General Surgery Hernias

At the London Day Surgery Centre hernias are performed as day cases.  They take less than an hour and can be carried out under local anaesthetic.  The advantages of local anaesthetic are not having to starve, recovering quickly, not feeling sick and light-headed and remaining in control at all times.  After the operation patients can be up and about straightaway after local anaesthetic but stay in the specialised recovery area for around sixty minutes after a general anaesthetic.

 

What is a hernia?

 

A hernia is a lump which occurs when part of the bowel or other abdominal tissue protrudes through an area of weakness in the wall of the abdomen.  When this occurs in the groin area it is either an 'inguinal' hernia or a 'femoral' hernia but hernias can also occur at or near the umbilicus and in old abdominal scars.  We repair all types of abdominal hernia at the London Day Surgery except hiatus hernia which is an internal hernia.

 

The Operation

 

In the repair operation the hernia sac is pushed back through the gap in the muscles into its proper place inside the abdomen and the gap is reinforced by non-tension mesh.  This is a sheet of material which looks a bit like nylon curtain but is far stronger.  All the skin stitches are absorbable and do not require removal.  The mesh remains for ever, becoming tough scar tissue, holding the hernia back.

 

After the surgery

 

It will be necessary to rest for a while after the repair and you will be given painkiller tablets as required.  You will very soon be encouraged to get out of bed and move about.  This may be uncomfortable but it will not cause any damage and it will speed-up your recovery.

 

You will be able to go home within an hour or so of the end of the operation if it was under a local anaesthetic or from your recovery time, which varies from patient to patient, if you had a general.  If you have a general anaesthetic you must have a friend or relative to take you home and stay with you till at least the next morning but you may also wish this after a local.

You will be given a 24 hour telephone number to call if anything worries you with regard to your operation.  Routine follow up appointments are not made but the surgeon will telephone you after a few days and again after a few weeks and you can be seen at any time by arrangement. 

 

Recovery

 

It will be necessary to rest for a while after the repair and you will be given painkiller tablets and, sometimes, suppositories after the operation and to take home to be used as required.  You will very soon be encouraged to move about.  This may be uncomfortable but it will not cause any damage and it will speed-up your recovery.

 

You will be able to go home within an hour or so of the end of the operation if it was under a local anaesthetic or from your recovery time, which varies from patient to patient, if you had a general.  If you have had a general anaesthetic you must have a friend or relative to take you home and stay with you till at least the next morning but most patients also wish this after a local.

 

At home you should resume normal activities as and when it feels comfortable to do so.  You DO NOT NEED TO HOLD BACK and you will find you are able to do more and more as the days pass after the first day or two.  For instance, even lifting weights can be resumed as soon as you find you are comfortable doing so and certainly by two weeks for most people.  Most patients are fully recovered and back doing everything they did before the operation by two weeks.  There may be some residual bruising and swelling which lasts longer but this will not stop you doing whatever you wish.  It often takes three months or so for the scar to become perfectly soft and smooth.

 

Emergency number & follow up

 

You will be given a 24 hour telephone number to call if anything worries you with regard to your operation.  Routine follow up appointments are not made but the surgeon will telephone you after a few days and again after a few weeks and you can be seen at any time by arrangement.  You are allowed to return to the London Day Surgical Centre at no charge (after a telephone call to make an appointment) to have the repair checked if you wish.

 

Complications

 

Infections are rare at The London Day Surgery Centre and all patients are given a dose of prophylactic antibiotic at the time of surgery (you will be asked if you have any allergies).  When they do occur they are treated with antibiotics but occasionally the mesh has to be removed surgically.

Bruising of the wound area and into the scrotum is common but clears up without any special treatment in nearly every case.  Rarely it is necessary to re-operate to stop bleeding.

A few patients develop a fluid collection between the mesh and the muscles, called a seroma, which is never a major problem but sometimes needs to be drawn off using a needle and syringe. and it can be easily aspirated if necessary.

An uncommon but troublesome complication of all hernia repairs is a persisting groin pain and treatment of this is, of course, also available.  Usually simple pain killers are sufficient but stronger tablets can be prescribed, the area can be injected (just as is a 'tennis elbow' or painful joint) and occasionally a nerve needs to be cut and frozen at another operation.

Finally, you need to know that there is a recurrence rate of between 1% and 2% of all hernia repairs whoever is carrying them out and whatever method is used;  it is far lower than it used to be before the modern non-tension mesh operation.