The operative site of the repaired hernia will typically exhibit swelling, hardness and bruising secondary to the tissue fluid and blood under the wound, the wound being pulled together by the stitches and lastly by scar formation. All this will settle within a few weeks as healing progresses. Bruising tends to track downwards as the blood moves under the influence of gravity so at times the genital area can become black and blue in colour, but again will settle.
Sometimes bruising can be very extensive. Occasionally bleeding from a small blood vessel under the skin or near the repair can produce a collection of blood, visible as a bulge under the wound, called a haematoma. This may settle slowly on its own but sometimes needs to be let out by a further operation. If bleeding spreads down into the scrotum some swelling may remain around the testicle for a long time.
During the operation a small nerve which travels across the incision line may be cut through, causing a minor area of numb feeling at the inner end of the incision. To do the operation well this nerve has to be cut but because the numb area gets smaller with time and is hidden under the pubic hair it does not normally cause any problems. A chronic pain problem over the area of the repair can develop in one in twenty patients and can be a significant problem. Nerve stretch as the operation is being done or the nerve becoming tethered as the healing proceeds are possible reasons for this pain. A pain killer can be injected into the painful area to reduce the pain but in some cases the surgeon will need to re-explore the area to find the trapped nerve and release it.
During the operation all the structures close to the hernia, including the tube carrying sperms, the vein and the artery, are all at risk of damage. In recurrent hernia surgery the risk to these structures is greater. Damage to the artery can result in ischaemic damage to the testicle and it may then shrivel and need to be surgically removed. Damage to the tube carrying sperms means that the ability to be fertile will depend on sperm from the remaining testicle which is usually plenty. In older patients the removal of the testicle can be advised before repairing a recurrent hernia to get the best outcome.
Wound infection is uncommon but is a risk and if the wound reddens then a prescription for antibiotics will be necessary. The wound may need to be surgically explored to release infection if pus develops and starts oozing from the wound. The hernia is more likely to return with an infection present. A further operation may be needed to remove infected mesh and then the hernia will be repaired once more at a later time. After hernia repair deep vein thrombosis (DVT) is rare but important, with doctors taking special precautions should the patient have a raised risk of clotting. To reduce the risk of thrombosis it is useful to start moving the legs and feet and getting walking about again.
The risk of getting a recurrent hernia is less than 1 in 20 overall after a primary repair of a hernia. There are some risks involved in having a general anaesthetic which increase if the patient has a long-term medical condition. There are temporary side effects, occurring 1 in 10 to 1 in 100 times, which include pain in the injection sites, bruising, sickness and blurred vision, side effects which are treatable and go off quickly.
Infrequent complications, risk one in a hundred to one in ten thousand, include temporary breathing difficulties, muscle pains, headaches, damage to teeth, lip or tongue, sore throat and temporary difficulty speaking. Extremely rare and serious complications, risk of less than one in ten thousand, include severe allergic reactions and death, brain damage, kidney and liver failure, lung damage, permanent nerve or blood vessel damage, eye injury and damage to the voice box. These are very rare and may depend on whether a patient has other serious medical conditions. - 14130
Sometimes bruising can be very extensive. Occasionally bleeding from a small blood vessel under the skin or near the repair can produce a collection of blood, visible as a bulge under the wound, called a haematoma. This may settle slowly on its own but sometimes needs to be let out by a further operation. If bleeding spreads down into the scrotum some swelling may remain around the testicle for a long time.
During the operation a small nerve which travels across the incision line may be cut through, causing a minor area of numb feeling at the inner end of the incision. To do the operation well this nerve has to be cut but because the numb area gets smaller with time and is hidden under the pubic hair it does not normally cause any problems. A chronic pain problem over the area of the repair can develop in one in twenty patients and can be a significant problem. Nerve stretch as the operation is being done or the nerve becoming tethered as the healing proceeds are possible reasons for this pain. A pain killer can be injected into the painful area to reduce the pain but in some cases the surgeon will need to re-explore the area to find the trapped nerve and release it.
During the operation all the structures close to the hernia, including the tube carrying sperms, the vein and the artery, are all at risk of damage. In recurrent hernia surgery the risk to these structures is greater. Damage to the artery can result in ischaemic damage to the testicle and it may then shrivel and need to be surgically removed. Damage to the tube carrying sperms means that the ability to be fertile will depend on sperm from the remaining testicle which is usually plenty. In older patients the removal of the testicle can be advised before repairing a recurrent hernia to get the best outcome.
Wound infection is uncommon but is a risk and if the wound reddens then a prescription for antibiotics will be necessary. The wound may need to be surgically explored to release infection if pus develops and starts oozing from the wound. The hernia is more likely to return with an infection present. A further operation may be needed to remove infected mesh and then the hernia will be repaired once more at a later time. After hernia repair deep vein thrombosis (DVT) is rare but important, with doctors taking special precautions should the patient have a raised risk of clotting. To reduce the risk of thrombosis it is useful to start moving the legs and feet and getting walking about again.
The risk of getting a recurrent hernia is less than 1 in 20 overall after a primary repair of a hernia. There are some risks involved in having a general anaesthetic which increase if the patient has a long-term medical condition. There are temporary side effects, occurring 1 in 10 to 1 in 100 times, which include pain in the injection sites, bruising, sickness and blurred vision, side effects which are treatable and go off quickly.
Infrequent complications, risk one in a hundred to one in ten thousand, include temporary breathing difficulties, muscle pains, headaches, damage to teeth, lip or tongue, sore throat and temporary difficulty speaking. Extremely rare and serious complications, risk of less than one in ten thousand, include severe allergic reactions and death, brain damage, kidney and liver failure, lung damage, permanent nerve or blood vessel damage, eye injury and damage to the voice box. These are very rare and may depend on whether a patient has other serious medical conditions. - 14130
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in London, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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