Post-Operative Concerns: Swelling After Inguinal Hernia Surgery

Post-hernia surgery

Dear Doctor,
Two weeks after undergoing total extraperitoneal laparoscopic inguinal hernia repair, the area remains swollen regardless of whether I am lying down or standing.
The skin color appears normal, with no bruising, and when gently touched, it feels a bit firm but not painful.
I had a mesh covered by health insurance and also used absorbable sutures for reinforcement.

Could this phenomenon be due to seroma accumulation? (What are the symptoms?) Or is it a hematoma? (If so, can the skin color indicate this?) Could it be a recurrence? (Is it possible to have a recurrence this soon?) Or is it just a normal reaction? How long will it take for the area to return to a flat appearance? Should I continue to observe for three months, or should I seek a follow-up appointment immediately to avoid delaying treatment? Thank you, Doctor.

Min, 40~49 year old female. Ask Date: 2019/12/29

Dr. Xu Kaixi reply Surgery

Based on your description, this is considered a normal postoperative change.
If there were fluid accumulation or a hematoma, you would experience localized swelling and pain.
In the case of a recurrence, the swelling would be more pronounced.
It is recommended that you continue to monitor the area for one to two months, as theoretically, it should appear smoother both visually and upon touch.

Reply Date: 2019/12/29

More Info

After undergoing an open inguinal hernia repair surgery, it is common for patients to have concerns about post-operative swelling and other symptoms. Based on your description, it appears that you are experiencing some swelling in the surgical area two weeks post-operation. Let's break down your concerns and provide some clarity on what you might be experiencing.

1. Swelling and Hardness: The swelling you are observing could be due to a few factors. One possibility is the accumulation of serous fluid, known as seroma, which can occur after surgery. This is a common post-operative phenomenon where fluid collects in the tissue surrounding the surgical site. Seromas are typically not painful and can feel firm to the touch, which aligns with your description. They often resolve on their own over time, but monitoring is essential.

2. Hematoma: Another possibility is a hematoma, which is a localized collection of blood outside of blood vessels. Hematomas usually present with discoloration (bruising) and can be painful. Since you mentioned that the area is not discolored and does not hurt, it seems less likely that you are dealing with a significant hematoma. However, small hematomas can sometimes occur without noticeable bruising.

3. Recurrence of Hernia: While it is possible to experience a recurrence of a hernia, it is generally uncommon to have a recurrence so soon after surgery, especially if the procedure was performed correctly and the mesh was properly placed. Recurrences typically present with a bulge or pain at the site, which you have not described.
4. Normal Post-Operative Reaction: Swelling can also be a normal part of the healing process. After surgery, the body goes through a healing phase, which can include inflammation and swelling as part of the natural response to tissue trauma. This is particularly true in the case of hernia repairs, where the tissue is manipulated and repaired.

5. Recovery Timeline: The timeline for swelling to subside can vary from person to person. Generally, you can expect some swelling to diminish within a few weeks, but complete resolution may take several months. It is not uncommon for patients to notice gradual improvement over time.

6. When to Seek Medical Attention: If the swelling persists beyond a few weeks, increases in size, becomes painful, or if you notice any signs of infection (such as redness, warmth, or discharge), it would be prudent to return to your surgeon for an evaluation. Regular follow-up appointments are essential to ensure proper healing and to address any concerns.

In summary, based on your description, it seems that the swelling you are experiencing could be a normal post-operative reaction, possibly a seroma. However, it is always best to consult with your surgeon for a thorough evaluation, especially if you have any concerns about your recovery. They can provide personalized advice based on your specific situation and ensure that your healing is progressing as expected. Regular monitoring and communication with your healthcare provider are key to a smooth recovery process.

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