INGUINAL HERNIA REPAIR AFTERCARE RISKS
Category: General Surgery
Abstract : Aftercare The hernia repair site must be kept clean and any sign of swelling
or redness reported to the surgeon. Patients should also report a fever, and men
should report any pain or swelling of the testicles. The surgeon may remove the
outer sutures in a follow-up visit about a week after surgery. Activities may be
limited to non-strenuous movement for up to two weeks, depending on t
Aftercare
The hernia repair site must be kept clean and any sign of swelling
or redness reported to the surgeon. Patients should also report a fever, and men
should report any pain or swelling of the testicles. The surgeon may remove the
outer sutures in a follow-up visit about a week after surgery.
Activities may be
limited to non-strenuous movement for up to two weeks, depending on the type of
surgery performed and whether or not the surgery is the first hernia repair. To
allow proper healing of muscle tissue, hernia repair patients should avoid heavy
lifting for six to eight weeks after surgery. The postoperative activities of
patients undergoing repeat procedures may be even more restricted.
Prevention of indirect hernias, which are congenital, is not possible.
However, preventing direct hernias and reducing the risk of recurrence of direct
and indirect hernias can be accomplished by:
• maintaining body weight
suitable for age and height
• strengthening abdominal muscles through
regular exercise
• reducing abdominal pressure by avoiding constipation and
the build-up of excess body fluids, achieved by adopting a high-fiber, low-salt
diet
• lifting heavy objects in a safe, low-stress way, using arm and leg
muscles
Risks
Hernia surgery is considered to be a relatively safe
procedure, although complication rates range from 1–26%, most in the 7–12%
range. This means that about 10% of the 700,000 inguinal hernia repairs each
year will have complications. Certain specialized clinics report markedly fewer
complications, often related to whether open or laparoscopic technique is used.
One of the greatest risks of inquinal hernia repair is that the hernia will
recur. Unfortunately, 10–15% of hernias may develop again at the same site in
adults, representing about 100,000 recurrences annually. The risk of recurrence
in children is only about 1%. Recurrent hernias can present a serious problem
because incarceration and strangulation are more likely and because additional
surgical repair is more difficult than the first surgery. When the first hernia
repair breaks down, the surgeon must work around scar tissue as well as the
recurrent hernia. Incisional hernias, which are hernias that occur at the site
of a prior surgery, present the same circumstance of combined scar tissue and
hernia and even greater risk of recurrence.
Each time a repair is
performed, the surgery is less likely to be successful. Recurrence and infection
rates for mesh repairs have been shown in some studies to be lower than with
conventional surgeries. Complications that can occur during surgery include
injury to the spermatic cord structure; injuries to veins or arteries, causing
hemorrhage; severing or entrapping nerves, which can cause paralysis; injuries
to the bladder or bowel; reactions to anesthesia; and systemic complications
such as cardiac arrythmias, cardiac arrest, or death. Postoperative
complications include infection of the surgical incision (less in laparoscopy);
the formation of blood clots at the site that can travel to other parts of the
body; pulmonary (lung) problems; and urinary retention or urinary tract
infection.
Normal results
Inguinal hernia repair is usually
effective, depending on the size of the hernia, how much time has gone by
between its first appearance and the corrective surgery, and the underlying
condition of the patient. Most first-time hernia repair procedures will be
one-day surgeries, in which the patient will go home the same day or in 24
hours. Only the most challenging cases will require an overnight stay. Recovery
times will vary, depending on the type of surgery performed. Patients undergoing
open surgery will experience little discomfort and will resume normal activities
within one to two weeks. Laparoscopy patients will be able to enjoy normal
activities within one or two days, returning to a normal work routine and
lifestyle within four to seven days, with the exception of heavy lifting and
contact sports.
Morbidity and mortality rates
Mortality related to
inguinal hernia repair or postoperative complications is unlikely, but with
advanced age or severe underlying conditions, deaths do occur. Recurrence is a
notable complication and is associated with increased morbidity, with recurrence
rates for indirect hernias from less than 1–7% and 4–10% for direct.
Alternatives If a hernia is not surgically repaired, an incarcerated or
strangulated hernia can result, sometimes involving life-threatening bowel
obstruction or ischemia.
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