Laparoscopic Incisional Hernia Surgery
What is an Incisional Hernia?
An incisional hernia is an area of weakness due to incomplete healing at a surgical wound or incision.
What symptoms may I suffer from if I have Incisional Hernia?
You may notice a swelling or bulge at the site of a previous wound which expands when you cough, sneeze or strain. If your hernia is painful then you need to see a doctor immediately as you may require an urgent operation.
How to diagnose an Incisional Hernia?
Usually the diagnosis is straightforward - a swelling or bulge at the site of a previous wound which expands when you cough, sneeze or strain would suggest that you suffer from an incisional hernia. Rarely it may not be possible to identify a small hernia by examination alone and your surgeon may request a scan.
What treatments are available for Incisional Hernia?
An incisional hernia can be repaired using traditional open surgery - in this method, the surgeon makes a cut in the skin directly over the hernia and repairs the defect. A small hernia can be repaired with sutures but for any hernia bigger than 2cms (3/4th of an inch) a mesh repair is advisable. If however, your hernia is bigger and requires a large cut (incision) or if a previous open repair has failed then your surgeon may advise a keyhole ("laparoscopic ") repair.
What happens at the first appointment?
Your surgeon will initially take a history and examine you. He will also ensure that you are fit to undergo surgery and an anaesthetic. If you are less than 40 year old and generally very fit then he may suggest an operation without further appointments or tests.
What happens at the subsequent appointments?
Your surgeon will check that all necessary information and reports are available and have been evaluated. He will discuss the results and reports of various investigations. He will discuss with you the various options available to treat your hernia. If you are willing to undergo surgery then he will agree with you a date for the procedure.
Admission for surgery
You must not eat any food from 6 hours before the operation. You are allowed to drink clear fluids, including tea and coffee without milk up to 3 hours before the operation. A nurse will admit you on the day of surgery. The surgeon and the anaesthetist will see you prior to your operation. They will confirm that you are willing to undergo surgery, all preparations are complete and it is safe to proceed with your operation. They will confirm that an appropriate facility is available for you to recover after surgery.
What happens during surgery?
The operation is performed under general anaesthetic and a small ‘telescope’ (laparoscope) is passed into your abdomen above the navel. Your abdomen is filled with carbon dioxide gas, to help see everything properly. Further 2-3 small cuts will be made in your abdomen to insert instruments to help with the operation. The surgeon will disconnect the hernia sac from the abdominal wall and then put a mesh in place with metal staples from inside.
What happens in hospital after surgery?
You will be sent to the Ward after the procedure. You will be looked after by a nurse and offered appropriate pain-killers. You will be offered light food and drink. You may be provided with a system that will allow you to self-administer effective painkillers safely (Patient Controlled Analgesia) – do not worry as you can not overdose on this system. This involves setting up a pump to administer small amounts of morphine in to your vein when you press a button in your hand. Alternatively, you may be prescribed oral painkillers with injections for back up. You may feel drowsy and develop constipation as a result of your painkillers - hence it is advisable that you drink plenty of fluids. You should be able to go home 1-3 days after your operation, depending on your home circumstances and your need for pain-killers. You will have a few small wound dressings which you can remove yourself after one week or a nurse / the surgeon can remove these at a subsequent visit.
Support available during early recuperation period after surgery
It is advisable to avoid strenuous physical activity for the first 2 weeks to allow proper healing of the wounds. It is usual for you to experience some initial pain in the wounds and in your abdominal wall - you may also experience minor discomfort in the shoulder. Most patients recover fully within 1-2 months. You will be given a number to ring for advice in case of difficulty.
Further follow up after surgery
You will be given an appointment to see the surgeon again - he will ensure that you are recovering as expected.
Will further surgery be needed?
This is usually not necessary, though rarely surgery may be required if you develop complications or the hernia recurs.