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Hernia Repair - Laparoscopic Incisional - Day Case

This page will provide you with information about incisional hernia repair. For further details, you should speak to your consultant.

What is an incisional hernia?

This type of hernia forms at the site of the cut made during a past procedure, where there can be a weakness in the wall of the abdomen.

In this case, the surgeon may suggest a hernia operation; although it is entirely your decision as to whether you choose to go ahead with it. Although this page is designed to highlight key information about the procedure, including benefits and possible complications, it is of paramount importance that you also speak to your surgeon or healthcare team with regards to any questions or issues you may have about the procedure.

Why do we get hernias?

The abdominal wall is designed to protect your abdominal cavity; this includes your intestines and other structures. The wall is made up of four layers: the inner membrane; the second muscle wall, the third layer of fat and the outer layer of skin.

A hernia develops when the incision made during surgery fails to heal properly, meaning a weak area forms in the muscle wall. When the abdominal contents and the inner layer push through the muscle layer, a lump is formed under the skin. This lump is known as a hernia (see figure 1).

Figure 1 - An incisional hernia
Copyright © 2015 EIDO Healthcare Limited

What are the benefits of having surgery?

After surgery, you will no longer have the hernia. In turn, you will not be at risk of the serious complications that can arise as the result of having a hernia.

Is surgery the only solution?

Without a surgical procedure, your hernia will simply not improve. Although it can be controlled with supportive clothing, the only effective way of actually curing the condition is by undergoing this surgery.

What if I decide not to have surgery?

If left untreated, a hernia can become larger over time. It can also develop into what is known as a ‘strangulated hernia’: where the intestines or inner structures become trapped and the blood supply is limited or cut off completely. In this scenario, surgery would be required as a matter of urgency. If a strangulated hernia is not operated on, it can prove fatal.

I already take medication; can I still have the operation?

Let your consultant know about any medication you are taking before the procedure, and follow their advice regarding the matter.

What kind of medication do I need to let my consultant know about?

  • Blood-thinning medication
  • Herbal/alternative remedies
  • Dietary supplements
  • Over-the-counter medication

What will happen during the procedure?

The healthcare team will carry out several checks prior to the operation to ensure the procedure will be performed on the correct side of your body – this will include basic checks like your name and the type of procedure you are having.

Typically, the operation takes between one to two hours and is carried out under general anaesthetic. You may, however, be offered a local anaesthetic to help with pain relief after surgery. Your surgeon may decide to administer antibiotics; these will help minimise the risk of infection.

During the operation, the surgeon will use a laparoscopic (keyhole) method of surgery.

What are the benefits of laparoscopic surgery?

  • Less pain
  • Less scarring
  • You should be able to return to your normal activities sooner

The surgeon will make a small incision on or close to your belly button (umbilicus) in order for them to insert an instrument into your abdominal cavity to inflate with carbon dioxide. They will then make numerous small cuts on your abdomen to allow them to insert ports (tubes) into your abdomen.

Following this, they will insert special surgical instruments through the ports (as well as a telescope to enable them to view the inside of your abdomen and carry out the operation). The surgeon will release the structures from your abdomen that are stuck in the hernia, inserting a synthetic mesh which will cover the weak spot.

Around 5% of patients will not be able to have keyhole surgery. In these instances, the surgery will be converted to open surgery – this involves a bigger cut at the site of your scar. Finally, the surgeon will take the instruments out and stitch up the cuts.

How can I help make sure the operation goes smoothly?

  • Are you a smoker? If so, try to quit several weeks, if not months, before your operation. This will minimise the risk of complications, as well as improving your overall health.
  • Strive to maintain a healthy weight for your height. If you are overweight, you have a higher chance of developing further problems.
  • Frequent exercise will help prepare your body before the operation, and also aid the recovery time post-operation. Avoid any kind of heavy lifting or any activity that makes your hernia painful. Please note: before you embark on any exercise regime, seek advice from your doctor.

Risks and complications

Any risks or complications will be discussed in advance of your treatment with your expert consultant.

Are there any complications that can arise?

Of course, your consultant will do all they can to ensure the operation is a safe as possible. However, complications can happen with any major operation; some of which can be serious and even fatal. Using keyhole surgery means it is hard for your surgeon to be made aware of some complications that may happen during the procedure. During the recovery period, you need to keep an eye on your symptoms and ask your healthcare team if there is anything that you are unsure about. They may be able to inform you whether the chances of a complication occurring is higher or lower for you. Ask your anaesthetist about any complications that can arise as a result of having an anaesthetic.

General complications

Infection of the wound (surgical site). The risk of this is 1 in 100. If you notice pus in your wound or it becomes painful, sore or red, tell your healthcare team. Also inform them if you have a temperature. An infection can usually be controlled with antibiotics, but you may need further surgery. You should be able to shower two days after the operation, but always check with your healthcare team first.

Bleeding during or after the procedure. It is quite normal for the area to be bruised. It is very uncommon that you will require another operation or a blood transfusion.

Pain. You will be given some form of pain control; this will allow you to move and cough freely.

Blood clot in your leg, otherwise known as deep-vein-thrombosis or DVT. DVT can lead to swelling, pain or redness in your leg, or the veins that run along the surface of your leg appear to be bigger than usual. The healthcare team will be able to monitor your risk, and give you stockings, medication or injections. Inform your healthcare team immediately if you believe you might have developed DVT.

Blood clot in the lung (pulmonary embolus) if the clot moves through your bloodstream and into your lungs. If you become breathless, cough up blood or feel pain in your upper back or chest, tell your healthcare team immediately. If you are at home, call 999.

Specific complications

Keyhole surgery complications:

  • Damage to structures, including your bladder, blood vessels or bowel when instruments are inserted into your abdomen (the risk of this is less than 3 in 1,000). If you have already had surgery to your abdomen, the risk is higher. If an injury does occur, you could need open surgery. Around a third of these injuries are not apparent until after the surgery.
  • A hernia developing close to one of the cuts made to insert the ports (the risk is 1 in 100). In order to reduce the likeliness of this happening, the surgeon will use tiny ports (diameter less than a centimetre) where possible. If they do need to use larger ports, they will use deeper stitching when closing up the cuts.
  • Injury to your bowel during the operation, or if the bowel becomes trapped between the abdominal wall and the mesh, resulting in bowel obstruction (the risk is 1 in 200). In this case, you may need further surgery.
  • Surgical emphysema. This feels like a cracking in your skin and is caused by trapped carbon dioxide gas. This soon settles and is not considered serious.

Hernia repair complications:

  • Difficulties urinating. For one or two days after the operation, you may need to have a catheter (tube) inserted into your bladder.

  • Damage to structures coming from your abdomen, within the hernia. This is uncommon, but you may require further surgery.

What is the recovery time for this operation?

In the hospital

Post operation, you will be transferred to the recovery ward, but you should be able to return home the same day. A responsible adult should be relied on to take you home, either in a taxi or car, and stay with you for 24 hours, at least. Always stay near a phone in case of an emergency. Here are the symptoms that may indicate a serious complication:

  • Pain that worsens over time or is particularly severe when you cough, breathe or move

  • A fever or high temperature
  • Feeling faint, dizzy or not being able to catch your breath
  • Lack of appetite or feeling nauseas (worsening over the first day or two)
  • Not being able to open your bowels/pass wind
  • Swelling of your abdomen

If you feel that you are not getting better over the first few days, or show any of the above symptoms, contact your healthcare team immediately, or contact your consultant or surgeon if you are at home. In an emergency, dial 999.

Returning to day-to-day activities

  • Do not operate machinery or drive

  • Do not partake in any dangerous activities
  • Do not cook for at least 24 hours, making sure you have recovered movement, feeling and coordination
  • Do not drink alcohol for at least 24 hours
  • Do not sign any important legal documents etc.
  • Follow advice of healthcare team to avoid blood clots (wear special stockings, etc.)
  • Increase how much you walk over first few days
  • Take painkillers if needed
  • Do not lift anything heavy for at least 6 weeks
  • Regular exercise can help, but seek advice from GP first
  • Do not drive until you are fully confident about controlling a vehicle
  • Check your insurance policy and with your GP first

The future

Although you are likely to make a complete recovery, there is a chance that the hernia can return (the risk is 1 in 20). The likeliness of it returning is dependent on several factors, such as the size of the hernia, whether you are overweight or have underlying medical problems, and the strength of your abdominal muscles. Ask your surgeon what the likeliness is of your hernia coming back.

Summary

An incisional hernia is known as a weakness in your abdominal wall which develops as a result of previous cuts failing to heal. If not operated on, an incision hernia can result in some major complications. Surgery is generally both safe and effective, but you should be aware that complications can happen. By understanding the risks and the complications, you can be fully informed to make a decision about the operation. It will also help you detect and catch any issues early on.

 

References: EIDO Healthcare Limited – The operation and treatment information on this page is produced using information from EIDO Healthcare Ltd and is licensed by Aspen Healthcare. 

The information should not replace advice that your relevant health professional would give you.

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