Umbilical Hernia Repair

Transcription

1 Umbilical Hernia Repair What is an Umbilical Hernia? The hernia is when a weak section of muscle allows your small intestine to protrude near your navel. The cause is usually a small hole in the muscle wall of the abdomen resulting in the bowel bulging through. Depending on the exact site of the bulge so the type of hernia will get its name - UMBILICAL. What are the alternatives to an operation to repair the hernia? Initially you may find that lying down stops the hernia from bulging, but after a while the only cure will be an operation. A hernia is not dangerous unless it becomes strangulated. Sometimes the hernia can twist on itself preventing proper blood flow to itself and can cause pain. It can also limit a person's level of activity by affecting their daily lives. It can be better to have the operation therefore. What are the potential risks and side effects? It is necessary to let the hospital know if you are taking a contraceptive pill. You will probably be advised to stop taking the pill prior to the operation. This is in order to prevent thrombosis (blood clots). You are requested to stop smoking at least eight weeks before surgery, as smoking can cause coughing post-operatively and is by far the most common cause of recurrence of hernia. It can also delay healing. Any operation may lead to complications, including the following general risks: Injury to nearby areas (bowel tissue) and excessive bleeding. Infection. Allergic reaction to drugs or anaesthetics. A recurrence of the problem. Breathing difficulties. The likelihood of complications increases in: Adults over the age of 70. New-borns and infants. People who are overweight, smokers or heavy drinkers. People who take certain medicinal or mind altering drugs - for example: antihypertensives, muscle relaxants, tranquillizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers, or cortisone. Recurrent hernias. Previous surgery around navel. Your doctor will discuss with you the advantages and risks of having this operation. Should you decide that you do not wish to go ahead with the procedure that has been described to you by the doctor, you may withdraw your consent. East Sussex Hospitals NHS Trust Page 1 of 5

2 What are the expected benefits of treatment? Cosmetic reasons. To relieve pain. To prevent gangrene should the bowel become strangulated. There is a small possibility of a recurrence of the hernia(s) in the future, but you will be given good advice to follow in order to try and prevent this happening. Generally speaking you should expect complete healing without complications. What should I do before I come into hospital? In most cases, you will be sent directly from your consultation to the pre-admission assessment clinic or the day surgery unit where you will be seen by a nurse and/or a doctor. This appointment will assess your fitness for operation and provide an opportunity to discuss aspects of your operation. You will also receive advice on what medications you should take, any preparation procedures required i.e. blood tests, ECG (heart recording), x-ray etc and also advice about when you should stop eating and drinking prior to the operation. If it is not possible to see you in the pre admission clinic on this visit you will receive an appointment for another day prior to your operation. Will I have an anaesthetic? A hernia operation can be performed under either a local or general anaesthetic. The surgeon will discuss the options with you: General anaesthetic is given by injection into the back of your hand or in the arm; and by inhalation of anaesthetic gas through an airway. The operation An incision is made slightly above or below the navel. A further incision in made in the lining of the abdomen (called the peritoneum). The contents of the hernia sac are located and replaced in the abdominal cavity. The peritoneum is closed. The large abdominal muscle is pulled over the defect. The membrane covering the muscle is overlapped and stitched to close the defect. Sometimes a large defect will be closed by covering it with a nylon mesh. The skin is usually closed, with dissolving stitches. In the case of clips or nylon stitches, these usually can be removed about seven to 10 days after the operation by the practice nurse at your GP Surgery. If you have any worries or questions at this stage don't be afraid to ask. Should you decide that you do not wish to go ahead with the procedure that has been described to you by the Doctor, you may withdraw your consent. East Sussex Hospitals NHS Trust Page 2 of 5

3 Please tell the Doctor if you have had any bad reactions with previous anaesthetic or drug allergies. It is important to advise the staff if you have a pacemaker, any problems with loose teeth or have had bridge or crown procedures. How will I feel afterwards? The wound: There is occasionally bruising of the skin, which will disappear in about one to two weeks. The weakness in your muscles has been repaired, but there is a degree of bruising in the deeper tissues. This can be felt as a tender thickening or even a "lump" under the scar. This may persist for some weeks, but will eventually be absorbed completely over the next few months. The area around the wound may itch and you may experience numbness around the scar. Care of the wound: The wound should be kept dry for three to seven days. Prolonged bathtime or swimming can begin at 21 days. Your wound will be covered with a dressing to protect it, which if you are only in for the day, can be removed on the 6th or 7th day. Otherwise the dressing will remain in place for 24 to 48 hours, when it may be removed and the wound sprayed with a clear plastic spray and left exposed. You MUST report to your doctor if: The wound appears red, hard and painful or if there is a discharge from the wound. These signs can indicate that there is an infection and can be promptly treated. You experience nausea, vomiting, constipation, difficulty in swallowing or abdominal swelling. You develop new and unexplained symptoms. Stitches: You will be advised as to the method used to close your wound i.e. whether you have stitches which are dissolvable and need not be removed, sutures to be removed or clips that need to be removed after a week. Pain control: You will be prescribed painkillers as there may be a feeling of tightness around the stitches. This may cause you discomfort. You will be offered regular pain relief such as Paracetamol. This should help to ease the "soreness" allowing you to move more easily. How long will I be in hospital? This procedure is often performed as a daycase visit. East Sussex Hospitals NHS Trust Page 3 of 5

4 What should I do when I go home? Going home will depend on your general state of health, how much help you have at home on your return and on your recovery after the operation. Other than that, you can go home as soon as you feel able to. Allow three weeks to recover from the operation. Bathing: When bathing or showering is permitted you may wash the wound carefully with soap and water. In some cases a waterproof dressing will have been used. This will protect the wound even while washing or bathing. It is best to wait for the wound to dry and heal before going swimming. Driving: You are advised not to drive for at least ten days following the operation. You must be confident that you can keep control of a vehicle in an emergency. Will I have to come back to hospital? In most cases, no hospital follow up is necessary. When can I return to work? You can return to work when you have been cleared to do so with your doctor when you feel strong enough. If your job involves heavy lifting, this should be avoided for at least one month after the operation. Other sources of information Royal College of Anaesthetists - The Royal College of Surgeons - Contact information Before Surgery Conquest Hospital Pre-assessment Unit Telephone: (01424) ext 7228 or 8119 Eastbourne District General Hospital Firle Unit (Pre-assessment Unit) Telephone: (01323) ext 4153 Contact information After Surgery Your GP NHS Direct Telephone: Important information Please remember that this leaflet is intended as general information only. It is not definitive. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please, therefore, always check specific advice on the procedure or any concerns you may have with your doctor. East Sussex Hospitals NHS Trust Page 4 of 5

5 Hand Hygiene In the interests of our patients the trust is committed to maintaining a clean, safe environment. Hand hygiene is a very important factor in controlling infection. Alcohol gel is widely available throughout our hospitals at the patient bedside for staff to use and also at the entrance of each clinical area for visitors to clean their hands before and after entering. Other formats If you require this leaflet in any other format such as larger print, audio tape, Braille or an alternative language, please ask at one of our PALS offices. If you require interpreting services during your hospital visit please ask a member of staff who will be able to organise this for you via the appropriate department. After reading this information are there any questions you would like to ask? Please list below and ask your nurse or doctor. Reference The following clinicians have been consulted and agreed this patient information: Consultant Surgeons Mr P Rowe Mr G Evans Mr A Aldridge Mr S Whitehead Mr G Khoury Mr J Lyttle Mr A Sandison Clinical Matrons Mrs E Fellows Mrs J Kinch Senior Sisters Linda Budd Gillian Churchill Trish Shult Date Agreed: October 2009 Review Date: October 2011 Responsible Clinicians: Mrs E Fellows and Mrs J Kinch - Clinical Matrons East Sussex Hospitals NHS Trust Page 5 of 5