Your surgery at. Oxford Hernia Clinic ( /

Transcription

1 Your surgery at Oxford Hernia Clinic ( /

2 Who is this leaflet for? This leaflet is for patients and family or carers of patients, who are undergoing hernia surgery at Oxford Hernia Clinic. Contents What s involved in hernia surgery?... 3 About your surgery... 3 About ProGrip mesh... 3 Anaesthesia... 4 Risks of hernia surgery... 4 Potential side effects of hernia surgery... 5 Preparing for surgery... 6 Arriving at hospital... 7 Going to the operating room... 8 During surgery... 8 After the operation Discharge from hospital Recovering from surgery Wound care Infection Bleeding Bruising Pain relief during recovery Shooting pain Massage Speeding up your recovery Driving Returning to work Sexual activity Sports hernia athletes recovery information Contact numbers

3 What s involved in hernia surgery? Your surgery at Oxford Hernia Clinic The Oxford Hernia Clinic performs the vast majority of its hernia operations under local anaesthetic as open tension-free mesh procedures. Some operations require general anaesthetic, including all keyhole laparoscopic (TAPP) or endoscopic (TEP) operations. About your surgery Open inguinal surgery needs just a single cut of about 6-8cm. For umbilical or epigastric hernias the cut is usually only about 2-3cm. Under anaesthetic, the hernia sac is either excised or pushed back through the gap into its proper place inside the abdomen. The weakness in the abdomen wall is usually covered with a sterile mesh called ProGrip. This mesh is self-fixing which means there are no stitches to hold it in place. The skin is then closed with a dissolvable stitch. This means there are no stitches to remove after the operation. About ProGrip mesh This mesh has been shown to reduce post-operative pain*. It also makes the operation shorter (lasting on average about 30 minutes). The mesh stays in your body and does not dissolve. Scar tissue will grow around the mesh to secure the weakness where your hernia bulge was. It s the scar tissue that fixes your hernia, not the mesh, so you ll need to avoid heavy lifting or straining after the operation to let your body heal itself. * Tarchi et al. Minerva Chir. 2014;69(3):

4 Anaesthesia Most of our patients have their surgery under local anaesthetic. General anaesthetic is needed:- For keyhole surgery; if the hernia is very large; if the hernia will not reduce (go back in); for most cases of incisional hernia. If you are having local anaesthesia you will be given a fast-acting sedative prior to surgery to help you to relax and to allow the local anaesthetic to be injected (you will not remember this happening). The sedative wears off very quickly but you won t be able to drive afterwards. Local anaesthesia ensures: a complete pain-free state during the operation no post-op nausea or sickness robust pain management for up to 6-12 hours, enabling you to be completely comfortable during your return home a short recovery time (you ll leave hospital 30 minutes after the operation) you will have significantly less pain in the week after surgery Although you ll be awake during the procedure there are surgical drapes in place so you won t see the actual surgery. The hospital staff will talk to you throughout, keeping you informed to ensure a relaxed and friendly experience. 4 Risks of hernia surgery Different patients have different risk factors; Mr. Sadler will have discussed any potential risks with you during your consultation.

5 Potential side effects of hernia surgery Your surgery at Oxford Hernia Clinic Temporary bruising varies between patients and usually takes about two weeks to disappear. Swelling is common after inguinal hernia surgery; male patients may experience puffiness in the skin of the penis and scrotum for several days. An incision scar line will always remain, but it will fade over time. Temporary difficulty in passing urine is very rare after local anaesthesia. It is more common after a general anaeasthetic and lasts between 12 and 24 hours. Nausea and sickness are side effects of a general anaesthetic. Infection inside your groin or in the wound on your skin is rare. Our procedures are always covered with antibiotics. Bleeding under the skin may occur after the operation. If the blood builds up and clots, your groin will swell and feel tender, leading to a big bruise called a haematoma. Usually the haematoma will resolve by itself, but rarely an operation to drain the clot may be needed. Very rarely patients may experience a haematoma in the scrotum. Damage to blood vessels or other organs is extremely rare. Damage to nerves leading to numbness in the skin after surgery is common. Feeling usually comes back but it may take up to 18 months. Most patients won t notice the numb area long term. Risk of the hernia reoccurring is roughly 1 in 500. Long-term pain or discomfort in the groin area is a potential problem following surgery. Evidence suggests the likelihood is reduced by using the ProGrip mesh. 5

6 Preparing for surgery 6 Don t eat any food after midnight the night before your operation. Drink plenty of fluids, preferably water, the day before your operation to help keep your body hydrated. You can drink clear fluids throughout the night and up to 6 a.m. on the day of surgery (water, black coffee or black tea are appropriate, but not juice or fizzy drinks). Take your regular medication as usual unless otherwise instructed. Don t worry about shaving the surgical site this will be done in theatre. Please leave jewellery and valuables at home. A wedding band can be left on and will be taped before going to theatre. Please remove any make-up and nail varnish from fingernails and toenails. Don t smoke on the morning of surgery (if possible, try to give up smoking altogether, or to cut down). The hospital has a no smoking policy so you won t be able to smoke before or after your operation.

7 Arriving at hospital Your surgery at Oxford Hernia Clinic On arrival, go to the Reception. You will be directed to the Day Suite where staff will book you in, check your personal details and put your identification wristband on. You will then be shown the changing room; you should remove all your garments an operating gown, dressing gown and slippers will be provided. A nurse will take you through to the anaesthetic room to record your blood pressure, pulse and temperature and ask you some questions for the operation checklist; to ensure you are correctly prepared for your operation. Staff will explain what will happen throughout the day. Surgeon Mr. Greg Sadler is your surgeon. He ll talk to you about your operation and answer any remaining questions you may have. Mr. Sadler will ask you to sign a consent form to demonstrate your understanding of the risk and benefits of the operation. The operation site will be marked on your skin with a marker pen. Anaesthetist Dr. Mark Stoneham is your anaesthetist, the doctor who manages your anaesthesia (blocking pain and sensation). He ll talk to you about the anaesthesia and answer any questions or concerns. 7

8 Going to the operating room The anaesthetist will give you a small sedative injection in the back of your hand. While you feel sleepy a local anaesthetic will be injected over your hernia to completely numb the area. You won t remember this happening! The anaesthetic takes about 20 minutes to work but lasts for 6 12 hours (so you ll remain pain-free for most of the day and can travel home in comfort after the operation). You will then be taken through to the operating suite. 8 If you are having a general anaesthetic the anaesthetist will put a needle in the back of your hand to give you the anaesthetic. When you are asleep a tube will be put into your windpipe to aid your breathing (this will be taken out before you wake up). You might have a sore throat after surgery but drinking water little and often will help. During surgery Under local anaesthetic you ll be conscious during the procedure, but you won t feel anything. There will be a surgical drape in place so you won t actually see the operation. The procedure s length of time varies from patient to patient but it usually takes around 30 minutes. A member of the team will talk to you throughout to make sure you re comfortable and relaxed. You can bring an MP3 player to listen to music, but music will be playing in the operating theatre as well. Absolute Radio is preferred by the operating team!

9 Our patients Mr S and Mr B (above) relaxing before their surgery, and (below) Mr M and Mr F in the recovery lounge 30 minutes after their operations. Thank you to our patients for kindly allowing us to use their photographs. 9

10 After the operation Following an operation under local anaesthetic, you ll be taken to the recovery lounge where you will be checked on by a nurse and offered a cup of tea, sandwiches and biscuits. You can leave the recovery lounge when the nurse is happy that you are in a suitable condition and there s a responsible adult to escort you to your transport. Most patients are ready to leave after 30 minutes or so. The nurse will provide you with a home pack including this leaflet and pain medication. A sick note can be provided on request General anaesthetic patients will take a couple of hours to re cover before discharge and occasionally may need to stay in hospital overnight. Discharge from hospital It s best that a responsible and able adult takes you home, although occasionally a few patients travel home alone on public transport. Remember, you won t be able to drive a car or ride a motorbike. 10

11 Recovering from surgery Your surgery at Oxford Hernia Clinic Oxford Hernia Clinic will write to your doctor about your surgery. You won t usually need to see your GP following the operation. Wound care You will have three layers over your wound after surgery: The bottom layer next to the skin are a number of paper Steri-strips. The middle layer is a white absorbent wound dressing. The top layer is a pressure dressing or strapping to reduce swelling and prevent bleeding at the wound edges. There are no stitches that need removing, only dissolvable ones under your skin. Steri-Strips applied after surgery for inguinal hernia (left) and umbilical hernia (right) Middle layer wound dressing Top layer pressure dressing 11

12 The wound should be kept dry and the pressure dressing left on for 48 hours. After 48 hours: 1. Remove the top pressure dressing layer. 2. Have a shower. 3. After the shower, remove the middle layer (the white wound dressing) 4. Dab the Steri-Strips dry with a clean towel and leave them in place. 5. You can now shower regularly with the Steri-Strips in place but gently dry them with a clean towel after each shower. 6. After 7 days remove the Steri-Strips and gently wash the wound. Don t use scented soap or talcum powder near the wound, and gently pat it dry with a clean towel. You can use a hairdryer to dry it further if you wish. 12

13 Infection Your surgery at Oxford Hernia Clinic Your operation will be covered with intravenous antibiotics, but wound infection is still a potential (but rare) complication. The first sign will be an increase in pain and the wound will start to look pink or red, and feel warm or hot to touch. If this happens, see your GP as soon as possible. If it s out of hours ring 111. Usually a short course of oral antibiotics will be prescribed to clear up the infection. Some of our high-risk patients (with diabetes, for example) may be discharged with antibiotics as a precaution. Bleeding You may see a little blood under the dressings, but please leave the dressing in place and the bleeding should stop on its own. If it s persistent or heavy, lie down and apply firm pressure to the wound for at least 30 minutes. If it continues to bleed after this time then please contact the clinic or the Manor Hospital on the numbers on the back cover. If you live a distance away you may need to contact your GP, the NHS 111 Service or go to your local Emergency Department. Bruising It s normal to have some bruising after surgery; some patients may experience a more profound bruising called a haematoma (blood collecting under the skin) which might be uncomfortable and require painkillers. Very rarely patients may have swelling in the scrotum which usually resolves on its own over time. Normal bruising 13

14 Pain relief during recovery 14 You will be given these pain relief tablets to take home: Paracetamol 500mg tablets Co-codamol 500mg tablets Ibuprofen 400mg tablets We recommend that you start taking pain relief tablets four hours after leaving the hospital and continue for the next 3 4 days. For standard pain relief: Take two paracetamol tablets and one ibuprofen tablet regularly every 6 hours. Take a maximum of eight paracetamol tablets and four ibuprofen tablets in a 24-hour period. This should be sufficient to control your pain in the first few days after your surgery. For severe pain relief: Take co-codamol tablets instead of the paracetamol tablets. Take two co-codamol tablets and one ibuprofen tablet regularly every 6 hours. Take a maximum of eight co-codamol tablets and four ibuprofen tablets in a 24-hour period. IMPORTANT: YOU MUST NOT TAKE THE PARACETAMOL AND CO CODAMOL TABLETS TOGETHER as this will exceed a safe dose. We recommend you do not to take co-codamol until after you have arrived home as codeine can make you feel nauseous and unwell (codeine stops gastric emptying very effectively). Co-codamol can cause constipation; if you are affected or take co-codamol regularly for a couple of days, ask your pharmacist for a laxative.

15 Don t drink alcohol, operate any machinery or sign any legal documents for 48 hours after your operation. Most people continue to experience discomfort for a few weeks after the operation, but this will gradually fade. If you are about to cough or sneeze, it will help if you put light supportive pressure on your wound site with your hand or with a small pillow. Shooting pain You may experience an occasional sharp shooting pain (lasting a second or two) in the area of your operation; it s common and is nothing to worry about. It will gradually settle. Massage Shortly after your operation you will start to feel a hard sausage-like ridge about 2cm wide and 6cm long this is the scar tissue forming around the mesh. Over the next 6-9 months this will slowly disappear. You can speed up this process with regular daily massage of the ridge using soapy suds in the shower or a simple moisturiser. Continual pain, redness or swelling of the wound could potentially indicate an infection and you should consult your GP as soon as possible if you experience these symptoms. 15

16 Speeding up your recovery You can speed up your recovery if you: Eat healthily Eating a healthy diet will help to ensure that your body has all the nutrients it needs to heal. A high fibre diet will help avoid constipation and reduce the strain on the site of the operation. Stop smoking By not smoking even if it s just for the time that you re recovering you will start to improve your circulation and breathing. Ask family and friends: to help you with things like driving, shopping or taking out the bins to keep your spirits up Keep a routine Get up at your normal time in the morning, get dressed and move about the house. If you get tired you can rest later. Don t be afraid to stand up straight: you won t pull at your wound. You may feel a little uncomfortable getting out of bed on the first morning, but it will get easier. Build up gradually When you are building up your activities, listen to what your body is telling you. If it feels painful it s too soon try again the next day. Remember in the first few days you will probably be taking regular pain relief, so don t try anything too vigorous. Avoid lifting anything heavier than 2.5kg or doing any strenuous pushing, pulling or stretching for 4 6 weeks. 16

17 Driving Your surgery at Oxford Hernia Clinic You can drive again when you can confidently make an emergency stop without worrying your hernia repair. This is usually between 7 10 days after the operation. You should inform your insurance company about your operation. Some companies won t insure drivers for a number of weeks after surgery so it s important to check. Returning to work The time you take off work depends on the job you do, how quickly you heal and how you respond to surgery. Most patients will be back at work in the following time scales: Light/supervisory work: 1 2 weeks Minimal lifting work: 2 3 weeks Heavy labour: 6 weeks Returning to work earlier won t cause any harm but you may experience significant discomfort if you do. Sexual activity Sexual activity can be resumed as soon as you are comfortable enough; there are no set rules or times. 17

18 Sports hernia athletes recovery information You can resume some exercise after 10 days if you feel comfortable. You can expect to return to full training after 4 6 weeks, but should work up to it with a tailored programme of exercise in agreement with your physiotherapist. Mr. Sadler will discuss your individual requirements with you. 18

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20 B A4 Road Bypass Northern Oxford Hernia Clinic Location Bypass Road Western Headington Road London A420 A34 OXFORD A4144a 4150 A 4150 A420 B480 Cowley Eastern Road Bypass Wheatley A40 M40 J8A A423 B480 Contact numbers: in an emergency always dial 999 Non-urgent numbers: Your GP Out of hours (NHS Choices): 111 Manor Hospital: (the hospital s switchboard is staffed 24 hours a day) Oxford Hernia Clinic: / Further information The Oxford Hernia Clinic Manor Hospital, Beech Road, Oxford OX3 7RP / Oxford Hernia Clinic Design by Oct 2015