In the modern practice of surgery there are several methods of inguinal hernia repair. These include: the Shouldice Operation (Canadian), the use of a synthetic mesh plug via open surgery, and the laparoscopic repair, also using a mesh prosthesis. Regardless of the method, the repair can be done as Same Day Surgery. The particular technique used is determined by the patient’s needs. The Shouldice and mesh plug repairs are usually done under local anesthesia. The laparoscopic technique usually requires general anesthesia. An anesthesiologist will be in attendance at all operations, however, to monitor vital signs, check the oxygenation of the blood, and provide sedation as needed.
You will be interviewed and examined. If you do indeed have a hernia that warrants repair, arrangements will be made to admit you to the hospital’s Same Day Surgery unit two hours before the operation. Preadmission testing will be scheduled as needed. Do not eat or drink for six hours prior to the time of surgery, but take any prescribed medications with a small amount of water. All aspirin products should be discontinued one week prior to surgery.
A. Open Repair
In the operating room the surgical site will be washed and local anesthetic administered. It is an injection of Xylocaine, similar to the one a dentist might administer. The operation takes about an hour. Very likely you will be dozing through it, though on several occasions the surgeon will ask you to strain or cough, first to demonstrate the hernia and then to demonstrate the repair.
Many patients are initially concerned about the prospect of local anesthesia. However, our experience with 6,000 patients over the past 25 years has shown this to be a well-accepted and well tolerated method.
B. Laparoscopic Repair
This technique is done under general anesthesia and is performed with specialized instruments through three small incisions in the midline between the navel and the pubis. The repair is made with a prosthetic mesh. It is suitable for those patients for whom a general anesthesia does not represent a risk. It should also be considered for those patients who have a hernia of both sides and wish to proceed with repair of both at the same sitting.
Upon completion of the operation, you will be asked to climb from the operating table to a stretcher and taken to the Same Day Surgery recovery area. Pain medication will be available to you should you need it. Most patients will be discharged within one to two hours after surgery.
In the first few days immediately after surgery, plan to be a “couch potato” so that the wound and mesh can settle and start healing. After about a week you may resume all ordinary activities as you find it comfortable to do so, but never persist beyond pain or fatigue. Twenty four hours after surgery you may remove the dressing and discard it. At this time, you may also start showering, washing the wound with soap and water and dabbing it dry.
People in sedentary occupations may resume work in about a week to ten days. Obviously, the more physically stressful occupations will require proportionally longer convalescence.
A prescription for pain medication will be provided on discharge. Most narcotic-based pain medications slow down bowel function. Take two tablespoonfuls of Milk of Magnesia twice a day to avoid constipation. Continue this until your bowels are regular.
After you are home, you will notice swelling around the wound. This firm area, “the healing ridge,” will be reabsorbed over several weeks. It is a normal reaction of the body to surgical trauma.
The first postoperative visit to the surgeon will be in approximately one week’s time. Please call the office for an appointment. Should you have any questions or concerns in the interim, do not hesitate to contact your surgeon.