Robert C Wright, MD, PS– Puyallup, Washington
Informed Consent – Inguinal Hernia Repair
(right / left / both sides)
Your symptoms and physical exam suggest that you have an inguinal hernia. A hernia is a defect or rupture in the normal abdominal wall. After careful consideration, an inguinal hernia repair has been recommended.
Risks of an Untreated Hernia
Inguinal hernia should be repaired soon after the hernia is detected. There is a possibility that abdominal organs could get trapped in the hernia sac and become stuck (incarcerated) or worse, become twisted (strangulated). This will require an emergency surgery, with possible severe complications. Secondly, the hernia will not go away with time; it will only get bigger. There are no other adequate treatments for an inguinal hernia.
Description of the Procedure
An inguinal herniorrhaphy is performed by making an incision in the skin above the groin over the opening in the hernia sac, identifying the hernia sac; and then closing the hole (or rupture) in the abdominal wall. Inguinal hernias can be of two types and the exact repair procedure depends on what type you have, and the size of the defect.
Additional Procedures that may be performed at time of Surgery
It is impossible to predict all of the variations that may be encountered during an operation. The following procedures may be performed in addition to the inguinal herniorrhaphy, if deemed necessary;
Mesh Placement - in many situations we recommend artificial mesh to buttress the hernia and prevent recurrence. It also significantly reduces the amount of postoperative pain.
Femoral or Obturator herniorrhaphy - if found these should also be repaired.
Removal of a testicle or Hydrocele repair.
Alternatives for Treatment
At this time, there are no effective alternative treatments for an inguinal hernia. Laparoscopic hernia repair techniques have been developed, with varying degrees of success. It is generally recommended for bilateral or recurrent hernia repairs. Your surgeon may offer this technique for you if appropriate.
Benefits for Treatment
The overwhelming majority of people undergoing an inguinal hernia repair will not have the hernia recur. The risks of avoiding repair outweigh the risks of surgery.
Risks/Complications of Treatment
Treatment risks fall into two categories; those that could happen during any operation under anesthesia, and those that are specific for the hernia repair operation. In any medical treatment, it is impossible to predict all the things that could go wrong. Fortunately, complications are the exception rather than the rule. Every reasonable effort is made to avoid complications. The most common possible complications are as follows:
Possible complications following any operation
1. Bleeding - this is a problem that could happen anytime the skin is cut. The need for a blood transfusion during or after this operation is extremely rare.
2. Infection - we take special precautions to prevent an infection, but it is always a possibility. An infection is a special concern if a mesh is placed.
3. Reaction to medications - this could be many things, from a minor rash to possible death.
4. Reaction to anesthesia—this could show up as a heart attack, blood clots, pneumonia, sore throat, or potential death, in rare cases.
5. Poor wound healing
(see other side)
Possible complications following hernia repair surgery
1. Hernia recurrence - a small percentage of patients will suffer a recurrence of their hernia, within months or years after the repair. It will need to be repaired again.
2. Scrotal/Wound hematoma - occasionally a large bruise will form over the wound or into the scrotum. If this is severe or happens right after surgery, reoperation may be required. Avoid aspirin to minimize this risk.
3. Prolonged numbness/pain in the incisional area or scrotum - there are several nerves in the area of the hernia defect. Despite careful operative technique, a patient may, on occasion, note prolonged numbness or pain in the inguinal area from nerve injury or scar entrapment.
4. Testicular atrophy or sterility - the blood vessels and structures going to the testes are in the area of
the hernia defect. Once again, despite careful technique, these structures might get injured on rare
occasion.
5. Bowel or bladder injuries - these organs may lie immediately next to the hernia opening, or may
even be involved with the hernia sac. Should injury to these structures occur necessary steps will be
taken to repair the injury. It may necessary to have a second operation for this purpose.
Anticipated Recovery/Expected Rehabilitation
Recovery is quite variable, depending on the individual. You will recover faster if you begin walking on the evening of surgery. For everyone’s safety, do not drive a motor vehicle or operate dangerous machines for a week following surgery, while on narcotic pain medications. Also do not lift anything greater than fifteen pounds for three weeks after surgery. You should then be restricted only from activities that cause discomfort. This usually ends by six weeks following surgery.
Consent for Treatment
I understand my condition to be an inguinal hernia and am aware of its risks if untreated. I have read and understand the above explanation of the procedure being proposed. My surgeon has answered my questions, and I choose to proceed with surgery.
I understand that every operation may yield unexpected findings. I give the surgeon permission to act on his best judgment in deciding to remove or biopsy tissues that appear to be diseased, understanding that complications may arise from that action.
I understand that while most people receiving an inguinal hernia repair benefit from the operation, I may not. My condition may not improve, and it may worsen. No absolute guarantee can be made.
HIPPA: Before and after surgery, unless otherwise requested in writing by you, visitors who you invite to attend the surgery will be informed of the surgical finding, your surgical status, and anticipated recovery issues for effectiveness of communications. Because of the anesthetic, you may or may not remember these important details.
Print Name of Patient ______
Signature ______Date ______
Witness ______Date ______
Surgeon ______Date ______
Relationship to Patient if Signature of Legal Guardian ______
I waive the right to read this form, and do not want to be educated and informed of treatment risks; nonetheless, I understand the need for this surgery and grant permission to the surgeon to proceed on my behalf.
Signature ______Date ______
3/03