Repairing Your Hernia

Over 75% of all hernias occur in the groin, of which the vast majority are primary inguinal hernias. Primary inguinal hernia repair remains one of the most frequently performed operations in the United Kingdom.
 

Each year around 95,000 procedures are undertaken within National Health Service hospitals and 25,000 procedures within the private sector. Hernias affect both men and women and can occur at all ages from neonates to the elderly. However, they are most common in men aged between 20-65 years.

Usually, the suggested treatment is surgery. The old fashioned use of ‘truss-like’ devices is not now recommended. There are various surgical procedures used to repair hernias.
 

The 'mesh plug' repair technique

The University Hernia Clinic uses the latest tension-free ‘mesh plug’ technique for inguinal hernia repair – the most common type of hernia repair performed. However, all other types of abdominal wall hernias are repaired.

The ‘mesh plug’ technique has an extremely low incidence of complications and recurrence, with The University Hernia Clinic having one of the lowest noted rates in Europe.

The ‘mesh plug’ repair represents, we feel, a significant advance over the Lichtenstein (flat mesh) repair, conferring real benefits to the patient, in terms of reduced discomfort and a more rapid recovery.The 'mesh plug' repair technique was developed originally in the USA. It has been pioneered in the UK within The University Hernia Clinic, at St. Luke’s Hospital.

The technique was first undertaken within the UK in 1997 and has proved very successful. As a result, it can now be offered as the treatment of choice to patients in The University Hernia Clinic at St Luke’s Hospital.

Increasingly, a mesh repair has been used as standard in the management of primary inguinal hernia. This involves inserting a piece of mesh to ‘reinforce’ the posterior wall of the inguinal canal. In the Lichtenstein procedure, the hernia is repaired by an anterior approach and the mesh is sutured into position. Suturing, however, causes some internal tissue tension which can be associated with post-operative discomfort and a slower recovery time.

The new 'mesh plug' technique involves making a small incision over the site of the hernia. The hernia is then reduced by returning the hernial sac into the abdominal cavity en masse. There is no need to excise the hernial sac. A piece of inert, shaped, sterile mesh is then inserted into the deep inguinal ring directly behind the weakened transversalis fascia. A second, onlay piece of mesh is used to ‘reinforce’ the area further. No permanent sutures are required at all, making the repair totally tension free. This surgical procedure takes around 25-30 minutes to perform as dissection is kept to an absolute minimum.

A recent prospective, randomised, controlled study1, comparing the mesh plug repair directly with the Lichtenstein repair, has shown the following results:

• less post-operative pain is experienced
• post-operative recovery and return to ‘normal’ activity is more rapid

There were no observed differences between the methods concerning post-operative complications which were minimal. A published clinical paper by Barker SGE et al is available on request.1

A second study, recently undertaken at the Royal Gwent Hospital, Newport, would seem to confirm the above benefits.2

The long term prospects for the mesh plug technique seem very good. In one USA institution, of 3091 primary inguinal hernia repairs carried out utilising the 'mesh plug' repair, only 22 people (<1%) experienced a recurrence at five years.3

References:
1. Barker SGE, et al. Primary inguinal hernia repair utilising the 'mesh plug' technique. Ambulatory Surgery 2000; 8: 31-35.
2. Goyal S, Abbasakoor F, Stephenson BM. Experience with the preperitoneal ‘plug and patch’ inguinal hernia repair. British Journal of Surgery 1999; 86: 1284-1285.
3. Rutkow IM, Robbins AW. Mesh-plug hernia repair: a follow up report. Surgery 1995; 117: 597-598.
 
We provide you with a three year guarantee at UHC We offer you complimentary surgery if you experience a recurrence of your hernia within three years. This reflects our confidence in this technique.
 
What to expect following my hernia repair at UHC For many, hernia repair represents a ‘first surgical experience’ and despite some comments in the public domain to the contrary, the post-operative period can be a little uncomfortable and worrying.

People do differ, but following hernia repair at The University Hernia Clinic, in general:

Immediate post-procedure discomfort is countered effectively by local anaesthetic, placed around the wound at the actual time of operation

On the same evening as surgery, medium strength analgesics are required (less common would be the use of an injectable agent such as morphine)

For two or three days afterwards, low to medium strength analgesics, such as Paracetamol or Codydramol (provided by The University Hernia Clinic) may be required.

(Analgesics often promote constipation. This can be countered by drinking plenty of liquids and eating plenty of fresh fruit and vegetables. Occasionally, laxatives may be necessary.)

Subsequently, whilst the wound is still healing (which will take a full 6-8 weeks in total), you may notice some mild aching, which may be more obvious with walking, or towards the very end of the day. ‘Pins and needles’-type sensations may be felt, magnified a little perhaps, by your knowledge that something has only recently been done. Very rarely is persistent discomfort felt, passing along the line of the incision, towards the top of the inner thigh.

Early on, if you feel along the line of the incision, at the site of the hernia repair, it is normal to feel a firm ‘sausage’-shaped mass. This represents the ‘healing process’ (with fluid being drawn into the area) and not the hernia coming back! It may take 6-8 weeks to flatten completely. After your follow-up review by the surgeon, the skin around the incision which is healing can be kept soft and supple by applying, for example, E45 cream or Johnson’s Baby Oil twice daily and rubbing it in gently.

Similarly, early on, you may notice an area of numbness around the incision. This occurs because the small nerves providing sensation in the skin have to be cut at the time of the surgery. Inside, another nerve can sometimes get in the way of the operation and may have to be cut. This can result in a small, permanently numb area just at the top of the thigh. Usually, however, after a few weeks, just about all sensation returns to near-normal.

The operation scar often becomes covered by regrowth of hair (previously shaved off just before surgery). The incision is usually 5-6 cm long and, whilst initially it will appear reddish, it will fade with time. The stitch used to close the wound is buried and will dissolve with time. There are no stitches that require removal. Some bruising around the wound is commonplace, but this soon disappears (like any bruise would). Occasionally, quite ‘colourful’ bruising can occur, although this too disappears quite promptly.

Any other complications following this type of surgery will have been explained to you, by the surgeon, beforehand. If, however, you experience any ‘abnormal’ symptoms or longer-term discomfort, please contact the The University Hernia Clinic 24-hour Post-operative Helpline. We will provide you with advice on what to do.
 
Recovering from your hernia repair at UHC
 
At home after your hernia repair at UHC
The speed of recovery from a hernia repair operation is a very individual matter. Each person will recover at his or her own pace. Rest is important and you may wish to consider getting additional help at home for the first few days after your operation.

The following guidelines however, will help you to take care of yourself and aid a speedy return to normal activities:

The first 24 hours...

• Feel free to walk around as you wish - you will not come undone!
• Do not overtire yourself - only do as much as you feel able
• Drink plenty of fluids and eat light meals
• If you experience pain or discomfort following your operation, take the pain killers provided by the Clinic to help you during the first few days
• Do not make any important decisions or sign any legally binding documents for 24 hours after having a general anaesthetic
• Do not drive a car or operate complex machinery for at least 48 hours
 
When you start feeling better after your hernia repair at UHC
We recommend that you consider taking time to rest for one or even two weeks after your operation.

• Do however, resume your normal day to day activities and light exercise as soon as you feel able
• Be patient - do not recommence more intensive activities (cycling, jogging, tennis, sex) until at least one week after your operation and then, only if you feel able to do so
• If you lift heavy weights at work, or do weightlifting as a hobby, you should wait at least 6-8 weeks for the wound to heal fully. The University Hernia Clinic can provide a letter of support to employers for those with physically strenuous jobs, asking for light duties.
 
Hernia repair aftercare at UHC
Rarely, some people can experience troublesome problems after their hernia repair operation. The following symptoms may need treatment:

• Moderate to severe pain, or persistent discomfort after 24 hours
• ‘Flu-like’ symptoms, with a high temperature
• A very sore or inflamed wound site
• An excessively bruised wound site
• Persistent nausea and sickness
• If you experience any of the above, call the 24-hour University Hernia Clinic post-operative helpline. We will provide you with advice on what to do.




Repairing your hernia (352.1KB)


University Hernia Clinic · St Luke's Hospital · 14 Fitzroy · Tel: 020 7388 4954
24-Hour Post-operative Helpline: 020 7388 4954
For more information about the Clinic and its' services, please call 020 7388 4954
or email information@uhc-herniaclinic.co.uk

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