• Reference Number: HEY-780/2023
• Departments: Endoscopy
• Last Updated: 1 November 2023

Introduction

This leaflet has been produced to give you general information about your procedure.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Why do I need a hernia repair?

A hernia is a protrusion of abdominal contents through a weakness in the lining or muscle of the abdomen or groin area. This causes a bulge that may or may not be painful. Initially hernias contain internal fat but as the “gap” increases in size, occasionally the bowel can push through, which can cause ache or pains.

There are various sites where a hernia may occur and the name of the hernia indicates the site. The inguinal hernia is the most common and occurs in the groin. Other sites include umbilical (around the navel) and femoral (at the top of the leg). An incisional hernia may also occur following previous surgery at a weak point in the scar.

If left alone, the bulge (contents) might increase in size but the opening/ weakness can remain the same size. Sometimes fat or bowel can get stuck in the narrow “neck” of this weak point. If not treated, hernias can result in complications of blockage of the bowel (obstruction) or strangulation (loss of the blood supply). Your surgeon will discuss the balance of risks of “non-operation” (wait and see approach) against a planned operation. However, a wait and see approach may allow the hernia to become larger or risk complications. If complications occur emergency surgery may be required, which may be more invasive, such as bowel may need to be removed and risks are greater.

A truss for groin hernias does not usually hold the hernia back in place and may cause complications if incorrectly fitted. Abdominal support “corsets” can be useful if repair of abdominal wall hernias is to be avoided and can support repairs after an operation.

What is a hernia repair?

Most hernias are repaired under general anaesthetic (while you are asleep) and occasionally some are carried out under local anaesthetic where the area is made numb and you remain awake.

To repair a hernia, the intestines or other protruding tissues are returned to their normal position and the weakness in the abdominal wall is repaired. Sometimes it is necessary to support the repair with a mesh patch stitched or stapled to the muscle inside the operation site. A sheet of mesh is usually used in groin hernia repair and larger hernias, as stitches alone may not be strong enough.

Open surgery involves making an incision in the skin and muscle layers large enough to find and repair the weakness. The size of the incision varies depending on the type of hernia being repaired.

If “Laparoscopic” (keyhole) surgery is used, this will involve several small cuts (approximately 1cm or less) which are made in the abdominal wall to place hollow tube “ports” into the cavity of the abdomen through which long thin instruments and a camera are passed to allow the surgeon access to your organs.

The abdomen is temporarily inflated with a gas (carbon dioxide) to create the space in which the surgeon works. It is necessary for you to have a general anaesthetic (be asleep) whilst your abdomen is distended by this gas. At the end of the operation the gas is released, the wounds are sutured and you are woken up.

Can there be any complications or risks?

Possible complications of your particular type of hernia repair will be discussed with you by your surgeon and may include:

• Conversion to a conventional open operation (uncommon)
• Bleeding
• Wound haematoma (old blood collecting under the closed wound)
• Wound or mesh infection
• Recurrence of the hernia
• Scarring
• Seroma (a collection of fluid between the skin and the muscle/mesh)
• Deep vein thrombosis and pulmonary embolism (uncommon)
• Bowel injury or peritonitis (very uncommon)
• Need to return to theatre for further surgery (very uncommon)
• Death (very uncommon)

In groin hernia repair may also result in the following complications:

• Damage to testicular blood vessels or testicular damage
• Urinary retention
• Chronic pain

Please contact your doctor if you develop any of the following:

• Abdominal swelling or worsening pain
• A fever or shivering
• Redness, swelling or pus drainage from the operation wound

How do I prepare for the hernia repair?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination.

Before your operation

You will be having a general anaesthetic and will have a pre-operative screening appointment to assess your suitability for surgery, before you are given a date for your operation. At this appointment the nurse will take details of your:

• medical history and current medication
• home care arrangements after you have been discharged from hospital including relative / friend support and transport arrangements

Please use this opportunity to ask any questions about your surgery and aftercare. You will also be given instructions about preparing for your operation, which will include advice about:

• having a bath or shower before you come to the hospital
• eating and drinking
• pausing or taking your normal medication, if appropriate
• returning to work after surgery

On the day of admission please bring:

• this information leaflet
• all medication in original containers along with the electronic printed list supplied by your doctor if available
• dressing gown, slippers and small overnight bag / toiletries in case of overnight stay
• contact telephone number for a lift home
• something to read or to pass the time

Please do not:

• bring any valuables or wear jewellery
• wear nail varnish or false nails
• wear face make up or lipstick

What will happen?

On the day of surgery

You should have a bath or shower before you come to hospital.  Do not eat from 2.00am, however you are encouraged to drink clear fluids only up to 6.00am,  e.g.no milk or pure orange (black tea or coffee is allowed).  Chewing gum is not allowed on the day of surgery. If you wear contact lenses, you will need to remove them prior to your operation.  Please bring your spectacles or an extra pair of contact lenses with you.

On admission to the ward you will be greeted by a nurse who will check that your details are correct.  The surgeon and the anaesthetist will talk to you and you will be invited to ask any questions you may have before signing your consent form. You will also be given graduated compression stockings to wear.

A member of staff will escort you to the operating theatre.  After the operation, you will recover in a special recovery area near to theatre until you are awake sufficiently to return to the ward.

What happens afterwards?

Following your operation

You will be transferred to the ward area where nurses will continue to monitor your condition.  If you feel any discomfort, please inform the nurse looking after you, so that pain relief can be given.  As long as you do not feel sick you will be encouraged to have something to eat or drink.

If the doctor/ nurse feels you are recovered sufficiently, you may be discharged home the same day, or the following morning. It is important that you arrange for someone to collect you at an appropriate time (if you have stayed overnight this will be before 11.00am).  Due to the nature of the ward you may be expected to vacate your bed early and wait for your discharge transport in a discharge area.

Care at home

You will have some mild pain for up to a week after the operation. You may also have some neck and shoulder tip pain if you have had keyhole surgery. This is due to the gas used (carbon dioxide), which can get trapped and will disappear after a couple of days.

You will be prescribed pain relief medication to take home with you. Please take only as directed. You will need to continue to wear the graduated compression stockings on your legs that were applied prior to the operation for 5 days (day and night).

You will be informed if the stitches in your wound are dissolvable or if you have stitches or skin clips that need to be removed. Some patients have Steristrips (small strips of adhesive tape) rather than stitches in their wounds. Even if you have dissolvable stitches, it is recommended that you have your wound checked by the practice nurse 4-5 days after your operation. You may shower on the day following your surgery. Any waterproof dressings over your wounds should remain in place for 5 days and then you may remove them.

You should remain off work for approximately 2 weeks, or as directed by the surgeon. Your surgical team will provide initial fitness for work certificates and any required extension is provided by your doctor. Routine follow up is not required for most hernia repairs unless specifically directed by your surgeon.

You should mobilise gently, gradually building up to normal activities; this includes sexual intercourse.  Light exercise, such as walking, should be undertaken during the first two weeks. Avoid any heavy lifting for at least 6 weeks. Please wear any support corset if advised to do so by your surgeon.

Driving and Flying

You should not drive until you can perform and emergency stop but please clarify this with your insurance.  This will not be for the first 48 hours following your surgery.  Please check that your insurance policy does not prohibit you from driving for a longer period, following general anaesthetic or surgery. Based on Civil Aviation Authority guidance we recommend at least 48 hours before flying after keyhole surgery or 10 days after an open surgical operation.

If you experience problems regarding your surgery after being discharged

PLEASE ALWAYS CALL FIRST FOR ADVICE

It is important you DO NOT present yourself to the ward from where you were discharged.  Please telephone the ward – Monday to Friday 8.00 – 6.00pm. After 6.00pm and Weekends – contact Ward 14 Castle Hill (01482) 623014.

If you are unable to get in touch with Ward 14 please call your GP’s emergency service or 111.

You will receive advice over the telephone as to the appropriate care for you. This may be:

• Over the telephone advice
• to contact your doctor practice to arrange a nurse-led clinic appointment
• an urgent outpatient clinic follow up appointment with your surgeon
• to contact your doctor to arrange emergency admission to Hull Royal Infirmary

If you are severely unwell contact your emergency doctor, attend Hull Royal Infirmary Emergency Department or dial 999 for an ambulance.  Castle Hill Hospital does not have on-site emergency services.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.