The description of a hernia and the need for operation or other treatment is discussed in part one. Now we review laparoscopic surgery and post operative care.
Repair via laparoscopy is advantageous if the patient has a double hernia (both groins affected) and for repeating hernias because the incisions can avoid the areas of the previous scars. Results up to five years after operation show that the success of this intervention is the same as normal open hernia repair but longer term results are not yet clear. It is possible to get back to normal activity more quickly after laparoscopic surgery but if it is a first time hernia repair the advantage of using a local anaesthetic for open surgery outweighs using a laparoscope.
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.
No food should be eaten for the six hours prior to the operation and no fluids for two hours before the event. Afterwards patients can get up and walk around when they feel they can with assistance from one of the staff the first time they get up. If stitches are only placed under the skin they will not need to be removed but if they or clips are used in the skin they should be removed after about seven days.
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.
A job involving driving all day or spending a lot of time standing means two to three weeks need to elapse before returning. A heavy manual job or a job involving much lifting means a month will be needed before work can be resumed. General sport or physical activities can be resumed as soon as the patient is more comfortable, but more violent activities and contact sports may delay resumption for a month. Full fitness and return to full activity should be gradually resumed to ensure a successful outcome. Heavy lifting should not be performed until a month has passed.
If you need to drive yourself or spend all day on your feet at work then you are unlikely to get back for at least two or three weeks. If the job involves heavy manual work or lifting you should probably not return for about one month. Patients can go back to sport and other physical activity as soon as their discomfort allows. It is sensible to start these activities gradually and work steadily back to full fitness. Violent or contact sports are best avoided for about one month. Heavy lifting should be avoided for a month.
