Post-Surgery Indentations After Inguinal Hernia Repair

After hernia surgery, the surgical site may appear sunken when sitting?

Hello Doctor: I underwent traditional left inguinal hernia surgery (with a self-funded mesh implant) on the 24th of last month.
For the first ten days, the wound site was normal, and the stitches were almost healed.
However, today (on the sixteenth day post-surgery), I noticed that when sitting in a chair, there is a depression in the left inguinal area, but it appears normal when standing.
I'm unsure what the issue might be; the wound does not hurt, but there is still some numbness.

Xiao Ya, 50~59 year old female. Ask Date: 2019/10/10

Dr. Chen Jiaming reply Surgery

In traditional hernia surgery, after making an incision in the skin, the subcutaneous fat layer is separated, and the external oblique fascia is opened to reach the location of the common hernia sac.
In patients with a thicker subcutaneous fat layer or larger original hernia sacs, it is more common to have a defect in the subcutaneous area at the surgical site postoperatively (resulting in a hollow appearance), which can cause a depression when sitting up.
Adhesions related to scar tissue also play a role, but this typically improves gradually over the course of several months post-surgery.

Reply Date: 2019/10/10

More Info

After undergoing an inguinal hernia repair surgery, particularly with the placement of a mesh, it is not uncommon to experience various sensations and changes in the surgical area during the recovery phase. Your observation of a depression or indentation in the left inguinal area when sitting, which normalizes upon standing, can be attributed to several factors related to the healing process and the anatomical changes that occur post-surgery.

Firstly, the presence of a mesh can alter the dynamics of the surrounding tissues. The mesh is designed to provide support to the weakened area, but it can also affect how the skin and underlying tissues settle as they heal. When you sit, the pressure and weight distribution can cause the skin and subcutaneous tissues to shift, leading to a temporary indentation. This phenomenon is often more pronounced in the early stages of recovery when the tissues are still adjusting and healing.

The sensation of numbness or tingling you mentioned is also a common occurrence after such surgeries. This can result from nerve irritation or damage during the surgical procedure. The inguinal region is rich in nerves, and the manipulation of tissues during surgery can lead to temporary nerve dysfunction. As the nerves heal, these sensations may gradually improve over time, but it can take several weeks to months for full recovery.

Regarding the absence of pain at the incision site, this is a positive sign indicating that the initial healing process is progressing well. However, it is essential to monitor any changes in sensation or the appearance of the surgical site. If the indentation persists or worsens, or if you experience increased discomfort, it would be advisable to consult your surgeon for a thorough evaluation.

In terms of recovery, it is crucial to follow your surgeon's post-operative care instructions, which may include avoiding certain activities that could strain the surgical site. Engaging in light activities, as tolerated, can promote circulation and healing, but be cautious not to overexert yourself.

Additionally, if you notice any signs of infection, such as increased redness, swelling, or discharge from the incision site, or if you develop fever, it is imperative to seek medical attention promptly. These could be indicators of complications that require intervention.

In summary, the indentation you are experiencing is likely a normal part of the healing process after inguinal hernia repair surgery, influenced by the placement of the mesh and the natural adjustments of the surrounding tissues. The numbness is also a common post-surgical sensation. Continue to monitor your recovery and maintain open communication with your healthcare provider to ensure a smooth healing process. If you have any concerns or if symptoms change, do not hesitate to reach out for further evaluation.

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