My Hernia Has Come Back After Surgery: What Should I Do Next?

For a very elderly person, the worry about hernia surgery often extends beyond the groin swelling. Families want to know how an operation will affect someone who already has heart disease, breathing difficulties, diabetes or several daily medicines. Will he cope with the anaesthetic? How will he manage afterwards?

For selected very elderly patients with multiple medical conditions, Dr (Major) RS Rengan prefers inguinal hernia repair under local anaesthesia when the hernia and the patient’s overall condition make this appropriate. The aim is to repair the hernia while limiting the anaesthetic burden.

There is an important detail behind this approach: 90% of Dr Rengan’s inguinal hernia cases are performed laparoscopically. Laparoscopy remains central to his practice. But a technique that suits most patients does not automatically suit every patient.

The decision begins with the person: their symptoms, medical conditions, independence and priorities.

A family may arrive expecting to choose between an open operation and keyhole surgery. For an 88-year-old with several medical conditions, a more useful discussion begins with what treatment is needed and how it can be delivered with an acceptable level of risk.

Laparoscopic inguinal hernia repair is normally performed under general anaesthesia. A suitable open repair can be performed under local anaesthesia, with the patient awake and the groin numbed. Both are established approaches, and the operation and anaesthetic should be planned together. Inguinal hernia repair, inguinal hernia repair guidance

Dr Rengan’s preference for local anaesthesia in selected patients reflects this flexibility. Having the ability to perform laparoscopic surgery is valuable. So is recognising when another approach better serves the patient.

Local anaesthetic medicine is injected around the operative area to block pain signals. The surgeon checks that the area is adequately numb before proceeding. The patient remains awake, although carefully selected sedation may sometimes be added for comfort. Local anaesthetic

During an open inguinal hernia repair, the surgeon works through an incision in the groin and repairs the weakness, commonly using mesh. Local anaesthesia changes how pain is controlled; the patient still receives a proper surgical repair. Inguinal hernia repair, inguinal hernia repair guidance

Local anaesthesia is different from spinal anaesthesia, which numbs a larger region through an injection in the back. Families should ask which anaesthetic is being proposed, because these terms are not interchangeable. Local anaesthetic

A way to limit the anaesthetic burden

When a suitable repair can be completed under local anaesthesia with little or no sedation, it can avoid general anaesthesia. This may be useful when frailty or coexisting disease makes the overall anaesthetic plan particularly important. The 2023 HerniaSurge guideline update supports local anaesthesia as an alternative in frail or comorbid patients when performed correctly by an experienced team. HerniaSurge guideline update

This does not mean that general anaesthesia is unsuitable for everyone over a particular age. A fit, independent older person and a frail person of the same age may need very different plans.

Evidence of benefit in selected frail patients

A study of 8,038 frail patients undergoing elective, open, one-sided inguinal hernia repair found that local anaesthesia was associated with fewer postoperative complications and a shorter stay in the immediate recovery area than general anaesthesia. Read the study

The study was observational and involved almost entirely male US veterans. It supports considering local anaesthesia, but cannot prove that changing the anaesthetic alone caused the better outcomes. It also did not compare laparoscopic repair with open repair. These distinctions matter when applying the findings to an individual patient.

Recovery that reflects the patient’s priorities

For a very elderly man, a successful outcome may mean being comfortable enough to walk to the bathroom, sleep properly and return to familiar routines. These practical goals belong in the planning conversation alongside the technical repair.

The proposed treatment should take account of what the hernia prevents him from doing now, the support available at home and what recovery is likely to require.

“Multiple comorbidities” simply means having several medical conditions at the same time. An assessment should look beyond the number of diagnoses and establish how well controlled they are and how they affect everyday life.

Useful information to bring to the consultation includes:

• Heart and lung diagnoses, recent symptoms and relevant reports.
• Diabetes treatment and any history of kidney problems.
• A complete medicine list, including blood thinners and supplements.
• Previous operations and any difficulties with anaesthesia.
• Changes in memory, mobility, appetite or independence.
• The help available at home after surgery.

A patient who can walk comfortably and manage daily activities independently may have different needs from someone who becomes breathless moving between rooms. The anaesthetic assessment helps translate those differences into a practical plan.

Do not stop blood thinners or change other prescribed medicines on your own. Ask for individual preoperative instructions.

Local anaesthesia is most readily considered for an elective, reducible inguinal hernia that can be repaired through the groin, with a patient who can cooperate comfortably. “Reducible” means the bulge can return into the abdomen. Experience with local-anaesthetic hernia repair is important. HerniaSurge guideline update

Large or complex hernias, recurrent hernias and hernias on both sides require a more detailed discussion of technique. Significant anxiety, inability to lie comfortably or difficulty cooperating may also affect the anaesthetic choice. Local anaesthesia should not be promised before examining the patient.

Pain control and monitoring remain essential. If the patient is uncomfortable or the operation is more complex than expected, additional anaesthesia or a change of plan may be needed. This possibility should be discussed beforehand.

No. It can be a useful way to tailor care, but it does not remove the risks of the operation or the patient’s underlying illnesses.

Hernia repair can cause bleeding, infection, persistent groin discomfort, difficulty passing urine or recurrence. Local anaesthetic medicines also have potential adverse effects, although serious reactions are rare. Sedation, if used, brings additional considerations. Appropriate monitoring and a team able to respond to problems remain necessary. Inguinal hernia repair guidance, local anaesthetic information

The goal is an acceptable balance of benefit and risk for that person, rather than a promise of a painless recovery or zero complications.

No. Some men with a reducible inguinal hernia that causes little or no discomfort may choose watchful waiting after assessment. Others may benefit from a planned repair because pain or swelling is affecting daily life. The discussion should include symptoms, the likelihood of needing treatment later and the patient’s preferences. Inguinal hernia repair, making a decision about inguinal hernia

Seek urgent medical assessment for sudden severe groin pain, a tender bulge that will not go back in, vomiting or abdominal swelling. These can indicate a complication and need a different assessment from a routine elective consultation. Making a decision about inguinal hernia

Local anaesthesia does not automatically mean same-day discharge. Discharge depends on recovery, medical stability and the support available at home.

Families should leave with clear instructions about pain relief, wound care, activity and when to seek help. Gentle movement is usually encouraged, with activity increased according to comfort and the surgical team’s advice. Full recovery can take several weeks and may be slower in someone who is frail. Inguinal hernia repair

Before surgery, ask who should be contacted if pain increases, the wound becomes red or the patient has trouble passing urine. An agreed plan is particularly valuable when an elderly person depends on relatives or carers.

If your father, grandfather or another elderly family member has an inguinal hernia alongside several medical conditions, bring the medical reports and medication list to a consultation with Dr (Major) RS Rengan.

The discussion should establish whether an operation is needed, which repair is suitable and how anaesthesia and recovery can be planned around the individual.

Book a consultation at Dr Rengan’s Surgical Centre, West Mambalam, Chennai. Appointments: +91 98411 42294.

Explore hernia surgery in Chennai or learn more about Dr (Major) RS Rengan.