Repair of Hernias Surgically ” 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.
A double hernia where both sides of the groin are affected is best repaired using a laparoscopic technique which is also best for recurring hernias as the surgeon can avoid going in through previously scarred areas. Five year results of these operations show that laparoscopic results are as good as open results but over longer times than this any differences have not been shown. Laparoscopic surgery has the advantage of the patient being able to get back to activity quicker but the ability to use a local anaesthetic means that open repair is better for a first repair.
Hernias can be repaired under general and local anaesthetic, the general injected into the hand and the local anaesthetic is injected into the area of the operation. During repair under local anaesthetic the patient is aware that something is happening in the area of the operation but this should not be painful. The operation usually takes 30 to 60 minutes and even under general anaesthetic the surgeon will inject some long acting local anaesthetic to make the patient more comfortable after they wake up. A long acting painkiller in the form of a suppository may also be used.
No food should be eaten for the six hours prior to the operation and no fluids for two hours before the event. Afterwards patients can get up and walk around when they feel they can with assistance from one of the staff the first time they get up. If stitches are only placed under the skin they will not need to be removed but if they or clips are used in the skin they should be removed after about seven days.
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.
There will be some pulling and aching in the operated area as the healing tissues regain their suppleness and are stretched in movements while the mesh is bedding in. Using a bath or shower to wash the wound with water and soap is acceptable once the dressing has been removed and about two days have passed. It is wise to avoid using talcum powder for about a week. A transparent dressing can be applied and remains over some days, permitting bathing and washing. At ten days from the operation the wound will be healed up and dry, allowing swimming which should not be attempted before this time.
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.