Hernia Surgery

Weak spots can develop in the layer of muscle in the abdominal wall, resulting in the contents of the abdomen pushing through. This produces a lump called a hernia. A swelling becomes apparent on the abdominal wall, most commonly in the groin region, where it is known as an inguinal hernia. A hernia develops because of a weakness in the abdominal wall that allows the protuberance of fat and/or bowel which is contained in a sac of the inner lining of the abdominal cavity (peritoneum). The weakness might have been present for many years or might have developed with age or after failure of a surgical wound (incisional hernia). The risks are that small bowel can enter the sac and become trapped, causing bowel obstruction and/or perforation.

Certain factors such as chronic constipation, chronic coughing, obesity, and an enlarged prostate may increase the risk of developing a hernia.

Dr.Himanshu Yadav is senior consultant at Global Rainbow Hospital, Agra expert in all types of Hernia repair & management provides comprehensive care to all his patients.

Common types of Hernia Inguinal hernia:This is a common type of hernia, especially in men. It often develops as a result of strenuous activity and becomes uncomfortable and is often associated with a bulge or lump in the groin area. Sometimes the hernia can be come very large and descend into the scrotum. The treatment for inguinal hernia is surgery. A truss, advocated by some, is not advised. Surgery can be performed from the front (open hernia repair) or with more extensive dissection from behind using laparoscopic methods (laparoscopic hernia repair). Both are effective, and both use mesh. Despite what enthusiasts for laparoscopic hernia repair wills say, the evidence shows that there is very little difference between the two approaches. The alternatives will be discussed.

Epigastric hernia:There is a natural line of weakness in the upper midline of the abdomen and this is where epigastric hernias develop. The principles of surgical repair are similar.

Umbilical and para-umbilical hernias: Another area of weakness is in and around the umbilicus (tummy button). The principles of repair are similar.

Incisional hernia:Incisional hernia occurs because of the failure of the scar from a previous previous surgical incision made in the abdomen. They are more common after infection of the previous incision and in obese or pregnant patients. Incisional hernias can be very small or large and there are several repair options that will be discussed.

Femoral Hernia: Femoral hernias more commonly develop in women and older patients. The defect is below the inguinal region.

Virtually all hernias need to be surgically repaired. The principle is the same for all hernias. The peritoneal sac needs to be identified and separated from surrounding tissue, opened and the contents reduced back into the abdomen, tied off and the sac removed, and then repair of the weakness in the abdominal wall. This repair can be done by just closing the edges together with strong stitches or by using an artificial mesh to bridge the defect. The mesh can be laid inside the defect or on the outside. Both traditional open and laparoscopic approaches are widely used. The operation is finished by closing the fat and skin layers.

Surgical repair of Hernias Open approach via an incision in the groin

Laparoscopic technique, “keyhole” surgery, using narrow instruments and a video monitor.

Open hernia repair: Under general anaesthetic a skin crease incision is made in the groin overlying the lump. The hernia is identified and dealt with by isolating the peritoneal sac, reducing its contents, closing and excising the redundant sac and then gently laying a reinforcing mesh over the weakened area. The muscle, fat and skin are closed over this.

Laparoscopic hernia repair: The laparoscopic technique of hernia repair avoids the large skin and muscle cut of open approaches, as well as closure of the defect with sutures under some tension. This way post-operative pain is decreased, and earlier return to discomfort-free work is possible. The laparoscopic approach to inguinal hernia repair involves three small incisions and an extensive dissection of the abdominal wall behind the hernia and a more difficult dissection of the sac. A much larger mesh is used and fixed with a series of tacks.

Post op care after hernia repair

1. Diet – Some patients may find that their appetite is poor for a week or two after surgery. This is a normal result of the stress of surgery– your appetite should return in time. If you find you are persistently nauseated or unable to take in liquids, contact our office and let us know.

2. Wound care – It is OK to shower starting around 36 hours after surgery. If you have a dressing on the incisions, take it off before showering. You might see little pieces of tape (called steri-strips) directly attached to your skin. It is OK to get these little tapes wet in the shower. The tapes will begin to peel up on the ends 7-10 days after surgery – at this point they have done their job and it is OK for you to peel them the rest of the way off if you wish. You do not have to have them on when you come for your postoperative visit. No baths, pools or hot tubs for two weeks following surgery. We try to close your incisions to leave the smallest possible scar. Do not put any ointment or other medication on your incisions – it will not make them “heal better.”

3. Activity – There are certain medical or physical restrictions on activity after surgery. That means it is OK to walk, climb stairs, lift, have sexual Intercourse as long as it doesn’t hurt. In fact, returning to normal activity as soon as possible will most likely enhance your recovery. However, if it doesn’t feel good, don’t do it. Take it easy and let pain be your guide! You may also feel easily fatigued and “washed out” for a week or two following the surgery. These factors will put some limitations on your activity, but you will not cause any damage even if some soreness is experienced. However It is recommended that patients who have undergone an umbilical hernia surgery avoid any strenuous activity for at least six weeks. Do NOT lift anything heavier than 15 pounds for a minimum of two weeks (or as instructed by your surgeon). Do NOT cough or strain while passing motion or do any activity that increases intra abdominal pressure.

It is recommended to do the following

  • Deep Breathing – Many patients want to take short, shallow breaths after umbilical hernia surgery to avoid aggravating the area. This can actually hurt your health instead of helping it. Shallow breathing can keep you from adequately inflating your lungs and increases your risk of lung infections. Instead, practice deep breathing. Taking deep, full breaths throughout the day can help keep mucus out of your lungs. If you’re scared of how you’ll feel while practicing deep breathing, try coughing carefully while holding a pillow on your abdomen for support.
  • Gentle Walks – Walking after an umbilical hernia procedure (or any hernia surgery) is beneficial for several reasons, including: Keeping your muscles strong Helping your muscles return to the correct place Bringing blood to the site of the surgery; and Reducing risks of complicationsYou don’t have to walk miles at a time, either. Start slowly and take breaks as needed.
  • Pelvic Tilts – Pelvic tilts are a great exercise to do to strengthen your core without putting excess pressure on your hernia site. To do pelvic tilts, you should: Sit on the edge of your bed or a chair. Tilt your pelvis backward, as if you’re about to lie down. Arch your lower back and tilt your pelvis forward. Repeat these steps in a back and forth rocking motion. Do this exercise ten times several times a day.
  • Core Twists – Core twists keep your torso flexible while also strengthening the muscles of your abdomen. Core twists promote healing by decreasing stiffness after surgery. Core twists can be done by: Lying on your back and extending your arms straight out to the side — imagine your body is a plus sign. Bringing your feet towards your body until your knees are at a 90-degree angle. Lowering your knees as far to the right side of your body as you can without feeling uncomfortable. Keep the upper half of your body still and remain in this position for 20 seconds. Keep doing the same thing on the left side of your body. Repeat this exercise three to four times daily
4. Work – Everyone returns to work at different times. If you want, you may return to work right away; however, as a rough guide, most people take at least 1-2 weeks off prior to returning to work. If you need particular documentation for your job, call the office. 5. Driving – You will usually be able to drive when you have not needed the narcotic (prescription) pain medications for two days. 6. Bowel movements – The first bowel movement may occur anywhere from 1-5 days after surgery – as long as you are not nauseated or having abdominal pain this variation is acceptable. Remember that it is very common to pass a lot more gas from your rectum than you used to – this is because you will not be able to really belch. Some patients also find that they have diarrhea or “loose bowels” for the first days after their hernia repair – in the vast majority of cases, the bowel function normalizes with time. Constipation may also be common due to the pain medication. We recommend taking Milk of Magnesia (2 tablespoons; twice a day) while taking the pain pills to avoid constipation. 7. Seroma – Some patients find that their hernia “returns” right after surgery. Don’t worry – this is a normal feeling and/or appearance. The hernia repair did not fail – the place where the hernia contents were can sometimes fill up with post-operative fluid – this fluid is a normal result of surgery and will usually be absorbed by the body in several weeks. 8. WHEN TO CALL @Dr.Himanshus clinic
  • Fever to 100.4 or greater
  • Shaking chills
  • Pain that increases over time
  • Redness, warmth, or pus draining from incision sites
  • Persistent nausea or inability to take in liquids

Post-Surgery Hernia Pain

  • It is important to keep your pain level low so that you are comfortable. This will help you to start moving sooner which helps you heal faster.
  • Pain medicine may not completely get rid of abdominal pain after hernia surgery; however, it should keep it at a level that allows you to move around, eat, and breathe easily.
  • Abdominal pain after hernia surgery is caused by injury to your skin, muscles, and nerves during the operation. The extent of the surgery may affect how much pain you have afterwards. Tell your doctor about your hernia pain so that they can help you manage it, our goal is to lessen your suffering. The following are some of the other reasons why it is important to control abdominal pain after hernia surgery.
    • Pain affects how well you sleep which makes you feel like you do not have any energy. Therefore, if you have too much post-surgery hernia pain you may not be able to do the things that help you heal faster, like sitting in a chair or walking.
    • Pain can also cause you to breathe too shallow and may prevent you from coughing. This can lead to pneumonia.
    • Abdominal pain after hernia surgery can affect your appetite (desire to eat) and can keep your bowels from working normally. This may make you not eat after surgery. Good nutrition is very important in helping you heal well.
    • Additionally, pain can also affect your mood (how you feel about things) and your relationships with others.
If you are experiencing pain after hernia surgery, we want to talk about it with you. This helps us learn how best to treat your hernia pain. As caregivers, we will ask many of the following questions before, during, and after pain control treatments to help us learn more about your abdominal pain after surgery.
  • Where does it hurt? Is the pain just in your incision (cut) or does the pain move from one area to another?
  • How would you rate the pain on a scale of 1 to 10? (0 is no pain, and 10 is the worst pain you’ve ever had.)
  • How does the pain feel? Is the pain sharp, cramping, twisting, squeezing, or crushing? Or, is the pain stabbing, burning, dull, numb, or “pins-and-needles” feeling?
  • When did the pain start? Did it begin quickly or slowly? Is the pain steady or does it come and go?
  • Does the pain wake you from sleep?
  • Do certain things or activities cause the pain to start or get worse like coughing or touching the area?
  • Does the pain come before, during, or after meals?
  • Does anything lessen the pain like changing positions, resting, medicines, or changing what you eat?
  • Medicine: Keep a written list of what medicines you take and when and why you take them. Bring the list of your medications to your appointments. Learn why you take each medication, if you do not If you have anxiety, it is important to let us know because lessening your anxiety can help lessen your pain.
  • Anti-nausea medicine: Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time. This medicine may be given to calm your stomach and control vomiting (throwing up).
  • NSAIDs: These medicines, such as ibuprofen lessen inflammation which helps lessen pain. You may be given one of these medicines in addition to other pain medicine to help keep your pain under control.
  • Pain medicine may not get rid of pain completely. But, it should keep it at a level that allows you to move around, eat, and breathe easily. Do not wait until your post-surgery hernia pain is too bad to ask for medicine. The medicine may not work as well at controlling the pain if you wait too long. Tell caregivers if the pain does not improve.

Pain control techniques help you deal with pain instead of taking it away. It is important to practice the technique even when you do not have pain if possible. This will help the technique work better during an attack of pain.

Activity: It is important to start moving as soon as possible after hernia surgery. Moving helps your breathing and digestion and helps you heal faster. But, it may hurt to move even though moving and being active actually helps lessen abdominal pain over time. At first you may need to rest in bed with your upper body raised on pillows. This helps you breathe easier and may help lessen post-surgery hernia pain.

Cold and Heat: Both cold and heat can help lessen some types of post-op pain. Some types of pain improve best using cold while other types of pain improve most with heat. Caregivers will tell you if cold and/or hot packs will help your abdominal pain after hernia surgery.

Pillow: Holding a pillow firmly against your incision can help lessen the pain.

Distraction: By distracting yourself, you can focus your attention on something other than the pain. Playing cards or games, talking and visiting with family may relax you and keep you from thinking about your hernia pain. Watching TV or reading may also be helpful.

Music: It does not matter whether you listen to music, sing, hum or play an instrument. Music increases blood flow to the brain and helps you take in more air. It increases energy and helps change your mood. Music may also cause your brain to make endorphins which further lessens pain.

Relaxation Techniques: Stress and anxiety can make pain worse and may slow healing. Since it is difficult to avoid stress, learn to control it. Ask for more information on deep breathing exercises, muscle relaxation techniques, or meditation.

  • Have someone help you get as comfortable as possible in bed, this includes asking for more pillows or blankets if you need them.
  • Make sure the temperature in the room is OK for you.
  • Having your back rubbed may help you relax and lessen your pain.
  • You may feel better by putting a cool cloth on your hands or face.
  • Keep the lights and noise in your room as low as possible.
  • Move your legs often while resting in bed to avoid blood clots.
  • How can you take pain medicine safely and make it work the best for you?
    • Some pain medicines can make you breathe less deeply and less often. For these reasons, it is very important to follow our advice on how to take you medicine.
    • Be sure to take your pain medication as directed to stay comfortable and heal more quickly. Do not take more than directed or more often than directed, this can become dangerous and potentially fatal.
    • If you are taking a medicine that makes you drowsy, do not drive or use heavy equipment.
    • Do not drink alcohol while you are taking narcotic pain medication.
    • Ask your caregiver before taking other medications.
    • Sometimes the pain is worse when you first wake up in the morning. This may happen if you did not have enough pain medicine in your bloodstream to last through the night. If this occurs, let us know and we may tell you to take a dose of pain medicine during the night or right before bed.
    • Some foods and other medicines may cause unpleasant side effects when you take pain medicine. Let us know if this is occurring. You may need additional/different medications.
    • If you are experiencing nausea after taking your oral pain medications, try taking them with food, such as a few crackers.
    • Do not stop taking pain medicine suddenly if you have been taking it longer than 2 weeks. Your body may have become used to the medicine. Stopping the medicine all at once may cause unpleasant or dangerous side effects. Ask for help weaning off the medications
    • With time, you may feel that the pain medicine is not working as well as it did before. Call if this happens and together we can discuss new ways to control the pain.
    • Pain medicine can make you constipated (hard BMs). Straining with a BM can make your pain worse. Do not try to push the BM out if it’s too hard. Following are some things that you can do to deal with constipation.
      • Avoid hard cheeses and refined grains, such as rice and macaroni. Eat more foods high in fiber (high-fiber foods are raw fruits and vegetables, whole-grain breads and cereals, dried fruits, popcorn, and nuts).
      • Talk to your caregiver about drinking more liquids if you are not on a fluid restriction. Drinking warm or hot liquids can help make your bowels more active. Prune juice may also help make the BM softer.
      • Walking is a very good way to get your bowels moving. You may feel like resting more after surgery. Slowly start to do more each day. Try to get up and around and do as much of your own personal care as possible.
      • Caregivers may suggest that you go to a pain clinic if you have chronic (long-term) pain (longer than 3 months).. These specially trained caregivers at the clinic can teach you different ways to control the pain along with medicines. Some of these methods are relaxation therapy, hypnosis, and acupuncture.
  • You have pain an hour after taking your pain medication (it may not be strong enough).
  • You feel too sleepy or groggy (your pain medication may be too strong).
  • You have problems such as nausea and vomiting (despite taking medications with food), or a rash which may be a side effect of the medicine you are taking.
  • You have a lot of pain or discomfort after normal activities, even after resting and taking oral pain relievers.
  • You are worried or have questions about your pain.

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ABOUT DR HIMANSHU YADAV

Dr. Himanshu Yadav is a well experienced Surgical Gastroenterologist & Head, Department of Gastro Intestinal Surgery & Bariatric Surgery, Global Rainbow Hospital (Agra), with more than 20 years of experience. He has the experience of doing more than 20,000 Laparoscopic Procedures that include gallstone surgery, obesity, hernia, liver surgery, pancreatic cancer and colorectal problems
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