Repairing Hernias Surgically " Part Three"
The operative site of the repaired hernia will typically exhibit swelling, hardness and bruising secondary to the tissue fluid and blood under the wound, the wound being pulled together by the stitches and lastly by scar formation. All this will settle within a few weeks as healing progresses. Bruising tends to track downwards as the blood moves under the influence of gravity so at times the genital area can become black and blue in colour, but again will settle.
Bruising can be very widespread at times and sometimes a blood collection called a haematoma can present as a bulge under the skin or close to the repair, caused by small blood vessel bleeding. A haematoma may gradually resolve over time but at times may need surgical exploration and evacuation. Swelling around the testicle can remain for a long period if bleeding tracks into the scrotum.
During the operation a small nerve which travels across the incision line may be cut through, causing a minor area of numb feeling at the inner end of the incision. To do the operation well this nerve has to be cut but because the numb area gets smaller with time and is hidden under the pubic hair it does not normally cause any problems. A chronic pain problem over the area of the repair can develop in one in twenty patients and can be a significant problem. Nerve stretch as the operation is being done or the nerve becoming tethered as the healing proceeds are possible reasons for this pain. A pain killer can be injected into the painful area to reduce the pain but in some cases the surgeon will need to re-explore the area to find the trapped nerve and release it.
There is the possibility of damage during the operation to structures around the hernia, the artery, tube to the testicle and the vein. These risks are greater when surgery is done for a recurrent hernia. The testicle can lose its blood supply and shrivel and require removal, and if the tube to the testicle is damaged it will mean the other testicle will need to maintain fertility. This is usually very possible. Removal of the testicle in older patients may be advised routinely by surgeons who are repairing a recurrent hernia and want the best outcome.
An infection in the hernia wound is a risk but not common and antibiotics are prescribed if the wound gets red or inflamed. If an infection worsens and starts producing pus then the surgeon may need to re-open the wound and clean it out to release the infection. The risk of a hernia recurring increases with the presence of infection. Infection of the mesh means it will need to be removed and once the infection has settled the repair will need to be repeated. There is a degree of risk of a deep vein thrombosis (DVT) but this is not common. Getting up and about walking again and keeping the legs and feet moving regularly are helpful to keep the circulation going and prevent DVT.
The chances of a hernia happening again are less than once in twenty cases after the first repair of a hernia. To have a general anaesthetic involves some risk and this is greater if the patient is suffering from a longstanding medical illness or disease. Short term side effects with the frequency of one in ten to a hundred are blurred vision, pain over the site of injection, bruising and sickness. These are easily managed and do not persist for long.
Less common complications with a frequency 1 in 100 to 10,000 cover pains in the muscles, damage to the lips, teeth or tongue, headaches, temporary problems with speaking, sore throat and short term breathing difficulties. Serious and very rare complications with a frequency of less than 1 in 10,000 cover kidney and liver failure, long term nerve or blood vessel damage, damage to the lungs, eye injury, voice box damage, brain damage, severe allergy reactions and death. The rarity of these complications means that the frequency depends on co-existing medical problems.