Hernia Repair " Part Two"
The description of a hernia and the need for operation or other treatment is discussed in part one. Now we review laparoscopic surgery and post operative care.
Repair via laparoscopy is advantageous if the patient has a double hernia (both groins affected) and for repeating hernias because the incisions can avoid the areas of the previous scars. Results up to five years after operation show that the success of this intervention is the same as normal open hernia repair but longer term results are not yet clear. It is possible to get back to normal activity more quickly after laparoscopic surgery but if it is a first time hernia repair the advantage of using a local anaesthetic for open surgery outweighs using a laparoscope.
Surgeons can repair hernias either under general anaesthetic or by using a local, the latter being injected into the operation site and the former injected through a venflon in the back of the hand. Pain during the operation under local should not be noticeable but patients may be aware that something is occurring at the site of the operation. Surgeons take thirty to sixty minutes to perform this repair and an anaesthetic with an extended time of action is often injected into the site so there is less pain when someone wakes up, and this can also be given by suppository.
Patients do not take any food for six hours before the operation and no fluids for the two hours beforehand. After the operation patients can walk about as soon as they feel able, with someone initially assisting them on getting up first. Stitches may be wholly placed under the skin and so they do not need to be removed. If clips or stitches in the skin are used they will need to be removed after about a week.
When a patient is ready to go home is very variable and the important factors are the presence of an adult at home to look after them, how well they are overall and the levels of pain they have been experiencing. Pain levels are extremely variable, with the majority having some pain for three to four days, especially when getting up into sitting from lying and getting down into a chair or back into bed. The muscles which have been repaired are working hard in these activities. To encourage activity and make sleep easier, painkillers are typically suggested.
Pulling and aching as the tissues stretch and become more mobile is common in the first four weeks as the amount of activity increases and the plastic mesh settles in. Careful washing of the wound with water and soap in a shower or a bath is allowable after about a couple of days once the dressing has been taken off. Talc should be avoided for about seven days. A transparent dressing can be used which is left in place for several days and allows both bathing and washing. The wound should be dry and well healed by about ten days after the event, making swimming unwise until this point.
Walking about can be attempted as soon as the patients feel they want to even though stiffness is common at first and long distance walking will not be easily achievable for at least a week after the event. Driving a car can be re-started once the patient feels confident enough to perform emergency manoeuvres, a point usually reached after ten days. Returning to work can be considered once patients feel they are comfortable enough to manage the physical activity. If they work from home or can resume work part time, patients can get back very early after the operation.
It is usual to feel stiffness in the abdomen whilst walking about although walking can be started whenever the patient feels like it. Longer distances are unlikely to be achieved until the first week has elapsed. Patients can go back to car driving when they feel sure they can perform emergency control activities and this is unlikely to occur before ten days. Work return can be attempted whenever the patient is comfy enough to get on with normal activities, although if they can work part time or from home they can re-start soon after operation.