OPEN HERNIA REPAIR

Hernias are discussed in more detail in the conditions section. They never improve without surgical intervention and typically continue to enlarge, causing discomfort and pain. In rare cases they can strangulate which is where the contents of the hernia lose their blood supply and become gangrenous. Not only is this a very painful condition it, if left untreated as an emergency, can have fatal consequences.

During open hernia repair, an incision is made in the groin for femoral and inguinal hernias or over the lump in the case of other abdominal wall hernias.

The contents of the hernia are replaced back into the abdominal cavity and a repair is carried out to prevent the hernia from coming back. Mesh is used in some repairs.

The good thing about open inguinal hernia repairs is that they can often be done under a local anaesthetic so are useful in the elderly or for people who should avoid a general anaesthetic.

Frequently Asked Questions

The Royal College of Surgeons, The World Health Organisation (WHO) and the generally accepted consensus internationally is that the majority of hernias should be repaired even if they are not causing symptoms such as pain. This is particularly pertinent for inguinal and femoral hernias because even if your are not fit for a general  anaesthetic they can be done under a very safe local anaesthetic if they are not too big. This is why it is important to consider early intervention as hernias if left get bigger and are then more complex to repair. There is also the risk of strangulation where the contents of the hernia become gangrenous. This obviously is very serious and can be life threatening.

Unfortunately this is a common misconception. The vast majority of hernias should be repaired and this  is particularly true for inguinal and femoral hernias. This consensus is backed up by the Royal College of Surgeons and the World Health Organisation. If your hernia is very small and not at all painful then a watch and wait approach maybe appropriate and Mr Stellakis will advise if he thinks this is the case. If your are not fit for a general anaesthetic then many hernias can be repaired under local anaesthetic. The problem in the UK is that NHS funds are very limited and hernias are not considered important. Hernia surgery therefore is highly rationed by the Clinical Commissioning Groups and this is probably why you were told this.

The risks for open hernia surgery depend on the type and size of hernia being repaired. For Inguinal, femoral, umbilical and epigastric hernias the risks are extremely low. The risks involved in any surgery include reaction to a general anaesthetic (if used), bleeding and infection. Risks that are specific to hernia repair include recurrence of the hernia, pain and discomfort at the site of the hernia and damage to the blood vessels, nerves or nearby organs. Mr Michael Stellakis will discuss these in full during the consultation.

Please refer to the specific information sheets below.

Mesh has gained some notoriety in the press recently particularly after the publication of The Cumberlege Report. That said most of the issues were with gynaecological meshes and implants and meshes deployed with the abdominal cavity. Meshes in inguinal hernia surgery have been used for almost 70 years and where there is a wealth of experience in their use.

Most patients are concerned with chronic pain and this does occur in about 4% to 7% of patients but is not usually debilitating pain. It becomes even rarer over the age of 60. Chronic pain is probably as much to do with ‘open approach’ as it is to do with the use of mesh.

If you want to avoid chronic pain then a laparoscopic (keyhole) approach if appropriate is probably for you. Chronic pain is very rarely seen after a TEP keyhole repair. Please see Keyhole Hernia Repair. Repairing hernias with out mesh may lead to higher recurrence rates. Mr Stellakis can do mesh-less repairs and often does in umbilical and femoral hernias. He will be happy to talk about meshes and their problems with you.

This depends very much on what type of hernia you are having repaired and on the patient. The following is average. For open inguinal and femoral hernias you will experience 2 to 3 weeks of discomfort, be back to work in 3 to 4 weeks and fully recovered at 4 weeks. For smaller umbilical and epigastric hernias recovery is quicker and full recovery is about 2 weeks. Incisional hernias take longer sometimes 6 to 8 weeks but depends on the size of the hernia. Most patients can go home the same day and you will be advised  on post op activities my Mr Stellakis accordingly. Also see post op instruction below.

Wound care

If a dressing has been used it  should stay on for 5 days. We advise just washing for 2 full days after surgery to reduce the risk of getting the dressing wet and encouraging infection. That means no showers or baths. On day 3 you can have a quick shower but try not to get the dressing wet. If the pad of the dressing does get wet then you need to replace it and you will go home with some extra dressings for this purpose. On day 5 take the dressing off and shower as normal and re-apply a new dressing if you wish. After 7 days just leave it open to the air. Avoid bathing, soaking or swimming for two whole weeks.

If cyanoacrylate glue is used as a dressing then you can forget about the wound and shower the next day as you normally would.

Activities

The general rule is to stay active; walking around; going up the stairs from day one but be sensible. Your body will let you know if you are overdoing it. Each day you can do more. Avoid heavy lifting for 4 weeks. Heavy lifting is furniture, garden machinery and people! You can drive when you are able to make an emergency stop without pain. This varies but generally most people are OK to drive at about 2 weeks but longer if you had an incisional hernia repair.