Part one covers the description of what a hernia is and its surgical and non-surgical treatment, moving on now to laparoscopy and post op management.
A double hernia where both sides of the groin are affected is best repaired using a laparoscopic technique which is also best for recurring hernias as the surgeon can avoid going in through previously scarred areas.
Five year results of these operations show that laparoscopic results are as good as open results but over longer times than this any differences have not been shown.
Laparoscopic surgery has the advantage of the patient being able to get back to activity quicker but the ability to use a local anaesthetic means that open repair is better for a first repair.
Hernias can be repaired under general and local anaesthetic, the general injected into the hand and the local anaesthetic is injected into the area of the operation.
During repair under local anaesthetic the patient is aware that something is happening in the area of the operation but this should not be painful.
The operation usually takes 30 to 60 minutes and even under general anaesthetic the surgeon will inject some long acting local anaesthetic to make the patient more comfortable after they wake up.
A long acting painkiller in the form of a suppository may also be used.
For six hours before the operation patients should not eat any solid food and they should not drink for the two hours leading up to the time.
Patients may mobilise whenever they feel well enough to get up and about, usually with someone helping them initially.
If the surgeon uses wholly subcuticular stitches they do not need to be removed, but if skin clips or stitches are used they should be taken out at one week.
The time a patient is discharged depends on how much pain they have, whether there is someone at home with them and how fit they are.
The levels of pain felt after operation vary greatly between individuals, with some having very little pain but some levels of pain are to be expected in the first few days.
Pain is usually worst getting up from sitting or lying and when getting back into bed or a chair, due to the stitches in the repaired muscles pulling on these movements.
Analgesics are prescribed to maintain activity and allow comfortable sleep.
Pulling and aching as the tissues stretch and become more mobile is common in the first four weeks as the amount of activity increases and the plastic mesh settles in.
Careful washing of the wound with water and soap in a shower or a bath is allowable after about a couple of days once the dressing has been taken off.
Talc should be avoided for about seven days.
A transparent dressing can be used which is left in place for several days and allows both bathing and washing.
The wound should be dry and well healed by about ten days after the event, making swimming unwise until this point.
Patients can start to walk about as much as they want although they will be quite stiff at first and probably not feel like walking long distances during the first week after the operation.
Patients can start to drive the car when they feel confident to control it in an emergency which is often about ten days after the operation.
Patients can return to work as soon as they feel comfortable enough to manage their job.
People who work from home or who can go back part time often do so very soon after operation.
It is usual to feel stiffness in the abdomen whilst walking about although walking can be started whenever the patient feels like it.
Longer distances are unlikely to be achieved until the first week has elapsed.
Patients can go back to car driving when they feel sure they can perform emergency control activities and this is unlikely to occur before ten days.
Work return can be attempted whenever the patient is comfy enough to get on with normal activities, although if they can work part time or from home they can re-start soon after operation.