Hernia Repair

Hernia Repair

What Is Hernia?

In general terms a hernia is a bulge or protrusion of an organ through the structure or muscle that usually contains it. A weakness or defect may be present from birth or develop over a period of time.

A hernia will tend to enlarge and continue to cause discomfort.

If a loop of bowel gets caught in a hernia, it may become obstructed or its blood supply may become impaired. A hernia that causes this type of obstruction could then become a life-threatening situation.

Types of Hernia

The most common types of hernia are
  • inguinal (inner groin),
  • incisional (resulting from an incision),
  • femoral (outer groin),
  • umbilical (belly button), and
  • hiatal (upper stomach).

Inguinal Hernia

In an inguinal hernia, the intestine or the bladder protrudes through the abdominal wall into the inguinal canal in the groin. About 96% of all groin hernias are inguinal, and most occur in men because of a natural weakness in this area.

Femoral Hernia

Femoral hernia appears as a bulge in the upper thigh, is a loop of intestine, or another part of the abdominal contents, that has been forced out of the abdomen through a channel called the "femoral canal" (a tube-shaped passage at the top of the front of the thigh).

This type of hernia tends to occur in older people and is more common in women than in men. 

Fat tissue or part of the intestine protrudes through the abdominal muscle into the femoral artery present in the upper part of the thigh.

Incisional Hernia

In an incisional hernia, the intestine pushes through the abdominal wall at the site of previous abdominal surgery. This type is most common in elderly or overweight people who are inactive after abdominal surgery.

Umbilical Hernia

In an umbilical hernia, there is a defect in the abdominal wall near the navel. Common in newborns, it also commonly afflicts women who have had many children.

Fat tissue or part of the intestine protrudes through the abdominal muscle near the belly button.

Hiatus Hernia

A hiatus hernia occurs when a portion of the stomach squeezes, slides or protrudes through the gap in the diaphragm through which the esophagus passes.

Hernia Treatment

A hernia may need to be treated surgically as it may 
  • have a risk of causing pain, 
  • discomfort or 
  • even becoming strangulated.

Hernia Surgery

A hernia repair is usually performed as an outpatient surgery with no overnight stay in the hospital.

The operation may be performed as an 
  • Open Surgery
  • Keyhole Surgery - laparoscopic

Laparoscopic Inguinal Hernia Surgery

Traditionally hernias were repaired with a large incision in the groin and placement of a synthetic mesh between the abdominal wall and the skin to cover the weakness. The repair can now be performed with three small cuts using the operating telescope (laparoscope) to place a mesh inside the abdominal wall. This modern operation is less painful and allows quicker return to normal activities.

Risks of Laparoscopic Inguinal Hernia Repair

As with any surgery, complications may occur. Complications related to laparoscopic hernia repair include:
  • Groin pain due to nerve injury
  • Infection at the incision site or mesh
  • Blood or fluid accumulation
  • Urinary retention

After the Operation

You will be able to go home after the operation once you are comfortable. This is usually on the day of the operation. Try not to drink too much fluid for the first 24 hours. Do not drive for 1 week after the operation. Do not partake in heavy lifting (nothing heavier than a bucket of water), strenuous exercise or return to work for 3 weeks. Dr Oliver is happy to provide you with a medical certificate if required.

It is not uncommon for patients to develop swelling and bruising in the groin or scrotum a few days after the operation. This is normal and requires no treatment. Dr Oliver would like to see you in the rooms about three weeks after your operation. If you have any problems come to hospital, see your GP or give Dr Oliver a call in the rooms.

Recovery After the Procedure

When first at home
  • Do not drive for at least seven days.  
  • Do not partake in heavy lifting (nothing heavier than a bucket of water) or strenuous exercise for 3 weeks.   
  • After two weeks - you should be able to return to office-based work.

Open Hernia Surgery

To treat a hernia, your doctor may push the hernia back into its normal location and have you wear a belt to hold the hernia in place.

However, surgical repair is recommended for hernias that cause pain and other symptoms, and for irreducible hernias (structures cannot be returned to their normal locations) that are incarcerated or strangulated. Surgery aims at closure and repair of the muscle wall through which the hernia protrudes.

Open surgery, also called Herniorrhaphy, for hernia can be done under general or local anaesthesia. Your surgeon makes an incision of about 5-10cm long (depending on the size of the hernia) to view and access the surgical site. Your surgeon pushes the part of the intestine that protrudes back into its normal position and repairs the weakened muscle layer by sewing the edges of the healthy muscle wall together. A synthetic mesh is often placed and sewn over the weakened area to provide additional support and strength, by a procedure called hernioplasty. The incision is closed after the procedure using dissolvable stitches.

Post Operative Care

Following surgery, you
  • Can go home the day of the procedure.
  • Do not drive for at least 7 days.
  • Can resume daily activities slowly while strenuous activities should be resumed only after consultation with your surgeon.
  • Recover in about 3 weeks.

Risks and Complications

Like most surgical procedures, hernia repair is associated with the following risks and complications:
  • Reaction to anaesthesia
  • Infection
  • Bleeding at operation site
  • Nerve damage and numbness of skin
  • Damage to surrounding tissue
Although the recurrence of hernias is seen in less than 5% of patients after surgery, you would need to follow preventive measures.

Laparoscopic vs. Open Surgery

For most patients the open operation is more painful, both in the short and long term, when compared with laparoscopic inguinal hernia repair. The rate of recurrence of the hernia after the surgery is about the same for the open and laparoscopic inguinal hernia repairs. There is a slightly increased risk of bowel, bladder and large blood vessel injury with the laparoscopic repair. The recovery period is much longer for the open repair. Whilst his preference is to perform inguinal hernia repairs using the laparoscope wherever possible, Dr Oliver is happy to repair your hernia using the open technique if you would prefer.
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