HERNIA INGUINAL - ADULT - NOT DAY CASE
MICHAEL EDWARDS
Author's note
This information describes what a patient may expect when having the described operation.
The information is specific to the author's practice.
Other surgeons will doubtless differ in their preferences.
The script can be down loaded and edited to suit other surgeons.
You will need Abobe Acrobat Reader which can be downloaded from http://www.adobe.com/uk/products/acrobat/readermain.html
Your Inguinal Hernia Operation - some information
These notes give a guide to your stay in hospital. They also give an idea about what it will be like afterwards. They do not cover everything. If you want to know more, please ask.
What is a Hernia?
A hernia (her-near) is a bulge or weakness in the muscles which form the front of the body wall. In your case the hernia is in the groin. Sometimes they are on both sides. They can be caused by the body wall being weak from birth. Sometimes the body wall weakens with the passing of time. Sometimes the body is overstrained by coughing, heavy work or sport etc. Hernias are very common and are easily treated. If left untreated they get bigger, cause pain and can cause a blockage in the bowel.
What does the operation consist of?
A cut is made into the skin overlying the hernia. The bulge is pushed back or is cut off. The weak part is mended and strengthened, usually with nylon stitches. The cut in the skin is then closed up.
Are there any alternatives?
Simply waiting and seeing if you have more trouble is not a good idea. The hernia will always get worse.
A truss is will usually hold the hernia back in place. It is useful as a stop-gap until you have the operation. It is a good idea if you do not like the idea of an operation, or if you are not fit enough for one.
Keyhole operations for hernia repair are experimental. It will be 5-10 years before we will know if this is a good way.
What happens before the operation?
Welcome to the ward
You will be welcomed to the ward by the nurses or the receptionist. You will have your details checked. You will be shown to your bed and will be asked to change into a cotton gown.
You will have some basic tests done, such as pulse, temperature, and blood pressure.
You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct.
Please tell the nurses of any allergies to drugs or dressings.
Visits by the surgical team
You will be seen first by the House Surgeon, who will interview and examine you. He, or she, will check all your special tests such blood samples are in order. The operation will be explained to you. You will be asked to sign your consent for the operation. If you are not clear about any part of the operation, ask for more details from the doctors or from the nurses. They are never too busy to do this.
You will have the operation site marked on you with a skin pencil.
You will be seen by the surgeon who will be doing the operation. He will check that all the necessary preparations have been made.
Visits by the anaesthetic team
One or more anaesthetists who will be giving your anaesthetic will interview and examine you. They will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had, plus any anaesthetic problems in the family.
Usually we give a general anaesthetic so that you will be asleep. Sometimes it is better just to freeze the skin with injections. The anaesthetist will talk to you about this.
The Periods
The periods do not affect the operation.
Shaving
You will be shaved to remove excess hair.
Timing of the operation
The timing of your operation is usually arranged the day before. The nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing.
Premedication
You may be given a sedative injection or tablets about 1 hour before the operation.
Transfer to theatre
You will be taken on a trolley to the operating suite by a ward nurse and a theatre porter. You will be wearing a cotton gown. Wedding rings will be fastened with tape.
Removable dentures will be left on the ward. There will be several checks on your details on the way to the anaesthetic room where your anaesthetic will begin.
If you are having a local anaesthetic
This means you will be awake during the operation. There will be a nurse to talk to all the time. You will be lying on the operating table.
We put several cuffs and pads on your chest, arms, fingers and leg. This helps check such things as your pulse and blood pressure during the operation.
We clean the skin round your groin with an antiseptic which is rather cold. Then we cover your trunk and legs with sterile green sheets. We then inject local anaesthetic liquid into the skin of your groin to make it numb. This stings a bit, but soon passes off.
Then we do the operation. If you feel anything, we can give you more anaesthetic. The operation takes about 40 minutes.
You can talk to us during this time, but you will not be able to see any of the operation.
If you are having a general anaesthetic
You will have an injection into an arm or hand vein, and will go off to sleep.
What happens after the operation?
After the operation, you go on a trolley to the recovery ward for a few minutes. Then you go by trolley back to the main ward.
Coming round after a general anaesthetic
Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes off. You will be given some treatment for sickness if necessary.
You may be given oxygen from a face mask for a few hours if you have had chest problems in the past.
Warning after a General Anaesthetic
The drugs we give for a general anaesthetic will make you clumsy, slow and forgetful for about 24 hours. This happens even if you feel quite alright.
For 24 hours after your general anaesthetic:
Do not make any important decisions.
Do not drive.
Do not use machinery at work or at home.
(e.g. do not boil a kettle).
Will it hurt?
Every patient has local anaesthetic injected into the wound, even if you have a general anaesthetic for the operation.
Usually the wound is pain-free. There may be some discomfort on moving. Tablets of CoCodamol should easily control this discomfort. If not, we can give painkilling injections.
Ask for more if the pain is still unpleasant.
You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you.
The second day after operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor.
By the end of one week the wound should be virtually pain-free.
WARNING
The local anaesthetic in your wound may make your leg give way for 12 hours or so. Be especially careful when getting in or out of bed. Ask a nurse to help you.
Drinking and eating
You will be able to drink within an hour or two of the operation provided you are not feeling sick.
The next day you should be able to manage small helpings of normal food.
Opening bowels
It is quite normal for the bowels not to open for a day or so after operation.
If you have not opened your bowels after two days and you feel uncomfortable, ask the nurses for a laxative.
Passing urine
It is important that you pass urine and empty your bladder within 6-12 hours of the operation. If you find using a bed pan or a bottle difficult, the nurses will assist you to a commode or the toilet.
If you still cannot pass urine let the nurses know and steps will be taken to correct the problem.
Sleeping
You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know.
Physiotherapy
The physiotherapist will check that you are clearing your lungs of phlegm by coughing. You can help your circulation by continuous movement of body and limbs.
The wound and stitches
The wound has a dressing which may show some staining with old blood in the first 24 hours. The dressing will be removed. The wound will be sprayed with a cellulose varnish similar to nail varnish. You can take the dressing off after 48 hours. There is no need for a dressing after this unless the wound is painful when rubbed by clothing.
There are no stitches in the skin. The wound is held together underneath the skin and does not need further attention.
There may be some purple bruising around the wound which spreads downward by gravity and fades to a yellow colour after 2 to 3 days. It is not important.
There may be some swelling of the surrounding skin which also improves in 2 to 3 days.
After 7 to 10 days, slight crusts on the wound will fall off. The cellulose varnish will peel off and can be assisted with nail varnish remover.
Occasionally minor matchhead sized blebs form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so.
Washing
You can wash, bathe, or shower as soon as the dressing is taken off. Soap and tap water are quite alright. Salted water is not needed.
What about informing my relatives and contacts?
With your permission, the nurses and doctors will keep your relatives and contacts up to date with your progress.
How long in hospital?
Usually after 1 to 2 days you will feel fit enough to leave hospital, provided there is someone to look after you.
The nurses will talk to you about your home arrangements so that a proper time for you to leave hospital can be arranged.
You will be given an appointment to visit the Out Patient Department for a check up about one month after you leave hospital.
Sick notes
Please ask the nurses for sick notes, certificates etc.
After you leave hospital
You are likely to feel very tired and need rests 2 to 3 times a day for a week or more. You will gradually improve so that by the time a month has passed you will be able to return completely to your usual level of activity.
Lifting
At first discomfort in the wound will prevent you from harming yourself by too heavy lifting. After one month you can lift whatever you like. There is no value in attempting to speed the recovery of the wound by special exercises before the month is out.
Driving
You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 10 days.
What about sex?
You can restart sexual relations within a week or two, when the wound is comfortable enough.
Work
You should be able to return to a light job after about 2 weeks, and any heavy job within 4 weeks.
Complications
Complications are rare and seldom serious.
If you think that all is not well, please ask the nurses or doctors.
Bruising and swelling may be troublesome, particularly if the hernia was large. The swelling may take 4 to 6 weeks to settle down.
Infection is a rare problem and settles down with antibiotics in a week or two.
Aches and twinges may be felt in the wound for up to 6 months.
Occasionally there are numb patches in the skin around the wound which get better after 2 to 3 months.
The risk of a recurrence of the hernia is about 1 in 100.
General advice
The operation should not be underestimated, but practically all patients are back to their normal duties within one month.
If you have any problems or queries, please ask the nurses or doctors.
Any Questions?
If you have any questions, jot them down here and ask the doctors or nurses for answers.
Any complaints?
If you have any complaints, please contact the doctors or nurses straight away. If this does not solve the problem, please write to your surgeon.
Have you any comments?
We welcome your comments and suggestions covering your illness, your treatment in hospital, and your recovery. Please write below any points you would like to make. If you prefer, you need not give your name.
Full name:
Hospital:
Ward:
Date of stay in hospital:
Operation:
Out patients department:
Your admission arrangements:
Your welcome on the ward:
Nursing staff:
General ward atmosphere:
Medical staff:
Ward orderlies:
Portering staff:
X-ray staff:
ECG staff:
Did you know who was who?:
Bedding:
Food and drink:
Privacy:
Locker space:
Toilets:
Bathrooms:
Other patients:
Noise:
Information:
Telephone/TV/radio/newspapers:
Timing of operation:
Preparations for your operation:
Going into the theatre:
In the operating theatre:
In the recovery room:
Coming back from theatre:
Intensive Care ward:
Recovery on the ward:
Pain control:
Sleeping:
Wound dressings:
Stitches, clips:
Progress reports:
Visiting hours:
Rest room:
Tablets, medicines, injections:
Going-home arrangements:
Out-patient follow up:
Anything else?
Continue comments overleaf if you wish.
Please send this questionnaire to your surgeon.
