Hernia

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What Is a Hernia?

A hernia (or “rupture”) is a weakness or defect in the wall of the abdomen. This weakness may be present at birth. Or, it can be caused by the wear and tear of daily living. If left untreated, a hernia can get worse with time and physical stress.

When a Bulge Forms

A weak area in the abdominal wall allows the contents of the abdomen to push outward. This often causes a noticeable bulge under the skin. The bulge may get bigger when you stand and go away when you lie down. You may also feel pressure or discomfort when lifting, coughing, urinating, or doing other activities.

Type of Hernias

The type of hernia you have depends on its location. Most hernias form in the groin at or near the internal ring. This is the entrance to a canal between the abdomen and groin. Hernias can also occur in the abdomen, thigh, or genitals.

  • An incisional hernia occurs at the site of a previous surgical incision.
  • An umbilical hernia occurs at the navel
  • An indirect inguinal hernia occurs in the groin at the internal ring
  • A direct inguinal hernia occurs in the groin near the internal ring.
  • A femoral hernia occurs just below the groin.
  • An epigastric hernia occurs in the upper abdomen at the midline

Surgery: The Best Treatment

A hernia will not heal on its own. Surgery is needed to repair the defect in the abdominal wall. If not treated, a hernia can get larger. It can also lead to serious medical complications. The good news is that hernia surgery can be done quickly and safely. In most cases, you can go home the same day as your surgery.

How a Hernia Develops

Although a hernia bulge may appear suddenly, hernias often take years to develop. They grow larger as pressure inside the body presses the intestines or other tissues out through a weak area. With time, these tissues can bulge out beneath the skin

Having Hernia Surgery: Traditional Repair

Surgery treats a hernia by repairing the weakness in the abdominal wall. An incision is made so the surgeon has a direct view of the hernia. The repair is then done through this incision (open surgery). To repair the defect, a mesh patch may be sewn (sutured) in place, to make a “traditional repair.” Follow your doctor’s advice on how to get ready for the procedure. You can usually go home the same day as your surgery. In some cases, though, you may need to stay in the hospital overnight.

Getting Ready for Surgery

Your doctor will talk with you about preparing for surgery. Follow all the instructions you’re given and be sure to:

  • Tell your doctor about any medications, supplements, or herbs you take. This includes both prescription and over-the-counter items.
  • Stop taking aspirin, ibuprofen, and naproxen if directed.
  • Arrange for an adult family member or friend to give you a ride home after surgery.
  • Stop smoking. Smoking affects blood flow and can slow healing.
  • Gently wash the surgical area the night before surgery
  • Don’t eat after midnight, the night before your surgery. Clear liquids may be taken up until 4 hours prior to surgery

The Day of Surgery

Arrive at the hospital or surgical center at your scheduled time. You’ll be asked to change into a patient gown. You’ll then be given an IV to provide fluids and medication. Shortly before surgery, an anesthesiologist will talk with you. He or she will explain the types of anesthesia used to prevent pain during surgery. You will have one or more of the following:

  • Monitored sedation to make you relaxed and sleepy.
  • Local anesthesia to numb the surgical site
  • Regional anesthesia to numb specific areas of your body.
  • General anesthesia to let you sleep during surgery.

Risks and Complications

Hernia surgery is safe, but does have risks including:

  • Bleeding
  • Infection
  • Anesthesia risks
  • Mesh complications
  • Inability to urinate
  • Numbness or pain in the groin or leg
  • Risk the hernia will recur
  • Damage to the testicles or testicular function
  • Bowel or bladder injury

During the Surgery

To make a traditional repair, an incision is made over the hernia. A piece of mesh is inserted to cover the area of the abdominal wall defect without sewing together the surrounding muscles. The mesh is safe and generally well-accepted by the body’s natural tissues

After Surgery

When the procedure is over, you’ll be taken to the recovery area to rest. Your blood pressure and heart rate will be monitored. You’ll also have a bandage over the surgical site. To help reduce discomfort, you’ll be given pain medications. You may also be given breathing exercises to keep your lungs clear. Later, you’ll be asked to get up and walk. This helps prevent blood clots in the legs. You can go home when your doctor says you’re ready.

Having Laparoscopic Hernia Repair

Once you know you have a hernia, you and your doctor can discuss laparoscopic surgery to repair it. Laparoscopic surgery is done with a laparoscope, a tiny “telescope” attached to a camera. It allows your surgeon a close-up view of your hernia using only small incisions. Because large incisions are not required, recovery from laparoscopic surgery is often faster and less painful than after open surgery. The surgery usually takes 1–2 hours. You can likely go home the same day.

Preparing for Surgery

  • Schedule lab tests: You may have blood tests or an ECG (electrocardiogram). These tests help ensure that your heart and lungs are healthy enough for surgery.
  • Ask about medications: Before surgery, you may be told to stop taking some medications, such as aspirin, ibuprofen, or herbal remedies.
  • Quit smoking: To avoid straining your abdomen from “smoker’s cough” and to promote good blood flow for healing, ask your doctor for help quitting smoking.
  • Avoid heavy lifting: Avoid putting strain on your hernia. Don’t do any heavy lifting before your surgery.
  • Keep your stomach empty: Don’t eat anything after midnight the night before surgery. Your surgery may be canceled if you eat before surgery. You may take clear liquids up until 4 hours before surgery. If you take any regular medications and have been told to continue them, take them with small sips of water.
  • Arrange for help after surgery: Plan to have someone drive you home afterward. You’ll want to take it easy after surgery, too, so you may need extra help at home.

Just Before Surgery

  • You’ll be asked to sign consent forms.
  • You will have 3–4 small incisions. The laparoscope and other instruments are inserted through these incisions. The laparoscope has a tiny video camera that sends clear images to a video monitor.
  • Carbon dioxide gas is injected into your abdomen through an incision near your navel. The gas inflates your abdomen, allowing your surgeon to work.

At VSA the totally extra peritoneal repair (TEP) approach during surgery is generally used. This provides for the placement of a large preperitoneal mesh with rapid return of patients to normal activity after repair and excellent long-term results. Robotic-assisted hernia repairs often use the transabdominal preperitoneal repair (TAP) approach. The recovery is similar for the two approaches.

Placing the Patch

The surgeon repairs the hernia, then places strong mesh directly over the weak spot in your abdominal wall. The mesh acts just as a patch would on a tire wall. The mesh is sometimes secured with surgical staples, tacks, clips, or sutures. These stay in place permanently. Neither the mesh nor the staples are harmful to your body. Other reinforcement methods besides mesh may be used. Often, however, the mesh is held in place by the body itself and tacks or sutures are not needed. After the mesh is applied, the gas is released from your abdomen.

Risks and Complications

  • Bleeding
  • Infection
  • Anesthesia risks
  • Mesh complications
  • Inability to urinate
  • Numbness or pain in the groin or leg
  • Risk the hernia will recur
  • Damage to the testicles or testicular function
  • Bowel or bladder injury

Discharge Instructions for Inguinal Hernia Surgery

What to Expect

The following are common after hernia surgery:

  • Bruising or swelling around the incision
  • Sore incision for 2–3 days
  • Feeling tired for a day or so
  • Pain when urinating
  • Bruised or swollen scrotum or penis

Activity

We encourage resuming walking and light activity immediately, as soon as you are sure you are not going to have issues with dizziness or lightheadedness. You may resume driving when it is comfortable to walk up and down stairs. Don’t plan on any strenuous activities, like sports or going to the gym, until your postop appointment. Your surgeon may have specific instructions to add to this; usually these are outlined to you before surgery. The bottom line: if it hurts, don’t do it!

For hernia surgery, and other abdominal procedures, we recommend avoiding lifting anything 40 pounds or more or any strenuous exercises such as situps or crunches. If you have a fairly physical job, we will provide a note for your employer restricting you to 20 lbs of lifting, and no strenuous activity, for up to a month to avoid workplace injury. Discuss your job requirements with your surgeon before the procedure to make sure you will be able to plan ahead for any restrictions.

Driving should not be attempted until you are off pain medications and able to go up and down stairs comfortably. You should be able to slam on the brakes to avoid an accident without causing any pain.

Eating:

The basic rule is take in what your body is telling you. Unless you have been given a specific diet plan, you may eat what you wish, even the day of surgery. Beware of nausea or queasiness the day of surgery, though. Some find it easier to digest bland foods, light foods, or predominantly liquids that evening. As you feel better, however, you can eat whatever seems good to you. Make sure you stay hydrated, and avoid excessive caffeine. Also, no alcohol if you are taking prescription pain medications.

Elimination:

Constipation is very common after surgery. We recommend staying well hydrated, and using Miralax, prune juice or Milk of Magnesia for a few days until things are back to normal. If you are at all prone to constipation, or if you need several days of pain medicine, it may help to add Benefiber, Metamucil or similar bulk fiber agents for a few days as well. Do not let more than 48 hours go by without a bowel movement without starting the above medications. If they fail to help within another 24 hours, call our office.

You should be able to urinate within 6-8 hours of leaving the facility. If you are unable to do so, call our office. Make sure your doctor is aware of any chronic difficulties with urination (like prostate trouble) before surgery.

Wound care:

Usually surgical wounds will have either glue or steri-strips (butterfly tapes) on them, often covered with gauze. Glue, steri-strips, or waterproof plastic dressings can all get wet the day after surgery (unless your surgeon advises differently). Wounds with visible staples or sutures can get wet in the shower after 48 hours. Do not submerge your wound (tub bathing or swimming) for one week. While soap will not harm the wound, do not scrub it. Do not apply peroxide or other chemicals unless you have been told to do so by your doctor. After 48 hours, change or remove gauze dressings or Band-aids. Do not leave soiled or wet dressings on the wound beyond 48 hours. Most wounds can then remain uncovered, unless you have been told otherwise. Light gauze covering to prevent chafing is acceptable if you wish. You may notice a slight drainage (usually pink or reddish in color) from the incision site. This is normal and not a cause for concern. Light pinkness immediately surrounding the incision, and not spreading over time, is normal. Bruising is common and may extend for up to an inch. Spreading redness, progressive swelling with bruising, and malodorous drainage are not normal and should prompt a call to our office..

Medication

Prescription pain medications are there to help you recover comfortably, but stop them as soon as you are able. Side effects of nausea, vomiting, dizziness, fatigue, poor appetite, and above all constipation, are common. If you have these issues, try to use ibuprofen and Tylenol instead (see below). Do not use alcohol or drive if you are taking prescription pain medications.

Unless you are told differently by your surgeon or primary doctor, you can take 400 mg ibuprofen every 4-6 hours, or 800 mg every 8 hours, for the first 3-5 days after surgery, for a maximum dose of about 2400 mg/day (refer to the label for specific dosing based on age and weight). It is best if you can take some food with this medication.

Tylenol is also acceptable to help with the baseline pain after surgery. It can be taken in conjunction with ibuprofen, and with your prescription (unless your prescription already contains acetaminophen--which is Tylenol). Be very careful not to exceed the dosage on the bottle. Taking more than 3 grams/day is not advisable.

Blood thinners should only be restarted after surgery according to the plan discussed with you by your surgeon or prescribing doctor before surgery. If this was not made clear to you, call our office.

All other medications should be resumed once you get home. Vitamins and supplements are not necessary to help you heal, unless you have a known deficiency, or unless your doctor suggests a multivitamin daily due to the type of surgery you had. You may resume any of these you normally take after you get home if you wish. We would suggest sleep aids not be used while you are on narcotic pain medications.

If Difficulties Arise

Please call our office immediately if you develop any of the following;

  • Fever over 101°F or chills
  • Increasing pain, redness, or drainage at an incision site
  • Vomiting or nausea that lasts more than 12 hours
  • Prolonged diarrhea
  • Chest pain or shortness of breath
  • Inability to urinate within 8 hours of discharge

Post-Operative Outcomes

To consistently provide top quality, innovative care for patients suffering from hernias, you may receive a post-surgery survey 6 months as well as 1 year after your hernia surgery via email in which provides outcome data to our practice. Your feedback assists us in tailoring our surgical techniques to provide minimally invasive surgeries as well as the most up to date care for sufferers of hernia related diseases.