What happens post hernia surgery?

 

Local Anaesthetic Procedure

 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.

Recovery post hernia surgery

Patients can expect to feel alert and well within an hour of surgery, and to be walking out of hospital within 2-3 hours of their surgery.The side effects of local anaesthetic, compared with general, are minimal.

Following a general anaesthetic, with its mix of drugs, surgery trauma and opioid pain relief, patients often experience difficulty passing urine; a few will need catheterisation. This is yet to happen using our local anaesthetic & sedation technique.

With no opioid or anaesthetic drugs, a local anaesthetic starts working before surgery begins and not only prevents pain but also alters the body’s physiological response to surgery. Therefore, recovery is more comfortable, even after the local has worn off. It’s also typically the case that after a local, rather than a general, patients take fewer opioid painkillers, if any, thereby avoiding unpleasant side effects associated with opiods: headache, nausea, poor appetite, constipation and stomach pains.

Bruising post hernia surgery

Local anaesthetic repairs have a quick recovery time. The length of time you will need to take simple pain relief is influenced by the amount of bruising. Hernia surgery can cause a lot of superficial bruising and sometimes swelling too that often affects the scrotum and penis. It looks alarming but don’t be alarmed. It will get better within 2 weeks. No matter how large the bruise, some simple pain relief and waiting up to a few weeks will fix it. Bruising is complicated. There are a lot of factors that influence the extent of bruising, including: size and complexity of the hernia, how the hernia is repaired – open or keyhole, being overweight, medical conditions that affect bone marrow and tissue healing, regular blood-thinning medication, age and general frailty.

Wound closure

The skin edges are closed with a suture that is invisible under the skin, so there are no sutures to see – if you can feel an end it will disappear in a few weeks.

Wound dressings post surgery

You will have three layers of dressing. We advise to leave the wound alone and wait for it to heal by itself over time. It takes approximately 12 days for the skin edges to join securely.

Bottom layer:

The bottom layer (layer one) of butterfly sutures needs to stay on for 12 days.

Middle layer:

The middle layer (layer two) is a flat waterproof dressing. You can shower with it on and then pat it dry. It may last 12 days but you might need to change it once or twice. The fewer times it is changed the better as it reduces the risk of a minor wound infection.

Top layer:

The top layer (layer three) is a pair of hernia support pants. We  use these as a pressure dressing. They should apply firm pressure to the area around the wound to reduce bruising and swelling. Hernia support briefs are used as the best method of applying pressure to the wound. We recommend that you wear the hernia support pants for a minimum of 48 hours.

 Hernia support briefs:

After a minimum of 48 hours you can stop using the pressure support pants at home. Many choose to wear these for longer as they can make mobilisation more comfortable in the first few days. We ask you wear them for 48 hours you can use them for longer if you choose to. This will leave the two dressing layers still in place.

 

For an inguinal hernia repair we always recommend you purchase a pair of firmly well-fitted hernia support briefs such as those produced by www.herniapants.com (Item #316 seems popular with previous patients). We will provide you with a discount code if you ask us. These come in 7 sizes. We recommend that you ensure that you buy the right size by measuring your waistline accurately. The better the fit the better the outcome. Measure your waist where your existing underwear is which should be well below the belly button area. Or call herniapants.com for more advise.

For those having an inguinal hernia repair we ask that you bring these with you for your operation This will be more comfortable and allow you to shower from the day of surgery. Wear them for a minimum of 48 hours. Some patients report finding them more comfortable to move around in in the early recovery phase. You can wear them as long a time (min 48 hours) as you find them helpful.

Hernia pants also help to control hernia symptoms if you wear them while waiting for your operation. They come in a range of shapes. Each shape suits a different body shape. Ask herniapants.com for help choosing the best shape for you if using these pre surgery too.

At 12 days, you can remove all the dressings including small steri-strips and the wound should be healed: dry and clean. Simply washing it with a wet flannel at this stage will remove any last ing old clot. An alcohol wipe can remove any sticky residue from the dressing adhesive.

To help the scar heal as neatly as possible start to apply a moisturizer (any that you would happily put on your face is fine) twice day. Rub firmly. After a few more days rub to the point that it is slightly uncomfortable.

 

Pain relief post hernia surgery

The best way to manage pain relief is to:

Take the simple pain medicines prescribed before any pain develops or becomes present enough to reduce your mobility or makes you feel unwell.

If you don’t actively try to control the pain, hernia surgery can be painful.

If you do actively manage it then recovery from hernia surgery should be reasonably straightforward.

To maximise your post surgery comfort and recovery we advise that before the anaesthetic wears off you start taking the paracetamol and ibuprofen prescribed to you on your discharge before leaving hospital. It is common with any open hernia surgery to feel a numb patch or area of altered sensation around the wound. This is due to disrupting the skin nerves with bruising or surgical damage. As the wound heals and bruise resolves this area will naturally fill in over the first 2-3 months (nerves heal slowly). In a small proportion of patients a numb patch about the size of a 50p piece around the middle and bottom area of the scar can occur. This can take up to six months to disappear and for a few this sensation can be permanent.

Paracetamol

Take two paracetamol capsules regularly four times a day. This medicine has few/no side effects and is safe in nearly everyone. Please discuss with us if you have been recommended in past not to use this drug.

Ibuprofen

Take two ibuprofen capsules, regularly to start with, three times a day. Always take them with food. Some patients can experience problems with this medicine as it can cause stomach irritation and affect kidney function. However, taking it for 72 hours with food should be safe and it is a very effective painkiller, especially when taken with paracetamol.

Dihydrocodeine

This is a powerful opioid painkiller with a long list of side effects. Only take it if needed. You can take it up to four times a day with the paracetamol and ibuprofen as instructed above. It can cause constipation, nausea, poor appetite, headaches, drowsiness and affect concentration. You should not operate machinery while taking this and you may need a laxative with it. We will send you home with one.

Mobility and returning to day-to-day activity post hernia surgery

The other significant factor involved in recovery is mobility. For the first 48 hours just move around gently as clots stabilise during this time and are important to tissue healing, minimal bruising and scarring which is what makes the hernia repair successful. Then early mobilisation after surgery is key – particularly with the older generation. Being still will only worsen stiffness and soreness making your recovery longer and more painful. After day 2 keep moving. There are no limitations on returning to activity as long as you follow this rule: If it hurts (more than just being a bit uncomfortable) stop doing it and try again tomorrow.

 • For driving the DVLA states that you must be able to do an emergency stop. It is illegal to drive a car if you cannot do this. Some insurers have time limits in the small print of their contracts so it can be worth calling them to make sure you are covered to drive again. On average after hernia surgery expect not to drive for 10 days.
• You can shower or wash at a basin from day one. To have a bath or swim the wound needs to be healed and dry (typically after 12 days).
• Most people can walk a mile and carry a small bag of shopping within a week.

DO NOT lift heavy objects for a minimum of 6-8 weeks post surgery as this can cause the hernia to return. Lift small objects initially building up the weight so you are never uncomfortable lifting.

  • Sport enthusiasts should return to exercise carefully 14 days after surgery. It is best to try aerobic exercise, such as running, swimming and exercise classes first and for a smaller distance or duration than you usually managed. Build it up again as comfort allows.
  • For those wanting a more structured return to activity please do the above and consider joining a yoga class to aid return to old levels of flexibility and core strength. The older you are the more this applies to you.
  • Cycling can be uncomfortable for several weeks so it is not encoraged until it feel comfortable.
  • Expect it to take between 4-6 weeks to lift weights in the gym. If lifting weights start with light weights that are comfortable and increase the number of repetitions before lifting heavy weights at a low repetition.

In short, try and use common sense and follow the first rule stated above: If it hurts (more than just being a bit uncomfortable) stop doing it and try again tomorrow.

For more details read our detailed leaflet Hernia Surgery Patient Advice”

Hernia surgery is low risk

As with all surgery there are potential issues.
These risks are:

• Bruising

We view minimal bruising as an indicator of success, and aim to limit it by using hernia pants worn for a minimum of 48 hours post surgery– Age, obesity, blood thinning medications and general frailty often leads to worse bruising. The ‘luck of the draw’ is also important.

• Wound infection

This is uncommon, and we use a waterproof dressing, beneath the pressure dressing, that can be worn while showering. We recommend patients leave the waterproof dressing intact for 12 days as it was put on while the wound area was clean and sterile.

• Hernia recurrence

This happens rarely, and carries the same risk regardless of how the operation is carried out. And because, under local anaesthetic, we can test the repair during surgery, the risk of early technical failure is low. The main risks for recurrence are smoking and being overweight. Alter these factors and the risk will reduce to become very small.

• Altered skin sensation

It’s common (with any open hernia surgery) to feel a numb patch or area of altered sensation around the region of the scar (to about the size of 50p piece); patients can expect this to fade slowly overtime. It can be permanent in a small number.

• Chronic pain

An inflamed pubic tubercle may cause discomfort, but this is very rare and broadly speaking of equal risk from either hernia repair technique. If you have any questions post surgery before your follow up consultation please get in touch with  Hernia Clinic Hampshire with your questions.

We will arrange a follow up consultation approx 4-6 weeks post-surgery for private surgery patients.