Hernia Repair

Introduction to Procedure

We know that undergoing any procedure is a scary experience. We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd. We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.

Description of procedure

Umbilical/Paraumbilical

This is a weakness or defect in the anterior abdominal wall, which may be congenital or acquired. It results in the protrusion of intra-abdominal contents, which are at risk of strangulation or obstructing, or is simply painful. The hernia is usually repaired via a transverse incision over the hernia protrusion with a Mesh to cover the defect.

Epigastric

The hernia develops due to a weakness in the midline linea alba where the fibres of the rectus sheath decussate.

Incisional hernia

This is an iatrogenic hernia resulting from previous incisions over the anterior abdominal wall. Incisional hernia formation is due to poor abdominal wall structure, infection, of failure in surgical technique. The rate of incisional hernia occurrence has been reported as high as 13%.

Operative techniques

Both laparoscopic and open surgical repair have been used for incisional hernias.

Additional procedures that may become necessary

More than one repair – since recurrence rates are high, especially for incisional hernia.
Postoperative surgical drain insertion.

Benefits

Relief of local symptoms of pain, discomfort, and cosmetic improvement.
Reduction in the risk of future surgical emergency (incarceration, bowel obstruction).
To treat the complications of an incarcerated or obstructed hernia.

Serious/frequently occurring risks

The risk of complications has been shown to be about 13%.
The risk of recurrence and repeated surgery is as high as 20 – 52% particularly with open procedure in obese patients.
Laparoscopy with mesh has shown rates of recurrence.

Postoperative complications include:

Seroma, sometimes requiring aspiration.
Postoperative bleeding, though seldom enough to require repeat surgery.
Prolonged pain, treated with pain medication or anti-inflammatory drugs.
Intestinal injury due to adhesions with the sac.
Nerve injury.
Surgical wound infection.
Infected mesh with chronic sinus, requiring removal of Mesh.
Urinary retention in immediate postoperative period.
Respiratory distress due to loss of domain from large hernia repair.

Blood transfusion necessary

Group and save: The process of determining the patient’s ABO blood group and screening serum for the presence of antibodies to common red cell antigens that can cause transfusion reactions.
Cross-match 2 – 4 units blood.

Type of anaesthesia/sedation

General anaesthesia.
Regional (spinal/epidural).
Local anaesthesia.

Follow-up or need for further procedure

Review as outpatient in clinic.