Hernia Surgery

Weak spots can develop in the layer of muscle in the abdominal wall, resulting in the contents of the abdomen pushing through. This produces a lump called hernia. A swelling becomes apparent on the abdominal wall, most commonly in the groin region, where it is known as an inguinal hernia. A hernia develops because of a weakness in the abdominal wall that allows the protuberance of fat and/or bowel which is contained in a sac of the inner lining of the abdominal cavity (peritoneum). The weakness might have been present for many years or might have developed with age or after the failure of a surgical wound (incisional hernia). The risks are that small bowel can enter the sac and become trapped, causing bowel obstruction and/or perforation.

Certain factors such as chronic constipation, chronic coughing, obesity, and an enlarged prostate may increase the risk of developing a hernia.

Dr.Himanshu Yadav is a senior consultant at Global Rainbow Hospital, Apollo Clinic and Wims Hospital Agra. He is an expert in all types of Hernia repair & management and provides comprehensive care to all his patients.

Common types of Hernia

Inguinal hernia: This is a common type of hernia, especially in men. It often develops as a result of strenuous activity and becomes uncomfortable and is often associated with a bulge or lump in the groin area. Sometimes the hernia can become very large and descend into the scrotum. The treatment for inguinal hernia is surgery. A truss, advocated by some, is not advised. Surgery can be performed from the front (open hernia repair) or with more extensive dissection from behind using laparoscopic methods (laparoscopic hernia repair). Both are effective, and both use mesh. Despite what enthusiasts for laparoscopic hernia repair will say, the evidence shows that there is very little difference between the two approaches. The alternatives will be discussed.

Epigastric hernia: There is a natural line of weakness in the upper midline of the abdomen and this is where epigastric hernias develop. The principles of surgical repair are similar.

Umbilical and para-umbilical hernias: Another area of weakness is in and around the umbilicus (tummy button). The principles of repair are similar.

Incisional hernia: Incisional hernia occurs because of the failure of the scar from a previous surgical incision made in the abdomen. They are more common after infection of the previous incision and in obese or pregnant patients. Incisional hernias can be very small or large and several repair options will be discussed.

Femoral Hernia: Femoral hernias more commonly develop in women and older patients. The defect is below the inguinal region.

Virtually all hernias need to be surgically repaired. The principle is the same for all hernias. The peritoneal sac needs to be identified and separated from surrounding tissue, opened and the contents reduced back into the abdomen, tied off and the sac removed, and then repair the weakness in the abdominal wall. This repair can be done by just closing the edges together with strong stitches or by using an artificial mesh to bridge the defect. The mesh can be laid inside the defect or on the outside. Both traditional open and laparoscopic approaches are widely used. The operation is finished by closing the fat and skin layers.

Surgical repair of Hernias

Open approach via an incision in the groin

Laparoscopic technique, “keyhole” surgery, using narrow instruments and a video monitor.

Open hernia repair: Under general anesthetic, a skin crease incision is made in the groin overlying the lump. The hernia is identified and dealt with by isolating the peritoneal sac, reducing its contents, closing and excising the redundant sac and then gently laying a reinforcing mesh over the weakened area. The muscle, fat and skin are closed over this.

Laparoscopic hernia repair: The laparoscopic technique of hernia repair avoids the large skin and muscle cut-off open approaches, as well as the closure of the defect with sutures under some tension. This way post-operative pain is decreased, and an earlier return to discomfort-free work is possible. The laparoscopic approach to inguinal hernia repair involves three small incisions and an extensive dissection of the abdominal wall behind the hernia and a more difficult dissection of the sac. A much larger mesh is used and fixed with a series of tacks.

Post-op care after hernia repair

1. Diet – Some patients may find that their appetite is poor for a week or two after surgery. This is a normal result of the stress of surgery– your appetite should return in time. If you find you are persistently nauseated or unable to take in liquids, contact our office and let us know.

2. Wound care – It is OK to shower starting around 36 hours after surgery. If you have a dressing on the incisions, take it off before showering. You might see little pieces of tape (called steri-strips) directly attached to your skin. It is OK to get these little tapes wet in the shower. The tapes will begin to peel up on the ends 7-10 days after surgery – at this point, they have done their job and it is OK for you to peel them the rest of the way off if you wish. You do not have to have them on when you come for your postoperative visit.
No baths, pools or hot tubs for two weeks following surgery.
We try to close your incisions to leave the smallest possible scar. Do not put any ointment or other medication on your incisions – it will not make them “heal better.”

3. Activity – There are certain medical or physical restrictions on activity after surgery. That means it is OK to walk, climb stairs, lift, and have sexual intercourse as long as it doesn’t hurt. In fact, returning to normal activity as soon as possible will most likely enhance your recovery. However, if it doesn’t feel good, don’t do it. Take it easy and let pain be your guide! You may also feel easily fatigued and “washed out” for a week or two following the surgery. These factors will put some limitations on your activity, but you will not cause any damage even if some soreness is experienced. However, It is recommended that patients who have undergone an umbilical hernia surgery avoid any strenuous activity for at least six weeks. Do NOT lift anything heavier than 15 pounds for a minimum of two weeks (or as instructed by your surgeon). Do NOT cough or strain while passing motion or do any activity that increases intra-abdominal pressure.

It is recommended to do the following

4. Work – Everyone returns to work at different times. If you want, you may return to work right away; however, as a rough guide, most people take at least 1-2 weeks off prior to returning to work. If you need particular documentation for your job, call the office.

5. Driving – You will usually be able to drive when you have not needed the narcotic (prescription) pain medications for two days.

6. Bowel movements – The first bowel movement may occur anywhere from 1-5 days after surgery – as long as you are not nauseated or having abdominal pain this variation is acceptable. Remember that it is very common to pass a lot more gas from your rectum than you used to – this is because you will not be able to really belch. Some patients also find that they have diarrhea or “loose bowels” for the first days after their hernia repair – in the vast majority of cases, the bowel function normalizes with time. Constipation may also be common due to the pain medication. We recommend taking Milk of Magnesia (2 tablespoons; twice a day) while taking the pain pills to avoid constipation.

7. Seroma – Some patients find that their hernia “returns” right after surgery. Don’t worry – this is a normal feeling and/or appearance. The hernia repair did not fail – the place where the hernia contents were can sometimes fill up with post-operative fluid – this fluid is a normal result of surgery and will usually be absorbed by the body in several weeks.

8. WHEN TO CALL @Dr.Himanshus clinic

Post-Surgery Hernia Pain

Is Pain After Hernia Surgery Normal? What You Should Know

What to Do for Abdominal Pain After Hernia Surgery
If you are experiencing pain after hernia surgery, we want to talk about it with you. This helps us learn how best to treat your hernia pain. As caregivers, we will ask many of the following questions before, during, and after pain control treatments to help us learn more about your abdominal pain after surgery.

Hernia Pain Medicine Options

Hernia Pain Control Techniques

Pain control techniques help you deal with pain instead of taking it away. It is important to practice the technique even when you do not have pain if possible. This will help the technique work better during an attack of pain.

Activity: It is important to start moving as soon as possible after hernia surgery. Moving helps your breathing and digestion and helps you heal faster. But, it may hurt to move even though moving and being active actually helps lessen abdominal pain over time. At first you may need to rest in bed with your upper body raised on pillows. This helps you breathe easier and may help lessen post-surgery hernia pain.

Cold and Heat: Both cold and heat can help lessen some types of post-op pain. Some types of pain improve best using cold while other types of pain improve most with heat. Caregivers will tell you if cold and/or hot packs will help your abdominal pain after hernia surgery.

Pillow: Holding a pillow firmly against your incision can help lessen the pain.

Distraction: By distracting yourself, you can focus your attention on something other than the pain. Playing cards or games, talking and visiting with family may relax you and keep you from thinking about your hernia pain. Watching TV or reading may also be helpful.

Music: It does not matter whether you listen to music, sing, hum or play an instrument. Music increases blood flow to the brain and helps you take in more air. It increases energy and helps change your mood. Music may also cause your brain to make endorphins which further lessens pain.

Relaxation Techniques: Stress and anxiety can make pain worse and may slow healing. Since it is difficult to avoid stress, learn to control it. Ask for more information on deep breathing exercises, muscle relaxation techniques, or meditation.

Comfort Measures to Aid with Hernia Pain

Additional Information About Post-Surgery Hernia Pain Medication

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