Spigelian Hernia Repair

These hernias are caused by a weakness in the muscles of the abdominal wall. Other factors, which contribute to the development of epigastric hernias are obesity, coughing, heavy lifting and sport.

Spigelian hernias can be repaired using an open conventional approach, or laparoscopic repair. Despite the increased popularity of the laparoscopic approach the open mesh repair is still the most common method employed.

The consultant will explain and discuss the risk of complication when he asks you to sign the consent form.

• Wound haematoma. Bleeding under the skin can produce a firm swelling like a bruise. This may simply dissipate gradually or leak out through the wound. If there is a lot of fluid this may occasionally result in a return to theatre for it to be dealt with.
• Wound infection. Minor wound infections do not need any specific treatment. Antibiotics are given during the operation to minimise the risk of deep-seated infection.
• Recurrence. Fortunately, recurrence after hernia surgery is rare, around 1-5%.

You will be asked to attend a pre-admission assessment clinic prior to treatment to ensure you are fit for surgery, allowing time for the necessary preoperative tests. We will give you detailed instructions about anything you need to do before your operation, such as when to stop eating and drinking.

The repair is performed as day case surgery and will should take about 30 to 45 minutes.

General or regional/local anaesthetic are both options for surgery. Using a regional or local anaesthetic means you will be awake during the procedure, but the area being operated on will be numb and you will not experience any pain. The choice depends partly on which you prefer and partly on what your anaesthetist and consultant think is best.

The incision is usually made in the abdominal wall overlying the site of the hernia. The pouch (hernia sac) is first dealt with and the weakness in the abdominal wall is strengthened. This is done using permanent stitches or a patch of nylon mesh that is stitched in place. The wound is then closed using an invisible dissolvable stitch and covered with a waterproof dressing.

You will usually be able to go home on the same day of your operation. Please arrange for a friend or family member to drive you home in a car or order a taxi.

If you have had a general anaesthetic an adult must stay with you for the first 24 hours after your operation as your co-ordination and reasoning may be affected for a short time. Avoid drinking alcohol, operating machinery or signing legal documents for 24 to 48 hours after any operation involving general anaesthetic.

If you feel sick after the operation, please tell the nurse looking after you, as they will give you an injection to help with this.

After the operation, your abdomen will feel sore and uncomfortable, and you will be given painkillers to help relieve the pain. If you are still in pain after going home, continue taking painkillers as advised by the hospital.

The wound will be sealed within five days after which time the dressing may be removed, and you may take a bath or a shower. Make sure you follow the instructions our medical team give you about caring for your wound, hygiene and bathing.

Straining on the toilet because of constipation can cause pain around your wound. You can reduce your risk of constipation by drinking lots of fluids and eating plenty of vegetables, fruit and high-fibre foods, such as brown rice, wholemeal bread and pasta. A mild, over-the-counter laxative may also help.

Most people make a good recovery and return to their usual activities within two weeks. Here are a few things you can do to make sure you recover well:

• Gentle exercise, such as walking, can help the healing process, but you should avoid heavy lifting and strenuous activities for about four to six weeks. You should not play football for eight weeks and rugby for at least 12 weeks.
• You should be able to return to work after one or two weeks if your employment involves light work, or a bit longer if more manual. The consultant will be able to give you a “Statement for fitness” to work before discharge, if this is the case.
• You may find sex painful or uncomfortable at first, but it is usually fine to have sex when you feel able.
• Avoid driving until you are able to perform an emergency stop without feeling any pain or discomfort (you can practise this without starting your car). It will usually be one or two weeks before you reach this point after having keyhole surgery, although it may take longer after open surgery. We recommend you contact your car insurance company before you start driving again.

After your operation, you should seek medical advice if you notice any:

• Increased pain, redness, swelling or discharge from the wound.
• Persistent bleeding.
• Difficulty in passing urine.
• High temperature.
• Nausea or vomiting.