How Do You Repair a Hernia?
There is more than one way to repair an inguinal hernia. At Hernia Clinic Hampshire we offer the full range of repair solutions. Some solutions to hernia repair suit some hernias more than others and different people suit some solutions to hernia repair more than others.
Hernia Clinic Hampshire offers an initial consultation to determine what would be the solution we would recommend to you and your hernia problem. We will explain our recommendations based on your consultation with us and between agree on the solution that we think best suits your uniqueness. We have a lot of experience of solving hernia problems and will be happy to help and honest in our opinion. Remembering surgery isn’t the start of every solution and one solution doesn’t fit all.
Telephone consultations are usually enough to confirm a hernia if it is a visible lump with a clear history of reducing on lying down and don’t need examining before surgery. A telephone consultation is often enough to proceed on.
Face to face consultation is better when the clinical history is less clear. It can help detect any other issues that can influence decisions and detect unknown bilateral hernias that can influence recommendations. For some they just feel more confident having been seen in person and examined. We have options for both.
If you choose a telephone consultation and at that consultation, we decide we need to see and examine you in person the cost of the second (face 2 face) appointment is the difference between a telephone and face 2 face appointment.
Options to consider when needing hernia surgery:
- Are life-style adaptations needed first to allow for successful hernia repair?
- Do you have more than one hernia?
- Is this the first time you have had that hernia repaired?
- How does your age; health; frailty and urine flow impact on the decision?
- Would you benefit from a laparoscopic (inaccurately described as keyhole) repair or open repair?
- Do you need a full general anaesthetic and the risks it can present, or would you be more comfortable having a local anaesthetic and sedation?
- Do we need to make any medication changes or optimize your health around your surgery to make it more successful?
Open Hernia Repairs
The hernia surgery repair procedure is straightforward and therefore no special measures are necessary.
- To help relax our patients, we use sedation. We like the effect this has. Some patients stay awake and chat to the team, others nod off
- As we can talk to you we will even be able to test the repair before completing the operation.
- If you’re taking blood thinners we will advise you when to pause your medication; aspirin can be taken throughout.
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Private Umbilical and Incisional Hernia Repairs
The risks regarding inguinal hernia surgery also occur in other types of hernia surgery when using either method to repair hernia. For umbilical and incisional hernia repairs there is the added risk of serum or fluid collection in the space the hernia occupied. called a seroma.
When using keyhole surgery for incisional and umbilical repairs there is also the risk of bowel adhesions causing obstruction at some point in the future because the mesh is placed inside the abdominal cavity. Most first time common hernia types are suitable for open local anaesthetic repair with sedation.
This includes one sided first time and recurrent: groin hernias, umbilical, epigastric and smaller incisional hernias. Most hernias that are bilateral or particularly large may need a general anaesthetic. These hernia types need to be seen and discussed face to face to discuss the best approach to repairing them
Laparoscopic Hernia Repairs
Also referred to as a keyhole repair, they involve using cameras to view the surgical area and the repair happens on the inside of the abdominal wall. (In open repairs the mesh is placed on the outside surface of the abdominal wall). The area of tissue dissection and manipulation is similar to, or slightly larger than in, open surgery so the difference in recovery time for most one-sided hernias is the same. Exceptions can be seen in the youngest and fittest patients where keyhole recovery may initially be faster but the time from surgery to lifting heavier weights is the same (6-8 weeks).
Bilateral groin hernia repair is one instance when a laparoscopic repair may confer benefit. Compared to performing open bilateral hernia repair on the same day the recovery is much quicker if performed keyhole. However, it is still a painful operation with a much slower recovery compared to a one-sided repair using either laparoscopy or an open repair technique. An alternative in older, frailer or patients with significant urine flow symptoms or certain health problems and medication is to perform a staged open hernia repair under local anaesthetic and sedation. In this instance the repairs are done 2-4 weeks apart. The total recovery time when done 2 weeks apart is similar to a single bilateral laparoscopic repair except in the youngest and fittest patients. It is much more painful to mobilize after same day bilateral surgery as the action of hip flexion and extension whilst weight bearing (think getting up out of or down into a chair or up and down stairs or into and out of bed) is more difficult as you cannot use one side to compensate and take the weight off the sore repaired side. In many, a staged repair has a lot of benefits. In some there is no benefit and a single operation to do both at the same time laparoscopically is the most time efficient in terms of recovery and comfort.
Recurrent hernia surgery
If you have had a previous inguinal hernia repair the same side, then using the surgical approach that was not used the first time is better in most. Particularly if that repair was after the year 2000. It is since then that meshes have been used routinely to repair hernias. Using the same approach to a previous mesh repair can be more difficult. A previous open mesh repair that recurs is better repaired laparoscopically and vice versa. Older open repairs done without mesh are much easier to redo using an open repair the second time. Given these tend to be seen in older frailer more co-morbid patients, a repeat open repair is safer and just as effective as a laparoscopic recurrent hernia repair. Lastly, a recurrent open hernia repair can be re done using an open approach but placing the mesh in the same tissue plane as a laparoscopic repair. This avoids general anaesthetic and the risks of GA laparoscopic surgery in those less suited to that approach. It is a good option when needed.
General or local anaesthetic hernia repair?
Laparoscopic repairs can only be done under general anaesthetic. This is safe in most and we will offer advice on this. Open repairs can be done either with general or local anaesthetic. We have not found any benefit, in any subgroup of patient suitable for surgery, to general anaesthetic over local anaesthetic with sedation. Therefore we do not offer general anaesthetic for open repairs as general rule of thumb.
Sedation is a medicine given via a vein. An anaesthetist is always present. Sedation makes people less anxious and less fearful of what they fear could happen. This is an important effect as fear (especially when unacknowledged) creates a lot of unpleasant sensations. The sedation gets rid of this element of our natural human response and makes surgery a pleasant experience in the most unusual circumstance. It tends to make patients either very chatty or sleepy – a bit like a couple of strong G&Ts or pints of beer. If you do fall asleep, we can wake you up and test how your repair looks, by getting to you to cough, at a stage when we can still tinker with it if needed.
Urine flow symptoms
Hernia repair is associated with difficulty passing water in a significant minority. Sometimes requiring a catheter to be passed via the penis into the bladder. Pre-existing symptoms of obstructive urine flow include hesitancy at getting a stream of urine flow started. weaker stream, dribbling post voiding, frequent need to pass smaller volumes of urine and frequency of need to pass water, especially getting up at night to go. Combinations of all of these are seen with an enlarging or (in younger patients) swollen prostate. These increase the risk of needing a urine catheter and in are cases prostate surgery to restore adequate flow. We have performed hundreds of open repairs in the highest risk group of patients and have not seen this complication arise with local anaesthetic and sedation. Unlike with general anaesthetic.
Combine this with the inflammation/repair modulating effects it has, and shorter early recovery and your can understand why we recommend open local anaesthetic repair in all except the selected cases more suited to a laparoscopic repair.