Laparoscopic hernia repair

Introduction

A hernia occurs when an internal organ (such as bowel) or abdominal fat is pushed through a weak point in the muscle. It can be caused from heavy lifting, straining or muscle weakness. They can generally be repaired using an open or laparoscopic/endoscopic technique and a mesh can be placed over the weak point to avoid recurrence.

Procedure

Laparoscopic or key-hole surgery is performed under general anaesthesia. Small cuts are made in the abdomen. Instruments are pushed into the holes and carbon dioxide gas is blown into the abdomen to lift the abdominal wall away from the internal organs so that the surgeon has a good view. A mesh can be sewn and/or stapled in place over the weak area. The instruments are removed and the gas is allowed to escape before stitching or stapling cuts together.

Post-operative Instructions

Pain

Post-operative pain is normal but the intensity can differ between individuals.

Wound

The wound site is kept clean and dry. The stitches are usually dissolvable but if not they will be removed in 7-9 days. A waterproof dressing will be applied to your wound before discharge. This is to be kept on for 7-10 days. If the dressing falls off before this time you will need to have this re-dressed. Keep your wound dry during this time to avoid infection.

Swelling

Bruising or swelling of the testicles and scrotum is to be expected after surgery. This can be eased by wearing firm underwear.

Food

You will be able to drink 4 hours after your operation and have a light diet if you desire. A normal diet and fluid intake is usually started on the day following your operation.

Nasuea and vomitting

Some people are very sensitive to surgical procedures. Nausea and vomiting may occur as a result of the general anaesthesia, the procedure performed or the medications prescribed. If you have vomiting and nausea, please do the following:

• Keep well hydrated with frequent small drinks of clear fluid. It is recommended that you drink water, lemonade or diluted fruit juice. Avoid milk.
• Cease your medications as in most cases the nausea and/or vomiting is related to the antibiotics prescribed. Once these have been ceased, the nausea/vomiting will usually resolve.
• Contact Dr Daoud’s office at Greenslopes if the nausea/vomiting persists.

Activities

You will be able to get out of bed later on the day of the surgery to go to the toilet. You will be able to walk short distances the next day and increase this slowly as you feel fit. 24 hours after surgery you must not drive any motor-vehicles or operate machinery. You must not drink any alcohol, as alcohol and prescribed medication is a dangerous mix. You must also check with your car insurance to ensure you follow their guidelines as well.

Return to work / school and Post-operative appointments

You will need to be off work for 2 weeks after surgery. If you require a medical certificate, please call Dr Daouds rooms and one will be arranged. During this time, you will not be able to do any heavy lifting, straining, bending, pushing or pulling. Dr Daoud will review you after these two weeks at your post-operative appointment. If you have been cleared to return back to work from Dr Daoud you are to be on light duties only. This has a 5kg lifting restriction with no bending, straining, pulling etc. 4 weeks after surgery you should be right to resume to full activities.

Medication

You will be prescribed an antibiotic and analgesia. It is imperative that you notify Dr Daoud of any allergies to medications. If you are taking medications prescribed by your doctor you need to return to your normal dosage schedule as soon as possible after surgery, unless directed otherwise.

Infection

If you develop a post-operative infection remember it will not generally appear until one to two weeks after the operation. If this does occur please call Dr Daoud’s office to book a review appointment. You will normally be prescribed a course of antibiotics.

It is important that the full course of antibiotics is completed.

Problems

Post-operative complications are uncommon but if they do occur please contact Dr Daoud for advice. Special issues of concern:

• Increasing or persistent pain after 4 or 5 days.
• Any swelling around the wound site.
• Redness or heat around the wound site.
• Persistent nausea or vomiting.
• Persistent discharge from the wound site.

Most problems can be solved by a simple phone call. Please do not call the referring doctor, or your local GP before you contact Dr Daoud’s office. Our office number is 07 3397 8499 and we are open from Monday-Friday 8:30am to 5:00pm. If you are concerned outside of these hours, please present to your closest emergency department.

Risks

• Conversion from an endoscopic approach to an open approach.
• Damage to large blood vessels, gut or bladder surgery.
• Trouble passing urine after surgery which may require catheter.
• Bowel injury due to strangulation of the bowel.
• Deformity of abdominal wall due to movement of tissue to repair the hernia.
• Swelling and bruising of the testicles or scrotum in males.
• Injury to the spermatic cord in males.
• Ongoing pain or discomfort.
• Wound infection or thickened or disfiguring scar.
• Bands of scar tissue (adhesions) may form.
• The hernia may reoccur resulting in another surgery.