TYPES OF ABDOMINAL HERNIAS
There are many different types of abdominal hernias with many different names that can be confusing.
An abdominal hernia is essentially a hole in the muscle of the abdomen that allows some tissue from inside the abdomen to protrude through.
The most common types are:
- Inguinal hernias,
- Umbilical hernias
- Incisional hernias.
Once a hernia forms, it will never go away by itself. Whether or not a hernia should be fixed depends on many different factors and this is where working with a surgeon really helps to determine the best treatment for you.
How do you know if you have a hernia? Usually a hernia will start off with some discomfort and then you will see and feel a lump in the area. To be sure the best thing to do is to have a consultation with a surgeon like Dr. Mandelbaum who fixes many hernias.
Am I too old or sick to have a hernia repair? It depends on many factors, the risks and benefits need to be weighed carefully. Dr. Mandelbaum will take the time to get to know you and your own personal circumstances to assist you in making a good decision for yourself.
I do heavy work in my job, how will I return to work successfully?
Dr. Mandelbaum has spent many years treating the patients in Scarborough, including many who do manual labour of various kinds in their workplace. He is particularly sensitive to these issues and aware of the pressures that can be applied to workers by themselves, colleagues and management. Dr. Mandelbaum will support you with a personalized return to work plan that will give you adequate time to heal properly the first time. Dr. Mandelbaum will ensure that any required forms or letters that are necessary for your workplace are completed promptly, and usually without charge.
INGUINAL HERNIAS
The inguinal area is the groin. An inguinal hernia is thus a hernia of the groin area. These are extremely common, particularly in men, and there are a number of different ways surgeons fix these.
Here in Canada there are three different methods that are commonly used to fix inguinal hernias:
- Open repair with mesh
- Shouldice repair
- Laparoscopic repair with mesh
Click here or on the picture on the left to see a 2 minute animation of Lichtenstein repair
Dr. Mandelbaum performs exclusively the open repair with mesh. The technical name of this surgery is the Lichtenstein repair. This is an area of particular expertise of Dr. Mandelbaum. He has repaired over 1200 inguinal hernias with this very common, simple and reliable technique. In the office Dr. Mandelbaum will discuss with you the differences in these operations and make a recommendation for you that will take into account your personal health history, social circumstances and personal preferences.
Dr. Mandelbaum performs his Lichtenstein repair with extraordinary care. Precision, extreme attention to anatomical detail, and gentle handling of tissue has resulted in a very large group of satisfied patients and a wide referral base.
These are the risks that will be quoted to you in the office for the open repair with mesh with Dr. Mandelbaum. These may be changed slightly based on a patient's own particular circumstances:
There is a 1% risk of superficial infection and a 0.1% risk of complicated infection that could require removal of the mesh. There was a 5% risk of ongoing discomfort or pain and 10% risk of hematoma or seroma. There is a recurrence risk of approximately 5%. There is a small risk of urinary retention and remote risks of bowel or bladder injury. In men there is a small risk of compromise of blood supply to the testicle. The area will have some numbness that will usually improve with time.
This Wikipedia article on inguinal hernia surgery is very detailed:
TRUSS FOR INGUINAL HERNIA
A truss is a hernia belt. It has two parts. A plastic piece is present that is designed to fit into the area of the hernia like a plug. The second part is a waist band and leg strap that holds the plug securely in place. They come in many different shapes and sizes.
Pain from your hernia is often caused by the tissue going out and then back in through the hole in the muscle. The truss will prevent this from happening and will stop the pain.
The truss will also prevent the hernia from popping out and getting stuck, which is a surgical emergency.
If you have a job that requires heavy exertion and you have a hernia it is strongly advised to wear a truss.
PUTTING A TRUSS ON CORRECTLY
Please click this link for a video on how to put the truss on properly.
POST OPERATIVE CARE INSTRUCTIONS
The instructions below apply to any hernia surgery you have had with Dr. Mandelbaum.
After having your hernia repaired, there are no limitations on your diet. Shortly after the surgery, you may feel full or nauseated easily. This is usually due to the anesthesia during the operation.
Please resume all your regular medications at their usual times immediately after surgery, unless directed otherwise.
Difficulty with urination can occur after an inguinal hernia repair. If you feel the urge to go but you cannot urinate you may need to visit the emergency department where a catheter will be placed. Do not wait until the pain is terrible!
If you take blood thinners you will have personal instructions, please discuss with Dr. Mandelbaum prior to surgery.
You have been given a prescription for narcotic pain medication. This often slows the bowels down and you may become constipated. It is advisable to take a laxative the first few days after the operation to make sure you do not become overly constipated, because if you are straining during a bowel movement this can damage your hernia repair in the first few weeks after the operation.
Remove the outer dressing after 48 hours. If you have “Steri-Strips” (or small tapes) please do not remove them.
You can then shower and allow the water and soap to run over the wound. Keep some paper towel by the shower to keep your towels from getting soiled if there is a small amount of discharge. Pat the wound dry and cover it with some loose gauze secured with tape.
The steri strips, staples or stitches should be left in place for your first visit after surgery with Dr. Mandelbaum. Avoid submerging the incision for 1 week from the procedure.
Your first post operative visit after a hernia repair with Dr. Mandelbaum will be approximately a week after the operation. If you do not have this scheduled please contact the office.
Feel free to peel off the steri strips any time after 10 days from the procedure.
Your activity level should be reduced the first two weeks after the surgery. The incisions are about 30 to 40% strength of normal tissue at 3 weeks.
Do not to lift anything more than 15lbs. for about 6 weeks.
You can increase your activity after the first two weeks, allowing pain to be your guide in your recovery. This just means you can steadily increase your activity as long as your pain is under control.
Often after surgery you may have a few days where you feel really well. This is usually when people increase their activity level and the following day feel very sore or very tired. This is normal. It’s OK to do this, just be aware you may experience these “ups and downs” for a few weeks. Just as long as you are improving from day to day and week to week, you are on the right road to recovery.
If you should have increasing pain, increasing redness, increasing bulge or discharge at or from the incision please contact the office.
If you have any other questions or concerns during your recovery, please do not hesitate to call us at any time.
