Abdominal hernia repair

About abdominal hernia repair

Abdominal hernia is a bulge or swelling that occurs when a part of the abdomen (tummy), such as the intestine, pushes through a weakness in the muscle of the abdominal wall. The aim of an abdominal hernia repair operation is to push the contents of the hernia back into place and strengthen the abdominal wall.

Diagnosis of abdominal hernia

Your GP will ask your about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will examine the bulge or swelling. This may be when you are standing up or lying down. He or she will check if the bulge can be pushed back in, and may ask you to cough while placing a finger over the hernia to see if there is a change in the swelling. Your GP may refer you to have an ultrasound scan to confirm the diagnosis.

What are the alternatives to surgery?

Most abdominal hernias generally get larger with time and don't go away without treatment. Umbilical hernias in young children usually get better on their own as the abdominal muscles get stronger. But in adults, surgical repair is recommended.

Preparing for abdominal hernia repair

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Abdominal hernia repair is usually done as a day case procedure under local or general anaesthesia.

Local anaesthesia completely blocks pain from the affected area and you will stay awake during the operation. If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. 

What happens during abdominal hernia repair

The operation usually takes between 30 and 50 minutes depending on the type of surgery you have.

There are two main types of abdominal hernia repair – keyhole (laparoscopic) and open surgery. Your surgeon will recommend the type that is most suitable for you.

Keyhole surgery

There are two techniques used in keyhole surgery – totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP). Both techniques can only be done under general anaesthetic.

Your surgeon will make three small cuts (about 1 to 2cm long) on your lower abdomen. He or she will pass a tube-like telescopic camera (called a laparoscope) through one of the cuts to view your hernia on a monitor. Your surgeon will then push the contents of the hernia back in place. A sheet of synthetic (artificial) mesh is put over the weakness in the abdominal wall to strengthen it. In a TAPP repair, your surgeon does the operation from within your abdomen. In TEP, the whole operation is done within the layers of the abdominal wall. The cuts on your skin are closed with dissolvable stitches.

There is a chance your surgeon may need to convert your keyhole operation to open surgery. This is only done if your surgeon is unable to complete the operation safely using keyhole surgery.

Open surgery

Open repairs can be done under general or local anaesthetic. Your surgeon will make a single cut (about 5 to 10cm long) on your lower abdomen and push the contents of the hernia back in place. He or she may then put a synthetic mesh over the weak spot to strengthen the wall of the abdomen. The cut on your skin is closed with dissolvable stitches.

What to expect afterwards

After a local anaesthetic, it may take several hours before the feeling comes back into your abdomen. Take special care not to bump or knock the area. You may need to rest until the effects of the anaesthetic have passed and pain relief to help with any discomfort.

If you have a local anaesthetic, you will usually be able to go home when you feel ready.

If you have a general anaesthetic, you will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your abdominal hernia repair operation. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your doctor or surgeon’s advice.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they should usually disappear in about seven to 10 days.

Recovering from abdominal hernia repair

It usually takes about two weeks to make a full recovery from abdominal hernia repair, but this varies between individuals, so it's important to follow your surgeon's advice. The time it takes to recover from keyhole surgery is usually less than open surgery.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Painkillers containing codeine should be used with care as these can cause constipation. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You should eat enough vegetables, fruit and high-fibre foods, such as brown rice, wholemeal bread and pasta. This helps to prevent constipation, which can cause straining and discomfort.

You should be able to return to work once you feel able, but if your occupation involves heavy lifting this can put a strain on your abdominal muscles, so you should first seek advice from your doctor. 

What are the risks?

As with every procedure, there are some risks associated with abdominal hernia repair. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. For abdominal hernia repair these include:

  • difficulty passing urine
  • pain, numbness, swelling or bruising in your abdominal and groin area
  • some scrotal swelling for a few days, if you are a man

Complications

Complications are when problems occur during or after an operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of abdominal hernia repair include:

  • infection
  • build up of blood or fluid in the space left by the hernia
  • painful swelling of the scrotum or testicles, if you are a man
  • damage to tissues in your abdomen, such as the bladder or bowel
  • damage to nerves, resulting in numbness in the groin area
  • re-occurrence – the hernia may develop again

If you are a man, you may also have complications such as damage to blood vessels supplying your testicles, resulting in permanent damage.

After I’ve had an abdominal hernia repair operation, how long should I wait before I exercise again?

Answer

You should wait for three to six weeks before you attempt strenuous exercise, but you can return to everyday activities after two weeks.

Explanation

It's generally recommended that you return to your normal, everyday activities as soon as possible after hernia repair as this can help you to recover faster.

You shouldn't try to lift heavy objects or do any strenuous exercise for three to six weeks after your operation. This will ensure that the hernia has had sufficient time to heal.

Your GP or surgeon can give you advice about when you can return to exercise, if you are unsure.

How long will my pain last after the operation?

Answer

The pain you have from the operation will normally go away after one to two weeks. However, it can sometimes last for over a year.

Explanation

For most people, the pain from an abdominal hernia repair operation will disappear after about two weeks. However, about one in five people have pain and numbness for up to a year. This will eventually go away, but rarely can last for longer. If you have keyhole surgery, you are less likely to have persistent pain or numbness.

If you have persistent pain after an abdominal hernia repair operation, see your surgeon. This is an uncommon complication, but may be caused by problems with the mesh, scar tissue irritating a nerve or the hernia recurring. If this happens, there may be a specific treatment available, including the possibility of further surgery.

Speak to your surgeon for further advice and information.

Will my hernia come back after I’ve had an operation to repair it?

Answer

It’s unlikely that your hernia will come back after you’ve had a repair operation.

Explanation

The chances of your hernia coming back are very small and vary depending on which method was used to repair it.

The reoccurrence rate for groin (inguinal and femoral) hernias is between two and five in 100. This is lower when a mesh is used to strengthen the abdominal wall and there is some evidence to suggest that keyhole surgery reduces the risk of your hernia coming back.

If you have a reoccurring hernia, keyhole surgery is generally recommended to repair your hernia again.