Hernia Surgery Adelaide – What are the options for hernia repair?
If you have a growing hernia or one that causes you troublesome symptoms, then you will need surgery to correct it. It is vital that you undergo a hernia repair surgery to prevent complications like strangulation where the blood supply to the trapped bowel and tissues are severely reduced. In this instance, if no action is taken, this trapped bowel will die off and eventually lead to peritonitis which is a life threatening situation.
The two hernia surgery options available for hernia repair are:
- Open surgery
- Laparoscopic/ keyhole surgery
Both of these surgeries use a non-absorbable polypropylene mesh to cover the defect. The benefits of using a mesh repair include a sound repair, minimal recurrence rates and promote fibrosis (scarring) thus closing the defect quickly.
Hernia Surgery Adelaide – Open surgery
Open hernia repair is an operation performed under general anaesthesia where you are full asleep during the procedure. Before the surgery, antibiotics will be given to minimise the risk of infection. During this procedure, an incision will be made over the site of the hernia and the tissues and the layers of the muscles will be dissected down to reach the hernial sac. The surgeon then opens the sac to visualise the contents (usually bowel or tissue and sometimes a part of the bladder depending on the site of hernia). These contents will be then pushed back into the abdominal cavity and the sac will be either removed or closed.
A mesh is then placed over the defect in the muscles and sutured into place. The dissected muscles are placed back together and sutured with absorbable sutures. The surgery is completed with the suturing of the skin incision with absorbable sutures and placing a dressing over the area.
What to expect after the surgery?
- Hospital stay – Following an open hernia repair, you may have to stay in the hospital overnight. However, some patients may be discharged on the same day if they are well.
- Pain – As soon as the effect of the anaesthesia wears off, you may feel the pain but it can be easily controlled with oral pain killers.
- The wound – Since the skin incision is stitched in place using absorbable sutures, it does not require suture removal. Your surgeon may ask you to visit them in one week’s time to inspect the wound. If the wound is dry and not infected, it does not need further dressings.
- Returning to your normal lifestyle – You can get back to your normal activities within 4 weeks if you are comfortable enough but avoid lifting heavy objects or any other strenuous activities for at least 4 weeks. After 4 weeks, you can start doing strenuous activities if you are comfortable.
What are the complications that can arise?
- Bleeding – A small amount of bleeding could occur but significant bleeding is uncommon.
- Infection – As with any other surgery, infections can occur. It can be treated with antibiotics.
- Seroma – This is a buildup of fluid under the wound and will require drainage using a needle.
- Chronic pain – A small number of patients may experience pain for more than 6 weeks and this can be managed with pain killers when necessary. Most of the time the pain disappears with time.
- Recurrence of the hernia – This is very unlikely and the recurrence rate is about 1 – 2%.
Hernia Surgery Adelaide – Laparoscopic/keyhole surgery
There have been several ways in which a keyhole surgery is performed for hernia repair but the most current trend is the totally extra peritoneal (TEP) repair. This is carried out under general anaesthesia. Initially a small 2cm long incision is made just below your umbilicus to pass the balloon dilating tube inside. Using this device, the balloon is inflated to create a space between the abdominal muscle layer and the peritoneal cavity (the cavity containing all the abdominal organs). Next this device is taken out and another tube known as a laparoscopic port is inserted into this space. This space is inflated using carbon dioxide to create room for the repair.
Two more incisions, each about 5mm, are made to allow passage of the operating instruments. Using these instruments, the surgeon will look for the defect and repair it using a mesh. Because the mesh is placed from the inside of the defect, the intra-abdominal pressure and the abdominal muscles will hold the mesh tightly- much like the cheese in a sandwich. Finally, the space is infiltrated with a local anaesthetic and the ports will be withdrawn, the space is deflated and the incision closed.
What are the advantages of a keyhole hernia repair?
- The incisions are very small and therefore scarring is very minimal and recovery is fast.
- You can return to your normal functions earlier compared to an open hernia repair.
- No limitation to activities except for those that may cause you pain and discomfort.
- In this procedure, the mesh is placed inside of the defect and it is mechanically better compared to placing it on the outside of the hernia repair.
- The damage to nerves and vessels is less.
- Post-operative pain is less.
What are the disadvantages of a keyhole hernia repair?
- General anaesthesia is always needed.
- Patients with a larger hernia or a previous abdominal surgery may not be suitable for this type of repair.
What are the possible complications?
The risks of a keyhole hernia repair are very low but the possible complications include:
- Complications due to anaesthesia such as anaphylaxis and cardiac arrest. Such complications are very rare because all anaesthetists take the necessary precautions to minimise them.
- Bleeding due to damage of the blood vessels which may require conversion to an open surgery.
- Recurrence of hernia – This is only seen in less than 5% of the cases.
- Infection of the mesh – The incidence is very less as all surgeons will take precautions to avoid such circumstances such as giving antibiotics and using sterile equipment for the surgery. If such a situation arises, then the mesh may have to be removed.
- Pain following the surgery – This is a common problem encountered following any surgery but it can be managed easily with pain killers.
Bowel trauma can happen but is very unlikely to occur in the most experienced hands.