Post-Surgery Swelling After Laparoscopic Inguinal Hernia Repair

Hernia recurrence and swelling issues after laparoscopic inguinal hernia repair surgery?

Hello Dr.
Lee, in October 2020, I underwent traditional surgery for a left inguinal hernia and had a piece of synthetic mesh implanted.
This year (2021), in the first half of the year, the hernia recurred in the same area, so I underwent laparoscopic inguinal repair surgery in early August.
I opted for a piece of absorbable synthetic mesh and a fixation screw.
After the surgery, I experienced some swelling and pain in the left inguinal area.
When I returned for a follow-up a week later, the swelling was manageable, but later the swollen area increased in size.
When sitting, it would rub against the inner side of my left thigh.
Initially, it felt quite firm, but it gradually became a bit softer.
However, if I walked for a longer period, the swollen area would feel firm again when I got home.
I initially thought it was a recurrence of the hernia, but the swollen area could not be reduced, and I was concerned about possible incarceration of the intestine.
However, my bowel movements remained relatively normal.
During my follow-up in early November, the doctor examined me and said it was due to edema and muscle fibrosis, and that it had not descended into the scrotum, so it should be fine.
Currently, the swollen area feels softer but has not significantly decreased in size.
Sometimes it hurts when touched, and sometimes it does not.
It is noticeable and palpable that the swollen area seems to be supported by a "bag" and has not descended into the scrotum.
I would like to ask the doctor if my condition indicates a recurrence of the hernia.
If it is edema and muscle fibrosis, how long might it take to resolve? If it is not a recurrence of the hernia, will the left inguinal area always protrude like this in the future?

Yinfa Zu, 60~69 year old female. Ask Date: 2021/12/09

Dr. Li Xinyi reply Urology

Since I am not the primary surgeon, I can only speculate about your condition.
It sounds like the abdominal wall at the hernia site has already been compromised.
It would be best if it does not get any larger, as it may not be reducible.
You should definitely consult the primary surgeon for more detailed information.

Reply Date: 2021/12/09

More Info

After undergoing laparoscopic inguinal hernia repair, it is not uncommon to experience swelling and discomfort in the surgical area. Your description of the swelling, which has changed in texture and size over time, raises several important considerations regarding post-operative recovery and potential complications.

Firstly, it is essential to understand that post-surgical swelling can be attributed to several factors, including inflammation, fluid accumulation (edema), and muscle fibrosis. The body’s natural healing process often involves an inflammatory response, which can lead to swelling in the affected area. This is particularly true after surgeries involving the abdominal wall, where manipulation of tissues can result in localized edema.

In your case, the swelling that initially felt hard and later softened may indicate that the body is gradually reabsorbing the fluid. However, the fact that the swelling has not significantly reduced and is accompanied by intermittent pain suggests that further evaluation may be warranted. It is reassuring that your doctor has ruled out a recurrence of the hernia and has attributed the swelling to edema and muscle fibrosis. Muscle fibrosis can occur as the body heals, leading to the formation of scar tissue that may feel firm or lumpy.

Regarding your concerns about the possibility of the hernia recurring, it is crucial to monitor any changes in the swelling or pain. If the swelling persists or worsens, or if you experience any new symptoms such as increased pain, changes in bowel habits, or any signs of infection (such as redness, warmth, or discharge), it is essential to follow up with your surgeon or a healthcare provider. They may recommend imaging studies, such as an ultrasound, to assess the area further and ensure that there are no complications such as fluid collections or hernia recurrence.

As for the timeline for resolution of swelling and discomfort, it can vary significantly among individuals. Factors such as the extent of the surgery, individual healing capacity, and adherence to post-operative care can all influence recovery. Generally, mild swelling may take several weeks to months to fully resolve, while more significant swelling or discomfort may require additional interventions, such as physical therapy or pain management strategies.

In terms of long-term implications, it is possible that you may notice some residual changes in the appearance of the inguinal region due to the surgical intervention and subsequent healing process. However, this does not necessarily indicate a functional problem or a recurrence of the hernia. Many patients experience some degree of change in the contour of the abdominal wall after surgery, but this often stabilizes over time.

In conclusion, while your symptoms are concerning, they appear to be within the realm of normal post-operative recovery. It is essential to maintain open communication with your healthcare provider, adhere to follow-up appointments, and report any new or worsening symptoms promptly. Engaging in gentle activities as tolerated, avoiding heavy lifting, and following any specific post-operative instructions provided by your surgeon will also aid in your recovery. If you have further concerns or if the swelling does not improve, do not hesitate to seek additional medical advice.

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