WHAT IS A HERNIA?
Underneath our skin is a much tougher layer called the fascia. This fascia is responsible for keeping our insides inside us. When you get a hole in your fascia some of the tissue inside you can bulge out. Men often get groin hernias because there is an area of structural weakness in the groin associated with the blood vessels and vas deferens that supply and come from the testicles. Many different things can bulge through such as omentum (normal fatty tissue which we all have inside us), bowel or sometimes even things like your appendix.
Will a hernia go away by itself?
No, hernias will either stay the same size or get bigger over time.
Does my inguinal hernia need to be fixed?
Most inguinal hernias have a low risk of strangulation, and so the reason for having your hernia fixed is that it is giving you discomfort, pain, or stopping you from doing exercise or other normal activities. A femoral hernia has a much higher risk of strangulation and should be fixed sooner rather than later to prevent complications
What do I do if my hernia becomes strangulated?
If your hernia becomes red, hot, sore and swollen whilst waiting for your operation, it is important to gently try and push it back in. You should lie down on a bed, push gently, firmly and continuously on the hernia until it pops back it. You should do this as soon as it happens, as the longer you leave it, the harder it can be to push it back in. If this starts happening frequently you should let Dr Hamer’s rooms know, and your hernia operation may need to be expedited. If you can’t pop your hernia back in (and you normally can), you should present to the hospital to be assessed for emergency treatment.
Laparoscopic groin hernia repair
Key hole surgery to fix a groin or inguinal hernia is a simple and safe operation. It is done under a general anaesthetic and most patients can go home the afternoon of their operation, or the following morning. 3 small incisions are made, one by your belly button and two smaller ones below this. After the hernia and its contents are brought back into your belly, a piece of reinforcing mesh is slid into the space below the fascia, covering the hole, to prevent the hernia from bulging through again. This method is used to fix both inguinal and femoral hernias.
Side effects to be aware of
All operations have side effects or potential complications you need to be aware of. Risks of any operation include the risk of the anaesthetic( small risks of heart attacks, strokes, leg or lung clots, death), risks of bleeding, infection and trouble healing at the wound site. After a hernia repair there is a 2-3% risk of chronic pain in the groin afterwards, this is a pain or uncomfortable feeling in the groin that stays after you have recovered from your surgery. This is lower with the key-hole approach than with the open (non keyhole) approach. There are small risks of problems with the mesh requiring reoperation including mesh infection or bowel obstruction. There is 3-5% lifetime risk of your hernia recurring, this is the same risk as all groin hernia repairs. There is a very small risk of damage to the vein and artery which supply your leg. If you have any questions about any of these please ask Dr Hamer before proceeding.
What to expect
You will be admitted to the hospital on the day of your operation. You will meet the nursing staff and the anaesthetist who will be administering your anaesthetic. After your operation you will wake up in the recovery area of the hospital where specialized recovery nurses will look after you and ensure you recover from your anaesthetic safely. After this you will be moved either to the day stay area of the hospital or to the ward. At any stage if the nurses have concerns about your recovery they will contact Dr Hamer.
Sometimes after surgery to fix groin hernias your bladder may temporarily be unable to empty itself (urinary retention). If this occurs a temporary catheter may need to be placed. This is more common if you have a history of prostate problems. You can expect some bruising in the groin afterwards. Because the spermatic cord runs through the groin into the scrotum, don’t be alarmed if you get bruising in the scrotum as well as the groin.
After your operation
After your operation, even if you have been discharged on the same day, the effects of the anaesthetic can take 24 hours to wear off. You need to avoid driving, operating machinery, drinking alcohol, climbing ladders, make any important or legal decisions. You should have a responsible adult with you for this 24hr period.
You will be advised to minimise movement for 2 days after surgery to minimise your chance of bruising. You should avoid driving for 1 week and heavy lifting for 1 week.
Dressings
After you have been discharged from the hospital, you will have dressings over your wounds. These do not affect how well your wounds heal, but they do protect your clothes from any seepage which may occur. If they become dirty or wet they may simply be removed and changed for a similar dressing or a band aid. After a week they can be removed and discarded. Occasionally people feel more comfortable leaving the dressing on for an extra week, particularly if the wound is somewhere that your clothing rubs on. This is ok and will not affect wound healing
Sutures
Your wounds will be closed with either glue or dissolving sutures, neither of which need removal.
Pain killers
Most people find taking regular paracetamol to be enough for their pain. Paracetamol has the advantage (unlike most other pain killers), that it won’t make you constipated or feel woozy. It is also very safe if taken carefully according to the instructions on the packet. In some circumstances you will be given additional pain killers to take home with you. If this is the case you should read and follow the instructions carefully and take only if needed.
Problems
Complications are unusual. Sometimes in the space where the hernia was, a fluid collection (seroma) develops. This is temporary and will resolve over a few weeks.
If you do have any problems you have multiple ways of accessing help. During office hours you can contact Dr Hamer’s rooms or your GP. For more pressing problems or after hours you can also contact the emergency department at the hospital or the surgical registrar on call.
Recovery
Generally most people find that they are fit to return to light duties at work after 1 week and full duties by 2 weeks. If you are still having significant problems at this time you should be reviewed to ensure you are still recovering properly.
Follow Up
You will be seen 4-6 weeks after your operation.
Workcover
If your hernia occured at work, and you are claiming for the hernia repair through workcover, please let Dr Hamer’s staff know when you book your appointment.