What are hernias?
Hernias occur when the inner walls of the abdomen weaken causing a bulge. A hernia is commonly described as being similar to an inner tube that has started to protrude through a damaged tyre. In the case of the body this may result in a small balloon or sac through which abdominal tissue or a part of the intestine pushes. This results in severe pain and in rare instances emergency surgery.

How do I know I have a hernia?
The most common symptoms of hernias are feeling pain during lifting, coughing, bowel movements or standing for a long time. It is also likely you will see a small bulge under your skin. Hernias usually occur in the groin (known as inguinal hernias), in the belly button (umbilical) and where there has been previous surgery (incisional).

What happens during consultation?
The surgeon will ask if you have had abdominal surgery and whether you suffer from any medical conditions. He or she will then decide if hernia surgery is appropriate for you. In most instances hernia keyhole or laparoscopic surgery can be easily carried out. In some cases however, such as on people who are obese or suffer from specific medical conditions more traditional ‘open’ surgery may be necessary.

Getting the most out of your consultancy
You have to make an informed decision before signing the consent form so make sure you ask plenty of questions. You want to feel relaxed, confident and completely understand what will happen during surgery.

You may want to know:

• About the surgeon’s qualifications.
• How many operations of your procedure are carried out each year.
• How you prepare for surgery.
• What realistic results can be expected and when.
• How long the results will last.
• About the side-effects and possible complications.
• How long it will take to recover.
• About the extent of scarring and how it will change in time.
• What happens if anything goes wrong.

Preparing for surgery

• Avoid alcohol, aspirin, garlic and food oils a least a week before surgery as they can cause excessive bleeding.
• Do not eat or drink anything six hours before your general anaesthetic.
• The surgeon and anaesthetist need to know your medical history and if you are on any medication.
• You will be advised of any health checks or X-rays required before your procedure.
• Prior to the operation you will meet your surgeon who will assess you and discuss your queries.
• Try and give up smoking a couple of weeks before your procedure as it interferes with healing processes.

What happens during surgery?
This depends on the type of hernia being treated and the surgical procedure required.

With keyhole surgery the patient is usually placed under general anaesthetic before the operation. A hollow needle is first inserted into the abdomen to inflate it. Another incision is made in the stomach to allow the laparoscope to be inserted which allows the surgeon to monitor the operation on a video screen. Two other small incisions are then made for surgical instruments

The hernia is then repaired from behind the wall of the abdomen. The hernia is pushed back in place and secured with stitches, mesh or a plug. The instruments are removed and each of the four incisions (approximately three centimetres long) are stitched.

In cases of open surgery the incision area is wider to allow the surgeon great access to the hernia. However, the treatment of the defect is fundamentally the same as that of laparoscopic surgery.

After surgery
When you come round from the anaesthetic there is a chance you will feel sore and painkillers are likely to be prescribed. Your surgeon will see you to check when you can be discharged. Bandages or dressings are normally removed after one to five days.

Whether you have had keyhole or open surgery it is vital that you take it easy for a few days and follow the advice of your surgeon. Avoid alcohol, aspirin, garlic, food oils and smoking. All of these can interfere with the body’s healing processes.

When to call your surgeon

• You must contact your surgeon if you suffer from bleeding or have a fever.
• If you experience any abdominal or groin swelling.
• If you have constant coughs, shortness of breath or persistent nausea.
• Consistent pain that is not relieved by painkillers.
• Any abnormal soreness around the area of the incisions.

Road to recovery

• Continue taking painkillers if you need them.
• Depending on the surgeon’s advice, dressings or bandages may have to be worn.
• If the surgeon recommends that you take medication, make sure you complete the course.
• Your treated area is likely to feel sore during the first couple of weeks, so get plenty of rest.
• The surgeon will advise you of when you can return to physical activity.
• If you are in doubt about any of the post operative effects speak to your surgeon.

All surgery carries an element of risk
Before you sign the surgery consent form you should be aware of any possible complications and side effects.

Complications associated with any type of surgery include problems healing, the danger of infection and the potential formation of clots that may be life-threatening. Excessive bleeding or bleeding under the skin, known as a haematoma, may require a return visit to the surgery. Some patients may also have an allergic reaction to anaesthesia. In a minority of cases there may be a problem with fluid loss or an excessive build up of fluid that needs to be drained.

Deciding on hernia surgery
Unfortunately surgery is the only cure for a hernia. Still, it is important that you take your time to make an informed decision before you proceed. Complications are rare, however you must consider any potential outcome.

• After a successful operation you may feel sick due to the anaesthetic and bruises formed by the procedure may take several weeks to heal.
• There will be scars left by the incisions.
• Rare complications include potential damage to other organs or blood vessels.
• In cases of inquinal hernas one to four per cent recur.

Complications are rare and depend greatly on individual circumstances such as a person’s health and the extent of the procedure. Your surgeon will be able to explain how the risks apply in your circumstances.