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Hernias have different names, depending on their location or cause. The problem is simply a weakness of the abdominal wall, either inherited or caused by a trauma or previous surgical procedure. In either case the problem is that the abdominal contents are protruding through a hole in the abdominal wall and there is danger for strangulation of the contents.
Hernias are fixed to prevent problems with strangulation of the contents, or due to symptoms that the patient has. Hernias can be repaired laparoscopically or with the open technique. The surgeon will discuss the options with the pt along with pros and cons.
A mesh (synthetic material) is usually used in both types of repair to prevent recurrence of the hernia. There are many types of hernia. I will mention here the most commonly seen.
Types
- I.ventral/incisional - could be seen anywhere in the abdomen. Many times around the umbilical area. Incisional hernia is the term for the hernia seen in an old scar. Most successful way to repair is laparoscopically
- Ii.inguinal - located in the groins. This is usually congenital (borne with) and it gets larger and symptomatic as time goes by. Can be repaired laparoscopically or open. It is my opinion that open is superior from the recurrence stand point and the risks stand point. Will discuss with the pt
- Iii.femoral - seen in the thigh usually, just below the crease of the leg. Same as the inguinal. This is more common in females while inguinal more in male.
- Iv.umbilical - smaller version of the ventral hernia. Usually fixed with the open procedure since is small and easy to fix
Risks of Hernia Surgery
The risk of hernia surgery is specific to each type of hernia and the repair. First i will list the common risks to all hernia surgery, then the procedure specific. Once more, this lists the most common risks and complications. There may be other risks and complications that are not listed here and are associated to anesthesia.
- Bleeding
- Infection
- Recurrence
Procedure specific
Ventra hernia/incisional/umbilical
Since the abdomen is entered there is the risk of bowel injury. Seroma formation can be seen. It is less of a problem when done laparoscopically. Seroma is a fluid collection. When the hernia is done open we leave a drain. Laparoscpic ventral hernia repair is not drained and the seroma reabsorbs itself. Inguinal/femoral
Seroma formation can be seen and it is not drained in either laparoscopic or open repair
In the open repair the abdomina cavity is not entered so there is no reiks of bowel puncture. The laparoscopic approach carries this risk, along with the risk of adhesions to scar and to mesh. Both repairs carry the risk of vas deferens damage (if injured is the equivalent of a vasectomy). Also testicular damage, nerve entrapment or injury causing pain or numbness in the groin. The nerve damage is to a cutaneous nerve and has no sexual dysfunction implications if damaged.
Before Surgery
- Shower the night before with regular soap
- Do not shave any part that will be operated on. this increases risk of infection.
- Avoid smoking 1-2 weeks before the procedure. it helps the
recovery time, wound healing and the recovery from anesthesia
- Avoid alcoholic beverages at least 48 hours before the surgery.
- Do not bring any valuables to the center or hospital
- If you are going home arrange for drop off and pick up
- Get a good night rest the night before surgery
- Make sure you have stopped all blood thinners at least 5-7 days before surgery. this includes
aspiring, plavix, coumadin, fish oil, vitamin E(large doses), or any non steroidal anti-inflammatory agent
- If you are having bowel surgery make sure that you have taken a bowel prep with antibiotics.
- If you have any questions call 281-737-0970. If after hours 281-604-1300
After Surgery
- Make sure that you have a follow up appointment fo 7-10 days. Call 281-737-0970 for one
- If it is a closed wound then the wound can and should be washed every day starting 24 hr
after the operation. Do not use peroxide or any other substance, just use water and soap.
- For open wounds, if packed then remove the packing every day and wash in shower every
day. Repack after washing and cover.
- If the wound has a drain then empty the drain every day and measure and record the amount.
Bring the amounts to the post op appointment.
- Call your doctor if bleeding, redness, ferver or any other symptom develops
- Start diet slowly since anesthesia can cause nausea and vomitting
- Stay active and ambulate daily, several times a day and take deep breaths.
(this is specially imporant for major surgeries)
- Stay hydrated and eat healthy
- Do not start any blood thinners, aspirin or aspirin like products for 5 days after surgery
- Call your doctor if any instruction is unclear or if yo have any questions at all
- If your had bowel surgery, diarrhea can be experienced, but if diarrhea is not improveing
then call yur doctor immediately. Avoid anti-diarrheasl unless your doctor tells you it is ok to take.
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