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ABC of General Surgery

Hernia

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 1. What is a hernia?
  A hernia is a weakness in the wall of the abdomen.  Abdominal contents, such as a loop of bowel, can push through the weak area and cause a bulge that is visible on the outside.  When the pressure in the abdomen increases, such as on standing, coughing or straining, the bulge gets bigger and may become painful.

2. What causes hernias?
Some hernias are present from birth while others develop later in life, often as a result of persistent straining. Hernias tend to occur at places where there is a natural weakness in the wall of the abdomen, such as in the groin (inguinal hernia), the top of the leg (femoral hernia) or around the tummy button (umbilical hernia). Some hernias occur at the site of a previous operation (incisional hernia).  Hernias occur in both men and women, although inguinal hernias are much more common in men.

3. How do you diagnose a hernia?
A careful examination by a doctor is usually all that is required to diagnose a hernia.  It is not usually necessary to perform any special tests such as X-rays to diagnose a hernia.

4. What will happen if I have a hernia and I do nothing about it?
Many people have hernias that never cause any problems.  Some people notice aching around the hernia after standing, lifting or straining.  In a few patients a loop of bowel gets stuck in the hernia and becomes blocked and if not treated urgently this sort of hernia can strangulate and cause a serious illness.  Treatment for the hernia is required to avoid this problem.

5. What treatment is required for a hernia?
It is possible to treat some hernias with a specially made support or truss.  A truss works by supporting the abdominal wall but does not cure the hernia.  The only way to cure a hernia is to have the weakness in the abdominal wall repaired and this requires a surgical operation.

6. What will happen if I need an operation on my hernia?
If your specialist advises surgery for a hernia it is necessary to come to hospital for the operation.  In most cases hernia surgery can be done as a day case procedure.  This means that you only come to hospital for the operation and can go home later the same day.  If your specialist feels that a day case procedure is not appropriate then you will be admitted to hospital, usually the day before the operation.  In most cases you can be discharged the day after the operation.  Many hernias can be repaired under local anaesthetic that makes the area around the hernia completely numb while you remain awake.  Other hernias require a full or general anaesthetic and you are asleep for the duration of the operation.  Your surgeon and anaesthetist will discuss with you before which type of anaesthetic is appropriate for you.

7. What does the operation involve?
A hernia operation has three stages: first the “bulge” is exposed; next the bulge is pushed back into the abdomen; and finally the weakness in the abdominal wall is repaired with stitches or reinforcing plastic mesh to prevent the bulge reappearing.  The position, type and size of the hernia will determine which technique is appropriate for you and your surgeon will discuss this with you before the operation.  The skin incision is normally closed with hidden stitches.  These stitches do not need to be removed and the body slowly absorbs them as the wound heals.

8. What are the possible complications of a hernia operation?
Hernia surgery is low risk but complications can occasionally occur.  Some degree of bruising is expected after this type of surgery and the area can get quite swollen, particularly if the hernia was large.  Infection can occasionally get into the wound and if so may require treatment with antibiotics.  A scar is expected after healing is complete.  Occasionally a small area of skin around the scar is slightly numb after the operation and this usually improves with time. 

9. What will happen after the operation?
After the operation you are asked to rest in bed for a few hours to reduce the risk of bleeding.  All surgery involves a degree of discomfort afterwards and you will be discharged with a short course of mild pain-killers which you are advised to take according to the instructions.  You can eat and drink as normal as soon as you have recovered from the effects of the anaesthetic.  After the operation you can walk freely but are advised not to attempt strenuous exercise, running or heavy lifting.  The dressings only need to be changed if any soiling occurs.  After two weeks the wounds should be healed and any bruising almost gone.

10. How long does it take to recover?
Most patients find that about two weeks is required to recover fully after hernia surgery but this depends on the site and size of the hernia.  How long you stay off work is dependent on the type of work you do.  Common sense says “if it hurts don’t do it”, and that is your best guide.  If you are a driver you are safe to drive again when you can do an emergency stop without significant discomfort.

11. What can I do to speed up my recovery?
Common sense tells you that a good diet, plenty of rest and a sensible amount of exercise will allow the natural healing process do its job properly.

12. Where can I go for help if I think there is a problem after the operation?
If you are concerned then first read the printed information booklet.  Most problems that occur are minor and can be easily remedied using the advice given in the booklet.  The booklet should give a telephone number at the hospital that you can call to ask for advice if you are still worried.  Only consider calling your GP if you are advised by the hospital or you cannot contact the hospital help line.

13. Will I need to come back to hospital after the operation?
Most patients do not need to be seen again in the outpatient clinic after their hernia operation.  If your specialist feels that you should be seen then an appointment will be made before you are discharged from hospital.

14. Will the operation cure all the symptoms?
It is always difficult to predict the exact outcome of surgery in every patient but most patients have no problems and get complete relief of their symptoms.

15. Will the hernia come back?
In most patients hernias do not come back but in a few patients the hernia may recur (less than one in fifty).  If this happens further surgery may become necessary.  Surgery on one side will not prevent a hernia from developing on the other side.

© S.R.Dodds 2006

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