Frequently Asked Hernia Operation Questions
What about arranging the operation?
The date and venue of the hospital are usually chosen at the time of the first consultation.
If there are complicating factors such as other conditions, heart problems, and blood thinning medications, allowances may be made for these. In addition we sometimes get you to check out with other Specialists whose care you have been under. We will arrange this as necessary.
You will need to fill in the hospital pre-admission form, which is then submitted to the hospital on your behalf.
We also need you to sign an informed financial consent to ensure you understand all of the different costs.
If you are insured you need to check with the hospital or fund you are covered with as to whether you have an excess to pay. If you have taken out your insurance less than one year previously you may not be covered because of the pre-existing rule. You should let us know so that we can help with this matter.
Once the formalities have been completed the Surgeon will speak to you again to ensure that you understand the process and to answer any specific questions you have thought of. You must ensure that we know about your allergies and medications.
Are there any risks to the operation?
The possible risks are outlined on the Website.
You are also given a form, which explains the risks, and the post-operative care and return to normal activities. We will discuss all of these issues with you. Generally the risks of surgery for hernia operations are low. If however, if you have a specific risk, which worries you, you should ask about it.
What about the mesh and the staples?
A non-absorbable mesh is used to make your hernia repair strong.
We have been using the mesh since it was developed in the 1980’s. We have been very pleased with its use. It is extremely rare for the mesh to be rejected or become infected and need removal. Many types of mesh have come into use. We mostly use a Polypropylene flat mesh, which is placed between the muscles and is fixed into position with non-magnetic staples (no worry at airports or MRI machines).
It has been shown recently that staples give a better result than sutures in terms of recurrence. They also cannot become infected.
The meshes come in various strengths, weights and pore size. They can be fashioned or supplied as a variety of plugs. We choose the appropriate mesh for each case. The use of the mesh means that stitching is minimal and muscles do not have to be pulled tightly together – thus there is less pain and less chances of the stitches pulling out. The technique used means that almost all patients go home the same day whereas years ago they might have stayed in, for several days at least.
What about the risks of infection?
Our audit shows an infection rate of less than 1% for inguinal hernias.
It is also very low for other types of hernias. Antibiotics are thus not routinely used for inguinal hernias but are routinely used for umbilical hernias, as the belly button is considered non-sterile.
An infection in the wound is treated usually in the office by drainage under Local Anaesthetic and an antibiotic cover. It is our experience despite the very occasional wound infection, that the mesh does not become infected or require removal.
What happens on the day of the surgery?
You will have had nothing to eat or drink from midnight if your operation is in the morning.
It is difficult to give you an exact time as to when your operation will start. We like to get you in early to allow you to settle down, to go through the admission process and for the Anaesthetist to see you in a relaxed atmosphere. You may bring a newspaper with you. We do try to reduce waiting time but if you may recall patients used to always come into hospital the day before surgery to settle down. It is much more convenient now.
The Anaesthetist will come and see you and go over your details. If there is something you would like to discuss with the Anaesthetist prior to surgery, you may contact them privately by obtaining their phone number from us. This might include such things as allergies, previous anaesthetic problems and even the anaesthetic fees.
The Surgeon and Anaesthetist will introduce themselves again prior to the surgery. In theatre, the side will be marked and all consents checked. You will need a shave at the time of surgery.
The Anaesthetist will discuss with you the type of anaesthetic you are to have. Our standard is to give you intravenous sedation through a needle, and then insert Local Anaesthetic into the operative field. You will not feel the injections, but are awake enough during the procedure to cough and strain to demonstrate the hernia and to demonstrate that the hernia repair is sound. In over 10,000 cases we have had no complaints regarding this technique and it is proved to be by far the safest way in our opinion of having a hernia repair carried out. Our Anaesthetist will cater to your special requirements about anxiety – some patients will be kept deeper. It is rare for a General Anaesthetic to be required.
What about recovery?
You will go to what is called the first stage recovery where you are lying down and monitored.
Because you have had such a light sedation you only need to stay there for a short time to have your observations taken to ensure all is well. The wound will be inspected to ensure there is no bleeding. You are then moved to the next stage where you are lying down but can have some light refreshments. Because you have not had a General Anaesthetic you are able to mobilise promptly and have something to eat and drink. You will then be asked to sit in the recovery area and the process of going home is commenced.
The whole time from “go to wo” might only be three or four hours. The standard time for an inguinal hernia operation is approximately 35 minutes but we have to allow an hour of theatre time for preparation and recovery.
What about going home?
You will need to be driven home and should rest the first day.
You will be able to get out of bed and go to the toilet. You should have somebody with you, as occasionally patients can feel faint. There is no pain for the first four to six hours because of the Local Anaesthetic in place. You will be given instructions regarding painkillers.
You are instructed to ring the Surgeon the following day on his mobile number to ensure all is well and you can ask any relevant questions. If he does not answer, leave a message or try again but he will definitely return your call. Most Day Surgery Centres will also be in touch with you the following day to ensure all is well. You can always ring the office during office hours.
Can anything go wrong in the first day or two?
Usually there are no problems.
The type of phone calls we get relate to some swelling or bruising in the area. This usually subsides within one week and does not signify any particular complication. We do review you within one week of the surgery and you are welcome to ring on any day if you have any concerns. Some patients complain about the effects of the painkillers, such as feeling light-headed or a little nauseated. The painkillers may require adjustment. You should be careful when going to the toilet or bathroom, as you may feel faint. You should have somebody accompany you.
You will have instructions regarding your dressing. Basically we prefer just to leave this alone as it is waterproof and rarely becomes disturbed. It is a see through dressing so sometimes some blood can be seen. Do not be alarmed it is usually only a small amount. However if the blood actually trickles from under the dressing onto your leg then you should let us know. If you wish the dressing can be changed for you by attending the hospital earlier.
What about the bowels?
This is a commonly asked question as the painkillers and the operation may slow your bowels down.
You may take some medication for this or adjust the painkillers as required. In occasional cases suppositories or enemas may need to be used. However patients never come to harm because of their bowels. If you have any concerns, ask about different medications even prior to the procedure.
Are there any other possible complications?
It is very unusual to develop any severe problems.
Rarely acute retention of urine, rarely clots in the leg and rarely lung problems. They are rare complications, which are associated with any operation not just specifically a hernia operation.
What about the pain?
This varies enormously.
We have audited our patients to find that many patients do not need painkillers whatsoever. However the majority require some type of painkiller for a day or two whilst other require painkillers for a longer period. Some patients do not tolerate some painkillers and the painkillers are sometimes altered if not working well.
What about return to activities?
The quicker you mobilise the better.
However if you have undue pain then just be careful. The most painful time appears to be getting out of bed the next day so you may like to take a painkiller before you do so and just get out of bed very slowly. This also reduces the risk of fainting as your blood pressure adjusts. If you live upstairs it is preferable not to have to walk up and down stairs for the first couple of days as you may find this difficult.
We usually advise you not to drive for the first four or five days.
What about the first post-operative visit?
You will be seen within six to ten days of the surgery.
At that visit you will be asked a few questions to complete our audit. A letter will be dictated for your General Practitioner so he is aware of what has transpired. He will also be sent a copy of your operation report.
The dressing will be changed. This is usually not painful. Usually dissolving sutures have been used in the wound and this reduces the risk of infection and usually leaves a very neat scar.
There may be some residual swelling and bruising. This will be checked. It is rare that any other measures will need to be taken.
Your post-operative recovery will be discussed and your return to work plan assessed. Many patients ask about their sporting activities and we also discuss this.
For example we usually say not to play golf for about four to six weeks – tennis etc the same. We also ask you to avoid heavy lifting for four to six weeks.
Will I be seen again?
This is up to you.
Many patients prefer not to have to come again but we offer you the choice of ringing up at any time or making an appointment to see us within a few weeks if necessary.
Pain may come and go a little but usually there is a downward trend.
Some patients are concerned about thickening under the wound – this ridge becomes apparent a week or so after the residual swelling has subsided. There may or may not be a ridge. The ridge is due to the tissues healing as we suture the underlying tissues well to prevent any bleeding. This will disappear completely within a few weeks.