Michael Gaunt is a renowned vascular surgeon and offers his expertise for the effective treatment of hernias and complex vascular conditions. He operates with a hospital setting offering local anaesthetic, and general anaesthetic depending on your condition.
- varicose veins
What is a hernia?
Hernias (Click here for more information on the Hernias) represent a tear in the muscles of the abdominal wall through which the abdominal contents – for example the bowel or omentum – may protrude and come to lie underneath the skin. Certain parts of the abdominal wall are weaker and hernias are more common at these sites. The most common is in the groin, especially in men.
Why is the groin a particular weak spot for hernias to occur?
This is because men have a weak spot in their groin muscles where the tube that carries sperm from the testicles to the penis passes through. Straining associated with coughing and lifting may stretch this natural gap enough to form a hernia – an inguinal hernia. This is also a weak spot in women because a structure known as the ‘round ligament’ passes through the gap.
Where else can hernias occur other than the groin?
Other weak spots include around the umbilicus (umbilical hernia), inside of the top of the thigh (femora hernia) and any point along the middle of the abdomen (epigastric or ventral hernia). Hernias in other sites can also occur.
How do hernias present themselves?
In the early stages, while there may be no lump to feel, there can be a sense of weakness, especially in lifting or straining. As the hernia enlarges, a lump becomes obvious which appears on standing, but either disappears on lying down or can be ‘pushed back’ inside. This is known as a reducible hernia. Typically, the lump appears on coughing. Later the hernia may become larger and is present most of the time. It may become more difficult to reduce or ‘push back inside’.
Will I require surgery to repair the hernia?
Once a hernia is present, it is unlikely to get better on its own and will usually get bigger and cause more symptoms. Strangulation is the main risk with hernias and for this reason they are usually repaired sooner rather than later.
What is a strangulated hernia?
Strangulation occurs when a loop of bowel or other abdominal organ enters the hernia and becomes stuck. Within a few hours, the bowel within the hernia begins to swell and eventually the blood supply to the bowel is cut off. This results in the bowel dying. This is very serious and requires emergency treatment.
What does hernia surgery involve?
An incision is made over the point of the hernia and the defect in the muscles of the abdominal wall identified. The contents of the hernia will be returned to the abdominal cavity, the coverings of the hernia removed and the defects in the muscles repaired using plastic mesh. The wounds are closed using self-dissolving sutures inserted underneath the skin so they cannot be seen. The operation usually takes between half an hour and an hour.
Can hernia surgery be performed under local and general anaesthetic?
If the hernia repair is performed under local anaesthetic, patients usually go home the same day providing they are well. If a general anaesthetic is used, then patients usually stay overnight.
Will I be in pain after the surgery?
You will not feel any pain while your hernia is being repaired but you will feel sore and uncomfortable afterwards. You will be given painkillers to help with this.
What advice should I follow to ensure my recovery is as straightforward as possible?
In general, you will need to take it easy for the first 2-3 days and it usually takes between 10-15 days before you can resume normal activities such as shopping and sport. You may resume sex when it is comfortable at about two weeks. Gentle exercise can help the healing process and walking is encouraged every day after surgery. But anything too strenuous, including heavy lifting, should be avoided. You may shower after three days and bathe after seven, but avoid soaking the wound.
When can I drive after hernia repair?
You should avoid driving until you are pain-free and in full control of the vehicle. This is usually about a week after surgery.
When can I return to the gym or start heavier exercise?
As a general rule, it is recommended that heavy exercise is avoided for about two weeks while healing occurs.
Can hernias recur after surgery?
Sometimes a hernia in one area may indicate a generalised weakness of the abdominal wall. Therefore, repairing a hernia at one site could increase intra-abdominal pressure at another weak spot, either producing or exacerbating another hernia. With the mesh technique, reoccurrence of the original hernia is unusual. However, it can occur in 1-5% of hernia repairs.
What potential complications may occur following hernia surgery?
Bruising around the wound may develop in the first 1-3 days after surgery. In men, this may include the scrotum and penis areas. This is not unusual or worrying as long as there is not increased pain or swelling. If it does, it could indicate the formation of a blood clot within the wound – known as a haematoma – which may require intervention. All wounds, but especially groin ones, can become infected which can be treated with antibiotics. A wound becoming painful and red could indicate infection. Small nerves next to the hernia can be disturbed during the surgery leading to patches or pain and/or numbness in about 10-20% of patients. This usually resolves over the first year after surgery but occasionally the numbness is permanent. Persistent pain in the region of one of these nerves is known as neuralgia and occurs in a small number of patients. Treatment usually consists of an injection nerve block. A deep veined thrombosis (DVT) can occur in the deeper veins of the leg. This occurs in less then 1% of patients.