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GROIN HERNIA

Groin Hernia Repair - Hernia Treatment Doctor in Ahmedabad

The Condition

A hernia occurs when tissue bulges out through an opening in the muscles. Any part of the abdominal wall can weaken and develop a hernia, but the most common sites are the groin (inguinal), the navel (umbilical) and a previous surgical incision site.

common symptoms?

Visible bulge in the scrotum or groin area, especially with coughing or straining

Pain or pressure at the hernia site

Treatment Options

Surgical procedure

open hernia repair An incision is made near the site and the hernia is repaired with mesh or by suturing (sewing) the muscle closed

laparoscopic hernia repair A hernia is repaired by mesh or sutures inserted The hernia is repaired by mesh or sutures inserted through instruments placed into small incisions in the abdomen.

Non-surgical procedure

Watchful waiting is a safe and acceptable option for adults with inguinal hernias that is not uncomfortable.Many patients become symptomatic after the first 1 to 2 years and crossover to surgery due to increased pain on exertion, chronic constipation or urinary symptoms

Benefits and Risks of Your Operation

Benefits—An operation is the only way to repair a hernia. You can return to your normal activities and in most cases will not have further discomfort

Risks of not having an operation—Your hernia may cause pain and increase in size. If your intestine becomes trapped in the hernia pouch you will have sudden pain, vomiting, and need an immediate operation.

possible risks include Return of the hernia; infection; injury to the bladder, blood vessels, intestines or nerves, diffi culty passing urine, continued pain, and swelling of the testes or groin area.

Expectations

Before your operation—Evaluation may include blood work and urinalysis. Your surgeon and anesthesia provider will discuss your health history, home medications, and pain control options.

The day of your operation—You will not eat or drink for 6 hours before the operation. Most often you will take your normal medication with a sip of water. You will need someone to drive you home.

Your recovery—If you do not have complications you usually will go home the same day.

Call your surgeon if you have severe pain, stomach cramping, chills with a high fever (higher than 101°F), odor or increased drainage from your incision, or no bowel movement for 3 days.

The Condition, Symptoms, and Diagnostic Tests

The Condition

The Hernia

A groin hernia occurs when the intestine bulges through the opening in the muscle in the groin area. A reducible hernia can be pushed back into the opening. When intestine or abdominal tissue fills the hernia sac and cannot be pushed back, it is called irreducible or incarcerated. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. This is a surgical emergency. There are two types of groin hernias: An inguinal hernia appears as a bulge in the groin or scrotum. Inguinal hernias account for 75% of all hernias and are most common in men. A femoral hernia appears as a bulge in the groin, upper thigh, or labia (skin folds surrounding the vaginal opening). Femoral hernias are ten times more common in women. They are always repaired because of a high risk of strangulation. Herniorrhaphy is the surgical repair of a hernia. Hernioplasty is the surgical repair of a hernia with mesh

Symptoms

The most common symptoms of a hernia are:

Bulge in the groin, scrotum, or abdominal area that often increases in size with coughing or straining.

Mild pain or pressure at the hernia site.

Numbness or irritation due to pressure on the nerves around the hernia

Sharp abdominal pain and vomiting can mean that the intestine has slipped through the hernia sac and is strangulated. This is a surgical emergency and immediate treatment is needed.

Common Tests

History and Physical

The site is checked for a bulge.

Additional Tests (see Glossary)

Other tests may include:

Digital exam

Blood tests

Urinalysis

Electrocardiogram (ECG)—for patients over 45 or if high risk of heart problems

Ultrasound

Keeping You Informed

Who Gets Hernia?

There may be no cause for a hernia. Some risk factors are:

• Older age—muscles become weaker

• Overweight and obesity—increased weight places pressure on abdominal muscle

• Chronic straining

• Family history

• Ascites: excess fluid in the space between the tissues lining the abdomen and abdominal organs; may be due to alcoholism

• Pregnancy, particularly multiple pregnancies

Other medical disorders

that have symptoms similar to hernias include enlarged lymph nodes, cysts, and testicular problems such as scrotal hydrocele

The Surgical and Nonsurgical Treatment

Surgical Treatment

The type of operation depends on hernia size and location, and if it is a repeat hernia. Your health, age, anesthesia risk, and the surgeon’s expertise are also important. An operation is the only treatment for incarcerated/ strangulated and femoral hernias. Your hernia can be repaired either as an open or laparoscopic approach. The repair can be done by using sutures only or adding a piece of mesh

Open Hernia Repair

The surgeon makes an incision near the hernia site, and the bulging tissue is gently pushed back into the abdomen. Sutures or mesh are used to close the muscle.

For a suture-only repair: The hernia sac is removed. Then the tissue along the muscle edge is sewn together. The umbilicus is then fixed back to the muscle. This procedure is often used for small defects.

For an open mesh repair: The hernia sac is removed. Mesh is placed beneath the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia. The mesh extends 3 to 4 cm beyond the edges of a hernia. The umbilicus is fixed back to the muscle. Mesh is often used for large hernia repairs and reduces the risk that a hernia will come back again.

Laparoscopic Hernia Repair

The surgeon will make several small punctures or incisions in the abdomen. Ports or trocars (hollow tubes) are inserted into the openings. Surgical tools and a lighted camera are placed into the ports. The abdomen is inflated with carbon dioxide gas to make it easier for the surgeon to see a hernia. Mesh may be sutured or fixed with staples to the muscle around the hernia site. The port openings are closed with sutures, surgical clips, or glue.

Nonsurgical Treatment

Watchful waiting is an option if you have an inguinal hernia with no symptoms. Hernia incarceration occurred in 1.8 per is often used for large hernia repairs 1,000 men who waited longer than 2 years to have a repair. Femoral hernias should always be repaired because of the high-risk sutures, staples, or surgical glue. (400 of 1,000) of incarceration and bowel within 2 years of diagnosis. sac is removed. Then the tissue along the muscle edge is sewn together. Trusses or belts can help manage the symptoms This procedure is often used for of a hernia by applying pressure at the site. A strangulated or infected hernias or truss requires correct fitting and small defects (less than 3 cm). complications include testicular nerve Open Hernia Repair Nonsurgical Treatment damage and incarceration may result.



Keeping You Informed

Open versus Laparoscopic Inguinal Repair

A laparoscopic repair of inguinal a hernia may result in less pain and numbness, lower infection rate, and faster return to normal activity when compared with open surgery. Laparoscopic repair may lengthen the operative time and may cost more. A recurrence from a previous open hernia repair is best repaired laparoscopically because you avoid scar tissue from previous incisions. Laparoscopic repair of a bilateral (both sides of the groin) inguinal hernias also resulted in the earlier return to work then open repairs. The risk of complications increases for both the open and laparoscopic procedure if the a hernia extends into the scrotum.

Risks of this Procedure

Risks Based on the ACS Risk Calculator

Risks from Outcomes Reported in the Last 10 Years of Literature Percent for Average Patient Keeping You Informed
Wound Infection: Infection at the area of the incision or near the organ where the surgery was performed Open 0.3% Laparoscopic 0.2% Antibiotics and drainage of the wound may be needed. Smoking can increase the risk of infection.
Complications: Including surgical infections, breathing difficulties, blood clots, renal (kidney) complications, cardiac complications, and return to the operating room Open 1.5% Laparoscopic 1.2% Complications related to general anesthesia and surgery may be higher in smokers, elderly and/or obese patients, and those with high blood pressure and breathing problems. Wound healing may also be decreased in smokers and those with diabetes and immune system disorders.
Pneumonia: Infection in the lungs Open 0.1% Laparoscopic 0.1% Movement, deep breathing, and stopping smoking can help prevent respiratory infections.
Urinary tract infection: Infection of the bladder or kidneys Open 0.1% Laparoscopic 0.1% Drinking fluids and catheter care decrease the risk of bladder infection.
Venous thrombosis: A blood clot in the legs that can travel to the lungs Open 0.1% Laparoscopic 0.1% Longer surgery and bed rest increases the risk. Getting up, walking 5 to 6 times per day and wearing support stockings reduce the risk.
Chronic (long-term) Pain 3 months 2.8% 2 years 4.5% to 23% 4 years 31% Factors contributing to chronic pain include emergency hernia repair, scrotal hernia, or recurrent hernia repair. 1 Pain may be less with laparoscopic procedures than open procedures. 2 Pain caused by compression or tension may gradually decrease with time as a result of tissue rearrangement
Immediate postoperative pain There is no difference in pain scores when comparing suture vs. mesh vs. laparoscopic repair by postoperative day The laparoscopic approach avoids a long incision. There may be a feeling of tightness in your abdomen because the muscle has been pulled together. Your pain will be managed with nonsteroidal anti-inflammatory medications and by resting and avoiding straining or lifting.
Recurrence: A hernia can recur after the repair All patients 1% to 17% 11 Open 4.9% Laparoscopic 10.1%Recurrence occurs half as often when the mesh is used versus non-mesh repair. 2 Laparoscopic repairs is recommended for recurrent hernias because the surgeon avoids previous scar tissue. There is a higher rate of recurrence in older men with laparoscopic repair.
Neuralgia: Nerve pain causing tingling or numbness Open 10.7% Laparoscopic 7.4% Pressure, staples, stitches, or a trapped nerve in the surgical area can cause nerve pain. Tell your doctor if you feel severe, sharp, or tingling pain in the groin and leg immediately after your procedure; an operation may be required if the nerve is trapped.
Seroma: A collection of clear/yellow fluid Mesh repairs 8% Nonmesh repairs 3.1% Seromas can form around the former hernia site. Removal of fluid with a sterile needle may be required

Expectations: Preparing for Your Operation

Preparing for Your Operation

Home Medication

Bring a list of all of the medications and vitamins that you are taking. Your medication may have to be adjusted before your operation. Some medications can affect your recovery and response to the anesthesia. Most often you will take your morning medication with a sip of water.

Anesthesia

Let your anesthesia provider know if you have allergies, neurologic disease (epilepsy, stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), or loose teeth; if you smoke, drink alcohol, use drugs, or take any herbs or vitamins; or if you have a history of nausea and vomiting with anesthesia. If you smoke, you should let your surgical team know and you should plan to quit. Quitting before your surgery can decrease your rate of respiratory and wound complications and increase your chances of staying smoke- free for life. Resources to help you quit may be found at www.facs.org/patienteducation or www.lungusa.org/stop-smoking.

Lenght of stay

If you have local anesthesia, you will usually go home the same day. You may stay overnight if you had a repair of a large or incarcerated hernia, laparoscopic repair with a longer anesthesia time, postanesthesia issues such as severe nausea and vomiting, or you are unable to pass urine.

The Day of Your Operation

Do not eat or drink for at least 6 hours before the operation.

Shower and clean your abdomen and groin area with a mild antibacterial soap

Brush your teeth and rinse your mouth out with mouthwash.

Do not shave the surgical site; your surgical team will clip the hair nearest the incision site

What to Bring

Insurance card and identification

Advance directives (see Glossary)

List of medicines

Loose-fitting, comfortable clothes

Slip-on shoes that don’t require that you bend over

Leave jewelry and valuables at home

What You Can Expect

An identification (ID) bracelet and allergy bracelet with your name and hospital/clinic number will be placed on your wrist. These should be checked by all health team members before they perform any procedures or give you medication. Your surgeon will mark and initial the operation site.

Fluids and Anesthesia

An intravenous line (IV) will be started to give you fluids and medication. For general anesthesia, you will be asleep and pain-free during the operation. A tube may be placed in your throat to help you breathe during the operation. For spinal anesthesia, a small needle with medication will be placed on your back alongside your spinal column. You will be awake during the operation but pain-free.

After Your Operation

You will be moved to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be closely watched. Be sure that all visitors wash their hands.

Preventing Pneumonia and Blood Clots

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour, take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and, for high-risk patients, taking a medication that thins your blood.

Questions to Ask


About My Operation:

What are the side effects and risks of anesthesia?

What technique will be used to repair the hernia (laparoscopic or open; mesh or with sutures)?

What are the risks of this procedure for me?

Will you be performing the entire operation yourself?

What level of pain should I expect and how will it be managed? You will be moved to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be closely watched. Be sure that all visitors wash their hands.

How long will it be before I can return to my normal activities (work, driving, lifting)?

Your Recovery and Discharge

Your Recovery and Discharge

Thinking Clearly

If general anesthesia is given, or if you are taking narcotic pain medication, it may cause you to feel diff erent for 2 or 3 days, have diffi culty with memory, and feel more fatigued. You should not drive, drink alcohol, or make any big decisions for at least 2 days.

Nutrition

When you wake up from the anesthesia, you will be able to drink small amounts of liquid. If you do not feel sick, you can begin eating regular foods

Continue to drink about 8 to 10 glasses of water each day.

Eat a high-fi ber diet so you don’t strain while having a bowel movement.

Activity

Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clot formation

You may go home the same day for a simple repair. If you have other health conditions or complications, such as nausea, vomiting, bleeding, or infection after surgery, you may stay longer.

Work and Return to School

You may return to work after 1 to 2 weeks after laparoscopic or open repair, as long as you don’t do any heavy lifting.Discuss the timing with your surgeon.

Do not lift items heavier than 10 pounds or participate in strenuous activity for at least 4 to 6 weeks.

Lifting limitation may last for 6 months after complex or recurrent hernia repairs.

Wound Care

Always wash your hands before and after touching near your incision site.

Do not soak in a bathtub until your stitches, Steri-Strips, or staples are removed. You may take a shower after the second postoperative day unless you are told not to.

Follow your surgeon’s instructions on when to change your bandages.

A small amount of drainage from the incision is normal. If the dressing is soaked with blood, call your surgeon.

If you have Steri-Strips in place, they will fall off in 7 to 10 days.

If you have a glue-like covering over the incision, allow the glue to fl ake off on its own.

Avoid wearing tight or rough clothing. It may rub against your incisions and make it harder for them to heal.

Protect the new skin, especially from the sun. The sun can burn and cause darker scarring.

Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year.

Bowel Movements

Avoid straining with bowel movements by increasing the fiber in your diet with high- fiber foods or over-the-counter medicines (like Metamucil and FiberCon). Be sure you are drinking 8 to 10 glasses of water each day.

Pain

The amount of pain is different for each person. The new medicine you will need after your operation is for pain control, and your doctor will advise how much you should take. You can use throat lozenges if you have sore throat pain from the tube placed in your throat during your anesthesia.

When to Contact Your Surgeon

Contact your surgeon if you have:

Pain that will not go away

Pain that gets worse

A fever of more than 101°F or 38.3°C

Continuous vomiting

Swelling, redness, bleeding, or bad-smelling drainage from your wound site

Strong or continuous abdominal pain or swelling of your abdomen

No bowel movement 2 to 3 days after the operatio

Pain control

Everyone reacts to pain in a different way. A scale from 0 to 10 is used to measure pain. At a “0,” you do not feel any pain. A “10” is the worst pain you have ever felt. Following a laparoscopic procedure, pain is sometimes felt in the shoulder. This is due to the gas inserted into your abdomen during the procedure. Moving and walking helps to decrease the gas and the right shoulder pain. Extreme pain puts extra stress on your body at a time when your body needs to focus on healing. Do not wait until your pain has reached a level “10” or is unbearable before telling your doctor or nurse. It is much easier to control pain before it becomes severe

Common Medicines to Control Pain

Narcotics are used for severe pain. Possible side effects of narcotics are sleepiness; lowered blood pressure, heart rate, and breathing rate; skin rash and itching; constipation; nausea; and difficulty urinating. Some examples of narcotics include morphine, oxycodone (Percocet®/Percodan), and hydromorphone (Dilaudid). Medications can be given to control many of the sides effects of narcotics

Non-Narcotic Pain Medication

most non-opioid analgesics are classified as non-steroidal anti-inflammatory drugs (NSAIDs). They are used to treat mild pain and inflammation or combined with narcotics to treat severe pain. Possible side effects of NSAIDs are stomach upset, bleeding in the digestive tract, and fluid retention. These side effects usually are not seen with short- term use. Let your doctor know if you have heart, kidney, or liver problems. Examples of NSAIDs include ibuprofen, Motrin, Aleve, and Toradol (given as a shot)

Pain Control without Medicine
Distraction helps you focus on other activities instead of your pain. Listening to music, playing games, or other engaging activities can help you cope with mild pain and anxiety.

Guided imagery helps you direct and control your emotions. Close your eyes and gently inhale and exhale. Picture yourself in the center of somewhere beautiful. Feel the beauty surrounding you and your emotions coming back to your control. You should feel calmer

Keeping You Informed

Pain after Inguinal Hernia Repair

Pain that continues one year after inguinal hernia repair is reported as 110 of 1,000 patients, with moderate/severe pain reported in 17 of 1,000. 80% of patients with severe groin pain had pain before the operation. The pain decreased by 50% in one year. The incidence of pain is higher in women than in men. Pain was higher when heavy versus light- weight mesh was used. Most studies do not report a difference in chronic pain between open versus laparoscopic repair.

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