HERNIA REPAIR SURGERY

Summary

A hernia occurs when an organ, fatty tissue or internal tissue pushes through a hole or weak spot in the structure that normally contains it – usually the muscular structure of the wall of the abdomen surrounding it. In many cases, people have no or very few hernia symptoms. However, a hernia will not go away without treatment. A surgical hernia repair is thus done to push the bulging tissue back into its proper position, after which a mesh patch is sewn over the weakened area to prevent a recurrence.

Depending on the size and symptoms caused, a hernia repair may be advised. Hernia repair surgery may be necessary if the hernia causes long-term pain and discomfort, interferes with everyday activities or seems to be worsening over time. In some cases, the tissue may become trapped or tightly pinched. When this occurs, it is called strangulation and require emergency surgery.

Hernia repair surgeries are also known as herniorrhaphy or hernioplasty. Dr Kavin usually chooses to perform these surgeries laparoscopically through small minimally invasive incisions. Sometimes surgery may be done through normal open surgery if these surgical techniques aren’t possible.

Reasons for hernia repair surgery

  • As treatment for a wide range of abdominal wall hernias
  • Formation of colostomies and intestinal stomas for management of a wide range of surgical and medical conditions
  • Management of intestinal fistulae

Types

1Groin hernia repair
Your surgeon may recommend surgery to repair a hernia in the groin. A hernia occurs when tissue pushes through the thing that contains it. A groin hernia is an abnormal protrusion through the abdominal wall into the groin. The protrusion may be an organ, but often it is fat that pushes through to the groin.

Typically, hernias are more obvious when standing or straining (for example coughing, heavy lifting, and digging) as this forces abdominal contents into the sac. Hernias usually develop over time for no obvious reason, although in some people there may be an inborn weakness in the abdominal wall. Occasionally a strenuous activity will cause a lump to appear suddenly. They may occur at any age and are more common in men than women.

Hernias may simply present as a painless bulge that enlarges with standing or coughing. Commonly they cause an aching discomfort or a dragging sensation.

Occasionally a piece of bowel or fat can get stuck and twisted within the hernia. This is very painful and can lead to a strangulated hernia which can become a serious emergency requiring emergency surgery. It is often recommended that hernias be repaired to prevent such complications arising.

Repair of a groin hernia is usually done using a keyhole technique under general anaesthesia. There are different types of groin hernias. They can be described as inguinal or femoral. Keyhole surgery to repair a femoral or inguinal groin hernia is identical.

Laparoscopic groin hernia repair uses a mesh technique very similar to the standard open operation, but instead of a cut in the groin, you have three very small (1-2cm) wounds after the operation.

The National Institute for Health and Clinical Excellence (NICE) has recommended that patients with two hernias (i.e. one in each groin) or those with recurrent hernias (hernias that have been previously repaired) should have their repairs performed by this technique. In addition, NICE now recommends that laparoscopic repair should be discussed with all patients presenting with an inguinal hernia. The amount of cutting used in this operation is less than the standard open technique; therefore, recovery is usually quicker and less painful. Most patients are back to their normal activities within 10 to 14 days. Many patients return to work within seven days of surgery.
2Hiatus Hernia Repair
This surgery is done to repair a hiatus hernia. The gullet passes through a hole (the hiatus) in the diaphragm on its way to the stomach. Sometimes, tissue around the hiatus weakens, so the hiatus stretches, and the weakened tissue bulges into the chest. This is known as a hiatus hernia.

Often, signs and symptoms of a hiatus hernia include heartburn. This is the acid from the stomach backing up into the oesophagus. Sometimes there is a feeling of regurgitation of food. This is made worse when stooping or lying flat; it gets better when standing.

If the hernia does not produce any symptoms, then no treatment is necessary. If there are symptoms, medical therapy is tried first. An operation is usually considered if medical therapy fails. The operation is usually performed laparoscopically (key-hole surgery).

You will be asleep for the operation. The technique would have been discussed with you by your doctor. This involves small puncture-like incisions so that a laparoscope may be inserted. The laparoscope may then be used to push the bulging tissue back into position and prevent it from recurring by securing mesh over the weak spot in the abdominal wall.

Recovery

  • After the surgery, you will go back to the ward and will be observed and mobilized slowly. You will be taken to a recovery room and observed. When you are stable, you will be taken to a regular hospital room.
  • You may have a thin plastic tube in your nose for a day or two. Your doctor will decide when to remove it.
  • Additional pain medication may be given. You may drink straight away, and if you can, you may eat something a little later. Sometimes people feel sick after an anaesthetic and may need medication to counteract this.
  • Dr Kavin will see you later in the day and make a decision about whether you may be safely discharged. Depending on the type of hernia and the kind of approach taken, you may need to stay in the hospital for 2 - 5 days.
  • You will have some pain at the operation site, but this should be well managed with oral painkillers. The medication given should be taken regularly for the first three days as prescribed whether or not you have pain. The pain will get progressively less over the first week. Each day should be a big improvement.
  • There is a small incision at the umbilicus and one either side of this measuring 0.5cm. The wounds have dissolvable sutures inside. The wounds will have a waterproof dressing on, which needs to be changed on alternate days for the first week. After this, the wounds may be left open.
  • Resuming normal activities, including work?
    • You are encouraged to remain active (gentle walking) within a day or two of surgery.
    • Most people will be able to resume normal activities after two weeks. You should not lift anything heavy (> 5kg).
    • Anything that causes pain should be stopped immediately.
    • You might need to wait for a little longer (up to 6 weeks) before resuming vigorous activity or manual labour. This includes weight training at the gym.
    • Returning to work will be dependent on your age and physical health as well as the type of work you do.
    • As a general rule, if you are able to do something without discomfort, it is safe to continue doing this.
    • Driving after the first week will be safe as long as you are not on heavy painkillers.
  • An appointment for follow up will be given for 2weeks from the date of your operation.


Complications:

  • Problems are relatively uncommon after a hiatus hernia repair and complications do sometimes occur.
  • The most common problem is a difficulty with swallowing food. This usually settles spontaneously, but on rare occasions, something active may need to be done. Likewise, there is sometimes an inability to burp, which may be uncomfortable. This frequently settles spontaneously, but occasionally something active may need to be done.
  • It is important for you to know that when the operation is attempted laparoscopically, there is a small possibility that it may not always be possible to finish it laparoscopically. It may need to be converted to an open operation. This is not considered a complication but usually reflects good surgical practice. However, this will entail more discomfort for you, a longer hospital stay and longer time off work.
  • This is a major intra-abdominal procedure, and various problems and complications relating to the stomach and gullet are possible. These include perforation of these organs, it includes problems with the blood supply to these organs, and it includes problems with the stomach moving up into the chest. It is possible for other intra-abdominal organs to be injured during the operation. These problems are rare in the hands of an experienced surgeon.
  • Intra-abdominal bleeding or bleeding in a wound may occur. Your doctor will decide how to manage this.
  • Infections in the abdominal wounds are infrequent but do sometimes occur. How this is managed will depend on your doctor.
  • Very occasionally an incisional hernia can develop in the wound or at a port site.
  • Systemic complications like venous thrombosis and pulmonary embolism are rare, but possible after any operation or anaesthetic.

Hospital

Operating from the new state-of-the-art, multi-disciplinary facility equipped with only the most advanced medical technology,

Equipment

As one of only two such robots in the Western Cape, Dr Kavin operates from a hospital boasting Robotic Surgery capabilities,

Technique

As a surgeon with adept skill in minimally invasive techniques, Dr Kavin opts for laparoscopic keyhole surgery whenever possible.

Expertise

Dr Bruce Kavin is a General Surgeon with particular expertise in Endocrine, Colorectal and Gastrointestinal Surgery and Surgical Oncology.

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