The description of a hernia and the need for operation or other treatment is discussed in part one. Now we review laparoscopic surgery and post operative care.
A double hernia where both sides of the groin are affected is best repaired using a laparoscopic technique which is also best for recurring hernias as the surgeon can avoid going in through previously scarred areas. Five year results of these operations show that laparoscopic results are as good as open results but over longer times than this any differences have not been shown. Laparoscopic surgery has the advantage of the patient being able to get back to activity quicker but the ability to use a local anaesthetic means that open repair is better for a first repair.
Hernias can be repaired under general and local anaesthetic, the general injected into the hand and the local anaesthetic is injected into the area of the operation. During repair under local anaesthetic the patient is aware that something is happening in the area of the operation but this should not be painful. The operation usually takes 30 to 60 minutes and even under general anaesthetic the surgeon will inject some long acting local anaesthetic to make the patient more comfortable after they wake up. A long acting painkiller in the form of a suppository may also be used.
No food should be eaten for the six hours prior to the operation and no fluids for two hours before the event. Afterwards patients can get up and walk around when they feel they can with assistance from one of the staff the first time they get up. If stitches are only placed under the skin they will not need to be removed but if they or clips are used in the skin they should be removed after about seven days.
When a patient is ready to go home is very variable and the important factors are the presence of an adult at home to look after them, how well they are overall and the levels of pain they have been experiencing. Pain levels are extremely variable, with the majority having some pain for three to four days, especially when getting up into sitting from lying and getting down into a chair or back into bed. The muscles which have been repaired are working hard in these activities. To encourage activity and make sleep easier, painkillers are typically suggested.
Patients are likely to get aching and pulling as they become more active during the first month as the tissues are stretched and become supple again and as the mesh beds in. Patients can wash the wound carefully with soap and water or bath or shower after about two days and when any dressing has been removed. Avoid the use of talc for about a week. Some surgeons use a transparent dressing which can be left on for several days even when washing or bathing. It is probably wise to avoid swimming until the wound is sound and dry about ten days after operation.
A job involving driving all day or spending a lot of time standing means two to three weeks need to elapse before returning. A heavy manual job or a job involving much lifting means a month will be needed before work can be resumed. General sport or physical activities can be resumed as soon as the patient is more comfortable, but more violent activities and contact sports may delay resumption for a month. Full fitness and return to full activity should be gradually resumed to ensure a successful outcome. Heavy lifting should not be performed until a month has passed.
It is usual to feel stiffness in the abdomen whilst walking about although walking can be started whenever the patient feels like it. Longer distances are unlikely to be achieved until the first week has elapsed. Patients can go back to car driving when they feel sure they can perform emergency control activities and this is unlikely to occur before ten days. Work return can be attempted whenever the patient is comfy enough to get on with normal activities, although if they can work part time or from home they can re-start soon after operation. - 14130
A double hernia where both sides of the groin are affected is best repaired using a laparoscopic technique which is also best for recurring hernias as the surgeon can avoid going in through previously scarred areas. Five year results of these operations show that laparoscopic results are as good as open results but over longer times than this any differences have not been shown. Laparoscopic surgery has the advantage of the patient being able to get back to activity quicker but the ability to use a local anaesthetic means that open repair is better for a first repair.
Hernias can be repaired under general and local anaesthetic, the general injected into the hand and the local anaesthetic is injected into the area of the operation. During repair under local anaesthetic the patient is aware that something is happening in the area of the operation but this should not be painful. The operation usually takes 30 to 60 minutes and even under general anaesthetic the surgeon will inject some long acting local anaesthetic to make the patient more comfortable after they wake up. A long acting painkiller in the form of a suppository may also be used.
No food should be eaten for the six hours prior to the operation and no fluids for two hours before the event. Afterwards patients can get up and walk around when they feel they can with assistance from one of the staff the first time they get up. If stitches are only placed under the skin they will not need to be removed but if they or clips are used in the skin they should be removed after about seven days.
When a patient is ready to go home is very variable and the important factors are the presence of an adult at home to look after them, how well they are overall and the levels of pain they have been experiencing. Pain levels are extremely variable, with the majority having some pain for three to four days, especially when getting up into sitting from lying and getting down into a chair or back into bed. The muscles which have been repaired are working hard in these activities. To encourage activity and make sleep easier, painkillers are typically suggested.
Patients are likely to get aching and pulling as they become more active during the first month as the tissues are stretched and become supple again and as the mesh beds in. Patients can wash the wound carefully with soap and water or bath or shower after about two days and when any dressing has been removed. Avoid the use of talc for about a week. Some surgeons use a transparent dressing which can be left on for several days even when washing or bathing. It is probably wise to avoid swimming until the wound is sound and dry about ten days after operation.
A job involving driving all day or spending a lot of time standing means two to three weeks need to elapse before returning. A heavy manual job or a job involving much lifting means a month will be needed before work can be resumed. General sport or physical activities can be resumed as soon as the patient is more comfortable, but more violent activities and contact sports may delay resumption for a month. Full fitness and return to full activity should be gradually resumed to ensure a successful outcome. Heavy lifting should not be performed until a month has passed.
It is usual to feel stiffness in the abdomen whilst walking about although walking can be started whenever the patient feels like it. Longer distances are unlikely to be achieved until the first week has elapsed. Patients can go back to car driving when they feel sure they can perform emergency control activities and this is unlikely to occur before ten days. Work return can be attempted whenever the patient is comfy enough to get on with normal activities, although if they can work part time or from home they can re-start soon after operation. - 14130
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, Physiotherapists in Kensington, 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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