Mr Ahmed Al-Bahrani

General Information:

 

Hernia is protrusion of intra-abdominal content (fat or bowel) through a defect or weakness in the abdominal wall. It can affect any age and is more common in men than women. Hernia in children has congenital factor attributing to its development while chronic cough, heavy weight lifting and straining are usually contribute to hernia in adults.

 

 

 

Symptoms:

 

Acute or chronic groin pain on straining is the usual symptom associated with groin swelling that tends to reduce on lying down. 

Complications of hernia include incarceration (irreducible groin swelling), bowel obstruction and strangulation (twisting of bowel or fat within the hernia leading to impede its blood supply) are the potential problems that could arise any time. The larger the hernia size the more symptomatic and more potential for complications.

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Diagnosis

 

Inguinal hernia are usually diagnosed clinically (signs and symptoms), but sometimes an ultrasound scan (or CT scan) is requested to demonstrate the hernia with its content.

 

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Benefit of Surgery

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No progress of the hernia, relief of symptoms and avoidance of potential complications. Allows you to return to normal activity and exercise. Laparoscopic (keyhole) surgery will be associated with less pain, smaller wounds/scars and faster recovery compared with open (conventional) surgery.

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Potential complications of Surgery

 

Infection and bleeding/haematoma formation as with any other surgery, visceral injury (injury to intra-abdominal organs e.g. bowel, bladder, vessels etc, risk <1%), testicular vessels and vas injury (may cause atrophy of the testis on the same side, risk <1%), urinary retention  (unable to pass urine leading to temporary insertion of catheter, chronic groin pain, recurrence (hernia coming back, risk <3%), conversion to open (conventional) surgery and anaesthetic risks that include DVT/PE (development of clot in the leg which might migrate to the lung) and cardiorespiratory complications (risks to the heart and chest).

 

 

 

Before Operation:

 

You can reduce risks of surgery by:

•   Stop smoking, try to maintain good health (higher complication rate with overweight patients) and regular exercise that does not include heavy lifting or straining, which put too much pressure on the hernia. 

•   Having a bath or shower on the night before or same day of surgery

•   While waiting for your surgery in the hospital, try to keep warm.

•   Avoid shaving the area as this should be done in theatre (to reduce infection risks).

•   You have to make sure you pass urine just before coming to theatre, otherwise, I have to insert a urinary catheter.

 

 

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Operation:

 

The operation will be a key hole surgery performed under General Anaesthesia 

(putting you completely to sleep) and takes an average of 45 minutes (can take 

anywhere between 30-90 minutes) and is usually performed as a day surgery 

(with the aim to be home within the same day or within 24 hours of surgery)

 

The operation will include:

 

TEP (Trans-abdominal Extra-Peritoneal)

•    1x sub-umbilical transverse incision of 2-3cm long

•    2x midline <1cm incisions, one above pelvic bone 

and one midway between umbilicus and pelvic bone. 

•    Reduction of the hernia content into abdomen

•    Reduction of hernia sac with/without transection 

(division) of sac

•    Insertion of permanent mesh (synthetic net) and fixed 

using special pins

 

TAPP (Trans-Abdominal Pre-Peritoneal)

•    1x sub-umbilical transverse incision of 2-3cm long

•    2x <1cm incisions on each side of the abdomen laterally

•    Create a peritoneal (liner of the abdomen cavity) pocket 

•    Reduction of hernia sac with/without transection 

(division) of sac

•    Insertion of permanent mesh (synthetic net) and fixed 

using special pins

•    Cover the mesh using the already formed peritoneal 

pocket (above) to protect the mesh from coming in contact with bowel.

 

The sub-umbilical wound fascia/muscle will be closed with delayed dissolvable sutures, while the skin of all wounds will be closed with dissolvable sutures and covered with special glue that is both waterproof and air tight. No dressing is usually applied although occasionally a pressure dressing will be applied at the groin.

 

 

 

Recovery:

 

As mentioned above, most of patients aim to be home the same day or within 24 hours of surgery provided you meet the following five conditions:

 

1.     Feeling well and mobilising

2.     Eating and drinking without being sick (vomit)

3.     Your observations (blood pressure, pulse, temperature…etc) are normal

4.     Manage to pass urine

5.     Someone will stay with you at home overnight

 

You can have a shower from the next morning but avoid baths until day 5 after surgery, and then, in the shower or bath, try to peel the glue off the wound.

 

You will have generalised ache (particularly patients who had TAPP repair), groin and wound pain that usually last for 3 days, during which, you are advised to take your pain killers regularly and then taper them down. You can walk, but be careful with stairs, always protect your groin when coughing, sneezing or straining. You should avoid driving for the first 10 days, after that, if you are able to control your vehicle and press the emergency brake, then you can drive (better to check with your car insurance). Gradually increase activity back to normal but avoid heavy lifting or heavy exercise for up to six weeks. You may be able to swim around three weeks from surgery. Ideally, you should avoid flights, especially long distance ones in the first four weeks after surgery and better to check with your flight insurer before booking. 

 

We can give you a sick note for two weeks and if you need an extra week, your doctor (GP) can provide you with this.

 

Aim to be reviewed in clinic in 4 weeks. If you have any problems before then, you could contact the ward at the Spire Hospital or contact my secretary for advice and I will be in touch.