, recurrence rate. Most recurrences will occur in the first 3 years, and the average rate is about 2-4% in most surgeon’s experience.

Gastrointestinal complications – Some patients develop nausea or vomiting the first 24 hours after general anesthesia. This will be self-limiting. If it continues beyond 24 hours, it could represent an extremely rare complication of an ileus or small bowel obstruction (<0.05%), and your surgeon should be alerted as soon as possible.

Constipation is common with the use of narcotic pain medication, and can be managed with a stool softener or laxative. Your surgeon can help recommend management if you experience constipation.

Shoulder Pain – this is a referred pain commonly experienced after laparoscopy, and is self limited within the first 3 days.

You will wake up from general anesthesia in the recovery room.

Any immediate discomfort will be managed by the anesthesia and recovery room nursing teams.

While in the recovery room, you may experience immediate postoperative  nausea, pain, dizziness, and fatigue.  These will all fade quickly.  If you had general anesthesia, your throat may feel sore for up to 3 days.  This is from the breathing tube, and can be managed with lozenges or tea with honey.  If you did not have general anesthesia, you will not experience this.

While in the recovery room, the nurses will monitor your vital signs, and eventually get you up from the stretcher into a chair, and then provide you with something light to drink. Within about 2 hours after surgery, you will be able to stand and even walk slowly.

You may be discharged after being able to void and drink liquids without significant nausea or vomiting, and after being able to walk without any dizziness.  The average patient is discharged 3-6 hours after the surgery ends (some quicker, some slower).

We recommend no driving for the first 2-4 days, and certainly don’t drive while taking pain medication.

You will be given a prescription for pain medication.  It has a side effect that includes, but is not limited to, nausea and constipation.  Most patients report that they use a total of 5 tablets of this pain medication over the first 2 days after surgery, at which point they do not need any pain medication.  Some patients report only needing to use extra-strength Tylenol® for several days.

Recovery:  The typical recovery after a laparoscopic inguinal hernia repair is associated with mild to moderate incisional pain and mild groin discomfort.  This may last anywhere from 2 – 14 days, but is almost always gone by the 3^rd or 4^th week after surgery.  By the 3-6 month post operative visit, less than 0.1% of patients are symptomatic.  The groin discomfort during the first week may be secondary to the gas used during surgery, the hernia dissection, or rarely the mesh material or tacks (if used).  For more detail, please see “risks of laparoscopic inguinal hernia repair.”

Your 3 incisions will have a bandage on them.  Your TEP laparoscopic inguinal hernia surgery will be performed through a single ½-inch incision beneath the belly button, and two additional ¼-inch incisions below this along the lower midline.  Your TAPP surgery will also use a single ½-inch belly button incision, but the other two ¼-inch incisions will be on the sides of your abdomen.    Specific instructions for wound care will be provided upon discharge from the hospital.  In general, you may remove the outer bandage after 2 days, and the white tape or skin glue after 7-10 days.

You may resume your normal diet when you are ready.

Activity:  You will be able to stand, walk, and climb stairs with some mild discomfort starting the same evening of surgery.

You may shower the first day after surgery, but no bathing or swimming for 5 days.

Regarding exercise, we encourage you to try to walk, use a treadmill, or use a stationary bike without any resistance the first day after surgery.  Heavier exercising at the gym, running, or lifting more than 25 pounds can generally resume without restriction after 2 weeks, or when completely pain free, whichever occurs first.

The majority of patients report that they are able to return to work without restrictions after 3 – 7 days.

Follow up with your surgeon within the first 2 weeks after surgery.

While we believe the recovery from a laparoscopic inguinal hernia repair is rapid, please allow yourself up to 3 weeks to feel completely normal/back to your baseline again.