Carlos Rodriguez, DO, MBA, FACSHernia & Gallbladder Surgery
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Inguinal Hernia & Open Repair

What an inguinal hernia is, why it happens, and what open repair involves, explained simply.

Written and reviewed by Carlos Rodriguez, DO, MBA, FACS. Last reviewed October 1, 2026.

📄 Open Inguinal Hernia – Patient Guide (PDF) Call for Appointment

The short version

  • One incision (about 10 cm) in the groin crease; it can be done under local anesthesia with sedation, a spinal block, or general anesthesia.
  • The groin nerves are protected throughout the repair to lower the risk of numbness or chronic pain.
  • The bulging tissue is returned to place and the weak spot is reinforced with .
  • Most patients go home the same day; nothing over 10 pounds until your 2 week visit, when we reassess.

A quick summary. The full details are below, and none of it replaces an exam.

What is an inguinal hernia?

An hernia happens when tissue, often part of the intestine or surrounding fat, pushes through a weak spot in your lower abdominal wall, in the groin area. This creates a bulge, and often discomfort or pain, especially when lifting, coughing, or straining. Not every ache in that area means you have a hernia, which is why an exam matters.

Close-up drawing of the inguinal canal from the front with the spermatic cord running through it. One hernia pushes up through the floor of the canal. The other comes through the internal ring on the middle side of the cord.
Where a groin hernia forms: (1) through the floor of the canal, or (2) through the internal ring.

Why does this happen?

The groin area naturally has a passage called the inguinal canal. While a baby is developing, this canal is where the testicles travel down into the scrotum (in males). That process leaves a natural weak spot in the abdominal wall for everyone, which can widen over time or under strain.

Three types of hernia in this area

  • Indirect inguinal hernia: the most common type. Often present from birth, it follows the same path the testicles took during development.
  • Direct inguinal hernia: develops later in life from general wear and weakening of the abdominal wall muscles.
  • : less common, and located just below the main inguinal area, near the blood vessels that travel into the thigh. This type is more common in women.

How open repair works

Open inguinal hernia repair is done through a single incision in the groin, directly over the hernia, rather than through small ports in the abdomen. Depending on your health and preference, it can be done under local anesthesia with sedation, a spinal block, or general anesthesia. We'll discuss which option fits you best.

Drawing of the open repair from the front: mesh lying on the floor of the inguinal canal, held to the pubic tubercle with two stitches, one of which anchors a running stitch along the inguinal ligament, stitched to the transversus along its upper edge, with two tails wrapped around the spermatic cord to rebuild the internal ring.
The open repair: mesh on the floor of the canal, under the cord.
Drawing of the inguinal canal from the front, showing the internal ring, the spermatic cord, the external ring, the inguinal ligament and the pubic tubercle, with three skin nerves: the iliohypogastric nerve above the cord, the ilioinguinal nerve alongside the cord and out the external ring, and the genital branch inside the cord. A dashed outline shows where the mesh will lie.
The three skin nerves that run through the canal.

This is a repair, not a removal. The hernia itself isn't taken out. Instead, the bulging tissue is reduced back into place, and the weak spot is reinforced with mesh to keep it from coming back.

Step by step

  1. Getting in: a single incision, about 10cm long, is made in the groin crease directly over the hernia.
  2. Opening the inguinal canal: the layers of tissue are opened to expose the inguinal canal and the .
  3. Protecting the nerves: three nerves run through this area: the ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerve. The ilioinguinal and iliohypogastric nerves are identified early and protected throughout the case. The genital branch is not usually seen directly; the surgeon knows where it runs and takes steps to avoid it. Together, this lowers the risk of numbness or chronic pain afterward.
  4. Reducing the hernia: the bulging tissue (hernia sac) is gently freed from the surrounding structures and either returned to the abdomen or tied off and removed, depending on its size and location.
  5. Placing the mesh: a flat synthetic mesh is laid over the floor of the inguinal canal and secured in place, reinforcing the weak area without tension. The surgeon ensures the mesh lies flat to allow proper healing, with no folds or gaps that could let the hernia come back.
  6. Closing up: the layers of tissue are closed over the mesh, and the skin incision is closed with absorbable sutures placed deep to the skin and a waterproof skin glue (no staples or visible stitches to remove).
  7. Nerve block: a numbing medication is often injected to numb the groin nerves, reducing pain afterward and cutting down on the need for narcotics.

See it step by step: an animated guide to where the hernia comes from and how the mesh goes in ↓

Possible complications

  • Bleeding or infection, lowered by careful cautery, antiseptic skin prep, sterile technique, and antibiotics before surgery
  • Nerve injury or chronic groin pain, lowered by protecting the ilioinguinal and iliohypogastric nerves and by knowing and avoiding the path of the genital nerve during the repair
  • Injury to the spermatic cord structures (in men) or (in women), or to nearby blood vessels. Uncommon, but possible given the close anatomy in this region
  • Hernia recurrence, lowered by making sure the mesh lies completely flat with no folds
  • Numbness around the incision, which is common and usually improves over time

Pain control after surgery

Pain is managed with a combination approach so you need fewer narcotics:

  • NSAIDs, such as Advil (ibuprofen) or Celebrex (celecoxib), to reduce inflammation
  • Tylenol (acetaminophen) for pain and fever
  • Robaxin (methocarbamol), a muscle relaxant
  • Narcotics only if needed, for the shortest time possible

Recovery: what to expect

  • Hospital stay: most patients go home the same day, with mild pain, swelling, or bruising.
  • Activity: walk as tolerated; avoid anything strenuous.
  • Lifting: nothing over 10 pounds until your 2 week visit, when we reassess.
  • Wound care: you can shower the day of surgery, but do not submerge your incision in a pool, tub, or other body of water for at least 4 weeks. The incision is closed underneath the skin and sealed with a waterproof glue.
  • Sun protection: healing incisions sunburn easily and can discolor, sometimes permanently, so keep them covered.

For more information, see Recovery and getting back to life.

Call our office if you notice:
  • Fever over 101°F
  • Pain that medication doesn't control
  • Redness, swelling, or drainage at an incision
  • Trouble urinating or breathing
  • Significant constipation

If it's after hours, your call will be routed to our answering service. The on-call surgeon or PA will receive your message and contact you.

For uncontrolled pain, shortness of breath, chest pain, or inability to keep fluids down, seek urgent medical attention right away rather than waiting for office hours.

Patient handouts

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Animated guide

The testicle's trip, two hernias, and the open repair

Where an inguinal hernia comes from, and how I fix it through an open incision, in ten steps. Press Next step to go at your own pace, or Play all to watch it straight through.

Animation in ten steps: the testicle descends from beside the kidney, through the internal inguinal ring, along the inguinal canal and out the external ring into the scrotum, bringing its artery, veins, nerves, vas deferens and cremasteric fibers with it. Then a direct hernia, an indirect hernia, and the open mesh repair. The caption under the drawing describes each step. Edge of the ribs Kidney Internal ring External ring Scrotum Inguinal canal Testicle The whole trip The canal, up close Toward the middle of your body → The finished open repair: mesh on the floor of the inguinal canal, under the spermatic cord, with its two tails wrapped around the cord.
Your right side is shown. Simplified, not to scale.

Step 1 of 10

Beside the kidney

Before you were born, your testicle started out inside your abdomen, right next to the kidney.

Read the whole script

  1. Step 1. Beside the kidney

    Before you were born, your testicle started out inside your abdomen, right next to the kidney.

  2. Step 2. The trip down

    It traveled down the back wall of the abdomen. As it went, the kidney drifted up a little. The artery that feeds the testicle comes off the aorta, and its veins drain back to the vena cava, so both came down with it.

  3. Step 3. Through the internal ring

    It left the abdomen through an opening in the muscle wall called the internal inguinal ring. The vas deferens, the tube that will carry sperm, came up from the pelvis and joined it on the inner side. On the way through, it picked up muscle fibers from the internal oblique. Those are the cremasteric fibers.

  4. Step 4. Along the canal

    Then it traveled along a tunnel called the inguinal canal. A skin nerve, the ilioinguinal nerve, joined it here and rides on top of the cord. Another skin nerve, the iliohypogastric, runs just above the canal. Behind the cord, the internal ring closed down snugly.

  5. Step 5. Out the external ring

    It left the canal through a second opening, the external inguinal ring.

  6. Step 6. Home

    Its final resting place is the scrotum. Everything it brought with it is now the spermatic cord. Cut across, the cord holds the vas deferens on the inner side, the artery near the middle with the veins around it, the nerve on top, and the cremasteric fibers wrapped around the outside. Sometimes some fat comes through the outer part of the ring too. That is called a cord lipoma.

  7. Step 7. Hernia 1, the floor gave way

    Here is where one kind of hernia comes from. It has nothing to do with the testicle's trip. Wear and tear over the years, from exercise, from work, from lifting, and the floor of the canal gives way. A bulge pushes up through the floor. This is a direct inguinal hernia, hernia number 1 on my map.

  8. Step 8. Hernia 2, the ring did not close

    The other kind goes back to the trip. If the internal ring did not close properly, a small pocket of the abdominal lining can slip out through it, right next to the cord. Over the years it works its way down the canal. This is an indirect inguinal hernia, hernia number 2 on my map. Believe it or not, this is by far the more common kind. It does not matter which kind you have. I fix them both the same way.

  9. Step 9. The open repair: moving the cord

    In the open repair, I place a soft rubber drain called a Penrose around the cord and move it a little to the side. That gives me room to work on the floor of the canal underneath it.

  10. Step 10. The mesh

    A large piece of mesh goes on the floor of the canal, under the cord. I start at the pubic tubercle with two stitches. One anchors a running stitch that holds the lower edge to the inguinal ligament. Separate stitches hold the upper edge to the muscle arch. The two tails of the mesh wrap around the cord, cross, and are stitched together. That rebuilds the internal ring.

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