For detailed information on each type of hernia, select the relevant hernia from the diagram in 'What is a hernia?'
| A hernia is the protrusion of an organ (or part of an organ)
through its containing wall. The more common abdominal hernias are shown
in the diagram.
Before a hernia can form, there must be a weakness in the containing wall (commonly the abdominal muscles). This weakness may be congenital (you are born with it) or it may be acquired later in life (due to on-going pressure such as from coughing, constipation, heavy lifting etc.). A bulge is noticeable at the hernia site. It may contain some fat from inside the abdomen or a loop of bowel. The bulge gets bigger if you stand or strain. It may cause no symptoms or it may cause a dragging sensation, ache or pain. If the hernia becomes painful, tender to the touch and cannot be pushed back in then it is at risk of strangulating - this requires an emergency operation. Back to Top |
Select a hernia to get more information |
When you are seen in clinic, your consultant (or the doctor who examines you) will be able to decide if you are suitable for a day-case procedure (admitted, operated on and discharged the same day) or whether you will require an in-patient procedure (discharged 1 or 2 days after the operation). This depends on your medical condition and your home circumstances.
A week or more before your operation you may be asked to attend the hospital for a pre-operative assessment. In this clinic you will be seen and examined by a junior doctor or day case nurse. Blood tests, a heart tracing (ECG) and chest x-ray may be taken. Sometimes these tests may be done at your initial consultation in the 'hernia clinic'.
 | Do not eat or drink anything for 6 hours before your operation. |
| Do not wear make-up, jewellery or nail-polish. |
| Bring a dressing gown, night-dress, slippers and toiletries. |
| Have a bath or shower before you come to hospital. |
| Make sure you arrange for someone (a relative or friend) to escort you home after the operation and stay with you overnight. |
| Do not bring too much money or valuables into hospital. |
You will be welcomed by a member of the nursing staff before being asked to change into a theatre gown. Your details will be checked by the nurse. The anaesthetist and surgeon will visit you and answer any questions that you may have. You will be asked to sign a consent form if you have not already done so. The surgeon will confirm and mark the side of your hernia. You should have had all the tests required already but occasionally the anaesthetist may request some further tests – such as a chest X-ray or a heart tracing (ECG). The ward nurse and a porter will take you to the anaesthetic room.
The operating department assistant will check your details again. Some routine monitoring equipment will be used to check your pulse, blood pressure and the amount of oxygen in your blood. The anaesthetist will insert a needle into the back of your hand and use this to give you drugs to send you to sleep. This is a ‘general anaesthetic’. Most hernia operations are done this way. Your consultant will have discussed other methods (local or epidural/spinal) with you. If the operation is to be carried out under epidural/spinal anaesthetic, the anaesthetist will insert a needle into your back. Using this technique the lower half of your body will be made numb but you will remain awake during the operation (unless you request a sedative). If the operation is to be done under local anaesthetic, the surgeon will inject the anaesthetic into the area he will be operating on. This stings for a few seconds before going numb. With this technique you are awake, can feel touch and pressure but will not feel pain (if you do, you must tell the surgeon who can inject more anaesthetic).
The skin of the area to be operated on will be cleaned with iodine (brown stain) or chlrohexidine (pink stain). Sterile drapes are positioned to keep the operation area clean. A cut is made in the skin (2 to 3 inches long) and the hernia identified by dissecting the tissues. The hernia is pushed back inside and the weakness in the abdominal wall repaired. This can be done in a number of ways: sutures alone, a flat sheet of mesh or using the mesh in the shape of a shuttle-cock or as a 2-layered mesh. The tissues are then stitched back together and the skin closed with a dissolving stitch buried under the skin (this does not need to be removed). A dressing is applied. Often this may be a special glue dressing (Dermabond) - this is water resistant and means you can have a shower the following day. It is also see-through allowing for wound inspection.
What are the possible complications of this surgery?
The possible complications of this operation include:
| Bleeding - this may be apparent immediately after the operation in the form of a lump at the operation site or may become apparent later in the form of excessive bruising. Rarely a second operation is necessary to correct this. |
| Wound infection - this is usually minor, is apparent 2-4 days after the operation and settles with antibiotics. Rarely an abscess may form or the mesh may become infected - this may need a second operation. |
| Damage to a nerve that is very near the hernia (this applies to inguinal hernias). If this happens you may be left with a numb patch, pins and needles or pain. This affects men at the base of the penis/scrotum and women around the vulva. Usually it settles in time but occasionally may be a permanent problem. Rarely a second operation to look at the nerve is necessary. |
| Damage to the blood supply of the testicle (this applies to inguinal hernias) - this is rare. |
| Damage to major blood vessels near the hernia - this is rare. |
| Damage to the bowel in the hernia - this is rare. |
| Deep vein thrombosis - is a risk after any surgery. |
After your operation you will be taken into the recovery area. The needle in the back of your hand will be connected to a bag of fluid. Routine observations will be carried out. You will have an oxygen mask on your face. Once you are fully recovered (after about 30 minutes) you will be taken back to the ward.
The nurses will continue to monitor your recovery. If you are in pain tell the nurses who will give you appropriate painkillers. When you are feeling more awake and recovered from the effects of the anaesthetic, you will be offered something to eat and drink. The nurses will allow you to stand when they are happy with your observations. Please do not try this on your own without a nurse present as you may faint and hurt yourself. Before discharge you will be given a supply of pain-killers and possibly laxatives (constipation can occur for the first few days).
On the first night simply rest at home. Thereafter, you must try to resume normal activity as soon as possible. Do not treat yourself as an invalid, but equally do not try to do too much too soon. Use common sense - 'if it hurts don't do it'. Take the pain-killers regularly for the first few days. Some discomfort is normal but occasionally severe twinges of pain may occur and may persist for some months.
If the wound bleeds and this does not stop after 10 minutes of pressure and lying down, call your general practitioner or attend the casualty department.
If the wound becomes more painful and red, see your general practitioner for antibiotics.
Keep the wound dry for the first 2-3 days. Then you can shower but avoid prolonged bathing for another week whilst the wound heals fully.
Some swelling and discoloration of the wound (which may spread into the scrotum or vulva) is usual and may last for a week or two. Once this settles you may feel a ridge under the scar - this is normal and may take a few months to go completely.
You can drive after a week - as long as you can do an emergency stop without pain. You can return to work when you are comfortable to do so (usually after 2 weeks for an office job and 4 weeks for physical work). Avoid heavy lifting or strenuous activities for 5-6 weeks (it takes this long for the scar tissue to heal fully).
