Hernia Repair Information for Patients

Transcription

1 Hernia Repair Information for Patients

2 Information for Patients Hernia Repair What is a hernia? A hernia occurs when part of the bowel sticks out through a weak area in the muscles of your abdomen - causing a bulge or lump. You can feel a soft lump under the skin. A hernia is sometimes described as a rupture. A hernia can be uncomfortable and feel tender, especially when bending or lifting. It may make it difficult for you to do normal activities, like shopping or having sex. Some people can push their hernia back in, but it's likely to come out again. Surgery is the only way to repair a hernia. What causes a hernia? A hernia can be caused by: Congenital weakness (present at birth) Age-related weakness in the abdominal wall Strenuous activity or excessive strain from heavy lifting Pregnancy Previous surgery involving the abdominal wall Can hernias be prevented? Probably not, hernias are very common (approximately 120,000 per year in the United Kingdom) and are experienced by people with both active and inactive lifestyles. Different types of hernia Inguinal (groin) hernia This is the most common type of hernia - affecting approximately 2-3% of the population. It is much more common in men than in women. The hernia is seen as a lump in the groin which may disappear on lying flat or which may be pushed back, only to reappear with standing, coughing or straining. It can cause discomfort and tends to increase in size with time. Occasionally the hernia can get stuck', or be very painful - when urgent surgery might be necessary. This is sometimes called a strangulated hernia. Femoral hernia This is more common in women than men. It is usually seen as a lump lower in the groin, near the skin crease towards the top of the thigh. It is more likely to become stuck than an inguinal hernia and should be repaired promptly by surgery.

3 Epigastric hernia This is caused by weakening of the muscles in the central, upper abdomen, causing a lump or bulge to appear anywhere between the breastbone and the navel. The lump can be quite small or extremely large and tends to be more common in middle age. It is best repaired by surgery. Umbilical hernia This occurs at, or near the navel. It is very common in children. In adults it is more common in women, often in those who have had children. Sports hernia (Gilmore s Groin) This is not a true hernia but is best described as a chronic groin strain. Usually occurring in active sports men and women, pain is usually located in the groin above the skin crease and comes on with exercise. Often physiotherapy and rest will alleviate the problem but in about 40% of sufferers an operation similar to inguinal hernia repair is needed. Incisional hernia This may occur at any site where an operation has been performed previously. The scar represents a weakened area, which, over time, may allow the intestines underneath to bulge through. Surgical repair is often necessary. Strangulated hernia Sometimes a hernia can become strangulated trapped in the gap it has come through. This can cut off the blood supply to this part of the intestine, which causes an acute blockage. This may lead to perforation of the bowel, which then allows bacteria to escape into the abdomen and cause a serious infection or inflammation called peritonitis. This is a potentially life-threatening condition which requires emergency surgery. The main symptom is usually severe pain over the hernia bulge, often with reddening of the overlying skin.

4 What is the treatment for hernia? Generally, a hernia that can be pushed back easily, or flattened, is not an immediate danger to your health, although it can be uncomfortable. An untreated hernia will not get better on its own. If left untreated, it is likely to continue to increase in size over time and become more painful. Surgery is the only way to repair a hernia. How will surgery help? Surgery will: Get rid of the bulge in your groin Make you more comfortable and lessen your pain Allow you to get back to normal activities and work Prevent a strangulated hernia (see above) Hernias however can come back. What are the alternatives? Surgery is the only way to repair a hernia, though some patients choose to wear a truss which helps to keep the hernia in place. What is involved in hernia repair surgery? The operation is usually performed as open surgery but it can be done as keyhole surgery. Open surgery takes about 30 minutes, keyhole surgery a little longer. A hernia repair is usually carried out as a day case you don t need to stay in hospital overnight. Open surgery This is performed through a cut about 5 cm (2 ) long in the groin. The hernia is pushed back through the gap into its proper place inside the abdomen. The weakness is usually covered by a piece of sterile mesh that is stitched in place (the Oxford Hernia Clinic uses a mesh that doesn t need any stitches to hold it). The abdomen is then closed with further stitches. Keyhole surgery In this type of operation the surgeon uses a camera to see inside your groin instead of opening it up. The surgeon makes a small cut near the belly button and inserts a camera. It requires a general anaesthetic. Either: A: A space is made with the camera behind the abdominal muscle and in front of the peritoneum (the membrane that lines the abdominal walls) and the abdominal cavity is not entered (This is called a TEP Repair). This is now the preferred method used by Oxford surgeons doing keyhole surgery for hernia. It is used for recurrent hernias, bilateral hernia and in selected first time cases. The advantage of this type of surgery is significantly less post operative pain and faster recovery, but a slightly increased risk of the hernia coming back.

5 Or: B: The camera is inserted into the abdominal cavity and the hernia is repaired by cutting through the peritoneum. This is called a TAPP Repair It was thought that these procedures would be more comfortable and offer a quicker return to activities after surgery. This has not been shown to be the case when compared to local anaesthetic repair. Keyhole surgery has the potential to damage bowel and bladder that is rare in open surgery. Recurrence in inexperienced hands is also a lot more common. It is also more expensive What happens to the mesh in a mesh repair? The mesh is usually surgically stitched in place (not in the Oxford Hernia Clinic) and as the stitches dissolve, tissue grows into and around the mesh to keep it in place. The mesh does not dissolve. OHC now uses ProGrip Mesh which does not need any stitches or staples to hold it in place ad has been shown to reduce the chance of long-term discomfort. Anaesthesia A local or general anaesthetic can be used for this operation. With local anaesthetic the area to be operated on can be completely numbed for the duration of the operation and longer (about 6-12 hours). Advantages of local repair are that it is quicker, safer, more comfortable and less expensive.

6 What are the risks of hernia repair surgery? There is a risk of complications and side effects. Your surgeon will be able to explain how these risks apply to you. Bruising, swelling or scarring at the site of surgery. This is very common and will only last a few days. Although the scarring will fade an incision line will always remain. Temporary difficulty in passing urine this can last usually between 12 and 24 hours, but it is rare. We have not seen any patients with this under local in over 2500 operations. Side effects of the general anaesthetic - such as feeling sick. Serious problems are rare. Infection - You may get an infection deep inside your groin or in the wound on your skin, but this is very rare. The procedure is covered with antibiotics. Bleeding you can bleed heavily under the skin after the operation. If the blood builds up and clots, your groin will swell and feel tender. This will give you a big bruise called a haematoma. Sometimes it will stop by itself, but sometimes an operation to drain the clot is needed. Damage to blood vessels or other organs this is extremely rare. Damage to nerves causing numbness in the groin area. Feeling may come back, but it can last for months or years. About 11 in 100 people have numbness in their groin area a year after the operation. The risk is less with keyhole surgery. Risk of the hernia reoccurring between 3 and 9 hernias in 1000 come back. Long-term pain or discomfort (reduced by using ProGrip Mesh) Preparation for your operation Do not 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 will be unable to smoke before or after your operation. Do not 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. (e.g. water, black coffee or tea, 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)

7 Arriving at hospital The reception staff will book you in, check your personal details and put your identification wristband on. One of the nurses will then 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. The surgeon will see you beforehand to talk to you about your operation and to answer any remaining questions you may have. The surgeon will ask you to sign a consent form which will describe the risk and benefits of the operation. The operation site will be marked with a marker pen. The anaesthetist will also see you before the operation and talk to you about the anaesthetic. If you have any questions or concerns, this is the time to ask. Going to the operating theatre A small iv drip will be placed in the back of your hand, you will be given a very fast acting sedative that lasts only about 3 minutes. The local anasethetic will be injected over the sight of your hernia (you will not remember this happening). The local takes about 15 minutes to work but lasts a long time (about 6-12 hours. If you are having a general anaesthetic the anaesthetist will put a needle into a vein 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. (This may leave you with a sore throat after surgery but drinking water little and often will help relieve this.) You will then go into the theatre, you will be awake during the local op, the radio is on it is very relaxed and there is often a lot of chat and joke telling. The vast majority of patients find the experience no problem at all. If you are very nervous the we can give you some more of the sedative so that you are not aware and don t remember the op, but very few patients need or request this. Recovery You will return the recovery area. You will have an oxygen mask on your face until your oxygen levels are back to normal if you had a general anaesthetic. The recovery nurse will check your blood pressure and wound site regularly. When you are comfortable and your blood pressure is stable a nurse will take you into the recovery lounge for tea and a sandwich.

8 Discharge instructions It is essential that you have a responsible and able adult to take you home following GA. This is not needed for local anaesthetic. Do not drink alcohol, operate any machinery or sign any legal documents for 48 hours after your general anaesthetic. You should not usually drive a car for 7-10 days after your operation, and then only if you feel confident about performing an emergency stop without discomfort. If you need a sick note one will be supplied for you. After your operation GP appointment It is not necessary to see your GP following the operation. If you are worried that the wound is showing any signs of infection i.e. if it is swollen, red, painful, hot, or if you are feverish, you should make an appointment to see your GP straight away. Pain relief We will give you painkillers to take home with you. We recommend that you take these at regular intervals for the first few days in order to get maximum pain relief. Most people continue to experience some discomfort for a few weeks after the operation, but this will gradually settle. 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. Whether recovering from open or keyhole surgery you will need to take it easy for the first 2 or 3 days. Stitches You will have dissolvable stitches that do not need removing. Wound care The wound should be kept dry for the first 48 hours. After this you can have a shower. The damp dressings need to be removed after showering in order to reduce the risk of infection. Pat the wound dry with a clean towel. You may use a hairdryer to dry it further if you wish. Do not use scented soap or talcum powder near the wound. Resuming normal activity and returning to work It is important you do not say in bed. Gentle exercise such as walking is beneficial. Do not lift any object that weighs more than about 5 kgs in weight, or do anything that involves strenuous pushing, pulling or stretching, for 4-6 weeks. Driving You may drive again when you can confidently perform an emergency stop, without worrying about your hernia repair. This is usually by about 7 after the operation.

9 Return to work The length of time you take off work depends on the job you do. However, 1-2 weeks for light, desk-based work, and 4-6 weeks for heavier, manual work is usual. Sexual activity can be resumed as soon as you are comfortable enough. It is advisable to have a high fibre diet to avoid constipation as this will help reduce the strain on the site of the operation. Further information If you have any questions or need any further advice or information, please contact us off the contact page of the web site. References Burkitt H.G. & Quick C.R.G. (2002) Essential Surgery: Problems, Diagnosis and Management. Churchill Livingstone London Phillips W. & Goldman M. (Clinical evidence for patients from the BMJ.)