Open hernia surgery : A guide to Hernias

This is a common form of surgery for hernia repair. Keyhole surgery (laparoscopic) has become increasingly popular but open surgery is still performed, and often on large hernias.

Pre hernia surgery preparation

Once you have agreed a date for your operation the surgeon will give you a set of ‘pre-operative’ instructions to follow. These include what to eat and drink beforehand, the time of your last meal etc.

Please ensure that you follow these exactly as shown. These are designed for your care and well being so it is important that you do exactly what they say.

If you are overweight then the surgeon will advise you to shed a few of those extra pounds before your operation. He or she will also ask you to give up smoking – if you are a smoker or stop at least a month before your surgery. Smoking can affect the healing of your surgical wound and will increase your recovery time so stop smoking, or if this is too difficult to do, stop for at least a month before your operation. Do not resume smoking straight after your surgery.

You may also undergo some tests before surgery which include a chest x-ray, ECG and a blood test.

Your surgeon will advise you if you are taking any contraceptives, medication or have medical problems such as high blood pressure.

Adults: arrange time off work and ask someone to drive you home after the surgery. If you are going to have a general anaesthetic then ask a friend or family member to stay with you the first 24 hours after your operation. Also ask them if they can help you for the first week following your surgery.

Do not eat or drink in the six hours preceding surgery.

Day of hernia surgery

On the day of your surgery ensure that you have a bath or shower and remove any make up, nail varnish and jewellery.

If you have not signed a consent form before surgery then you will be asked to do so. This consent form will outline the risks of the procedure and is designed to safeguard you and the surgeon. Read through this carefully and make sure you understand it before you sign it. Do not sign until you are ready to do so.

You will be asked to change into a theatre gown.

The open hernia surgery procedure (with mesh repair)

The surgeon will make a single incision in the abdominal wall, over the area of the hernia. He/she will push the hernia back into place before securing the area with a special nylon mesh. This sterile mesh is secured over the weak spot in the abdominal wall and is designed to strengthen that area.

The mesh also starts the natural healing process in that it causes fibrous tissue to grow around the mesh from the surrounding muscles and tendons. This acts as a ‘support network’ for the abdominal wall.

The incision is covered with a dressing and closed with dissolvable stitches.

Previous techniques include pushing the hernia back into place followed by stitching the abdominal wall; stapling this area or patching the weak spot.

This surgery takes from 45 minutes to an hour to complete. This is often performed as day surgery although in some cases it may require an overnight stay.

This procedure is used for a variety of hernias such as inguinal, femoral, umbilical etc.

Post hernia surgery

If you have been given a general anaesthetic then you will be taken to a recovery room following surgery. Highly trained staff will monitor your condition and as you regain consciousness. Once they are satisfied with your progress they will return you to your ward or private room.

Once back in your room/ward a nurse will check your heart rate, blood pressure and your surgical wound. You will be given painkillers if needed and can have food and drink when you are ready.

You will be discharged once the surgeon is happy with your progress. You will be given painkillers to take, antibiotics to prevent an infection, a date for your first outpatient’s appointment and a list of instructions about your post-operative recovery. This includes looking after your surgical wound.

Once home, do not operate any machinery or engage in any tasks which require you to make a decision as your cognitive abilities will still be impaired by the anaesthetic.

Get plenty of rest and avoid any unnecessary movement or lifting. Eat a diet high in fresh fruit, vegetables and fibre to avoid the risk of constipation.

Your stitches will be the dissolvable ones which means that they will disappear after a week to ten days.

Do not resume sport or any other physical activities for at least 14 days after your operation. It will be at least two weeks before you are ready to return to work.

Complications of open hernia surgery

Complications are rare but they do occur and it is as well to be aware of these. These include:

• Infection
• Bruising/swelling
• Bleeding
• Fever
• Blood clot
• Recurrence of the hernia
• Discharge from the hernia
• Difficulty in urination/defecation

If you notice any of these then contact your GP or surgeon.

Risk of recurring hernia

There is always a risk of the hernia coming back once you have had surgery but this is low. However there are a few things you can do to reduce the risk of this which include:

• Eating a high fibre diet
• Taking exercise which also includes strengthening the abdominal muscles
• Maintaining a sensible weight

It is important to note that a hernia becomes increasingly difficult to repair after the first operation.