A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery. Both men and women can get a hernia. You may be born with a hernia (congenital) or develop one over time. A hernia does not get better over time, nor will it go away by itself.

No. Hernias vary in location and size and in the symptoms they cause. Common locations for hernias are the groin (inguinal Hernia and less commonly Femoral hernia), Umbilical region (belly button hernia) and epigastrium (midline hernia above the belly button). Another common location is at the site of a previous surgical incision (incisional hernia). Hiatal Hernia is another common form of hernia but this does not cause a visible lump on the abdomen because the hernia occurs in the diaphragm muscle and the protrusion of abdominal contents is into the chest. Hiatal hernias are discussed in the section on Hiatal hernia surgery and anti-reflux surgery. Hernia varies in size from pea-sized to containing the entire abdominal contents and every size in between. The size of a hernia is one of the factors that determine how extensive the surgery required to repair it. Other factors that can influence the complexity of hernia repair are previous abdominal surgeries and previous hernia repairs.

Laparoscopic or Keyhole hernia surgery is a method of hernia repair using a small telescope with a camera attached for vision and small ports for operative workings. Carbon dioxide is insufflated to give working space to perform the hernia repair. Keyhole surgery allows smaller incisions which results in less post operative pain and less risk of post-operative wound infections. For laparoscopic Inguinal hernia repair there is usually one 12mm incision at the Umbilicus (Belly Button) and two 5mm incisions in the lower Abdomen. For incisional hernia the number of incisions and position of the incision vary according to size and position of the hernia

Open or traditional hernia repair involves an incision in the region of the hernia allowing direct visualisation of the hernia to be repaired. In inguinal hernia repair, an incision of 7 to 10cm is usually required. This method of hernia repair is very safe and has stood the test of time. In many cases, an open repair is still the most appropriate surgical choice.

Several factors influence the type of hernia required for the individual patient. 1. Location of hernia 2. Size of the hernia 3. Previous surgery 4. Overall general health of the patient Your surgeon will assess you and advise the appropriate surgery specifically tailored to your hernia

Yes, the aim of the surgery is for a permanent repair. All hernias can recur over time but with the use of permanent re-enforcement/scaffolding material for your repair (mesh), this significantly reduces the risk of the hernia recurring.

Risks for surgery can be divided into general risks (associated with any surgery) and Specific risks. General risks include cardio-vascular complications (heart attack, stroke), respiratory complications (pneumonia, partial lung collapse), thrombo-embolic events (blood clots) and anaphylaxis (severe allergic reactions). These are very rare occurrences in hernia surgery. In some patients who have a complex medical history or a complex hernia these risks may be more relevant, and your surgeon will discuss this with you. Specific risks include inadvertent bowel, bladder or vascular injury. These are rare but serious complications that may require more extensive surgery and a prolonged stay in hospital. Less rare but less serious complications include post-operative Haematoma (collection of old blood beneath the wound or internally), infected mesh and wound infection. The most common minor problems post hernia surgery are bowel and bladder issues and and pain that persists for longer than a few days. These are discussed further in the post-operative instructions.

They time to return to work depends on the size and complexity of the hernia repair, the type of work and individual patient factors. For routine inguinal hernia repair: Most people will be able to return to desk jobs at one week. Active jobs requiring frequent movement, car travel and light duties (lifting up to 12kg) could be 2-3 weeks. Jobs involving heavy manual work and heavy lifting could be 6 weeks.

Early return to light physical activity is encouraged after all hernia surgery. This includes walking from day 1 post-operatively, starting with short distances, building up to normal walking distances at one week. The same goes for light stretching. Swimming is an excellent recovery exercise and can be undertaken after 2 weeks (providing the wounds have healed without issues). Exercise bike riding is also encouraged after 2 weeks. Other forms of exercise that can be undertaken after 2 weeks includes low impact core work such as Pilates, and Yoga, light limb weights, light jogging and Sexual Intercourse. Activities that should be avoided for the first 6 weeks include Heavy Lifting, Weighted squats, abdominal crunches and sports that require explosive rotational movement such as Golf, Tennis and Surfing.

After most routine hernia repairs, it is safe to drive a car short distances at 5 days postoperatively. The important test is that you can brake quickly if required and you are no longer taking strong painkillers. Travelling long distances in a car as passenger or driver is not advised until 2 weeks post-operatively. Short Haul Air Travel should be safe after one week. Long Haul Flights should not be undertaken ideally for 3 weeks post surgery.

You will leave hospital with 2 layers of dressings on your wounds. The Outer layer is waterproof and allows you to shower from day 1 after your surgery. It can be removed after Post-operative Day 7. Beneath this dressing will be small strips (Steristrips) directly applied to the wounds. You should leave these intact until they curl up and fall off. This can take up to 4 weeks. After removing the Waterproof (top) dressing, the steristrip dressings can be treated like normal skin and washed over in the shower.

In the first 24 hours post surgery there are often 2 types of discomfort. Firstly, there is often some referred shoulder tip pain from residual gas from the laparoscopy irritating the diaphragm. This can vary from irritating to severe and you will be given pain medication for this. The referred pain does not usually last for more than 24 hours. The other pain is at the incision sites (often called wound pain) This is less severe and usually is worst on day one and rapidly improves. One in ten patients also suffer from post-operative nausea and vomiting which is related to the anaesthesia and the post-operative pain relief. You will be given anti-nausea medication as needed. You will be given pain medication upon discharge. Usually 2-3 days post surgery, the discomfort should be easily controlled with paracetamol alone. Whilst the stronger pain medication is useful in the early post –operative period, prolonged use will result in constipation, nausea and episodes of light headedness. Therefore, we strongly recommend to stop the stronger medications as soon as the pain starts to subside.

They time to return to work depends on the size and complexity of the hernia repair, the type of work and individual patient factors. For routine inguinal hernia repair: -Most people will be able to return to desk jobs at one week  -Active jobs requiring frequent movement, car travel and light duties (Lifting up to 12kg) about 2-3 weeks -Jobs involving heavy manual work and heavy lifting – 6 weeks Early return to light physical activity is encouraged after all hernia surgery. This includes walking from day 1 post-operatively, starting with short distances building up to normal walking distances at one week. The same goes for light stretching. Swimming is an excellent recovery exercise and can be undertaken after 2 weeks (providing the wounds have healed without issues). Exercise bike riding is also encouraged after 2 weeks Other forms of exercise that can be undertaken after 2 weeks includes low impact core work such as Pilates, and Yoga, light limb weights, light jogging and sexual intercourse. Activities that should be avoided for the first 6 weeks include Heavy Lifting, Weighted squats, abdominal crunches and sports that require explosive rotational movement such as Golf, Tennis and Surfing.

All patients experience some slowing of bowel function after Surgery. This results for a number of reasons:  -Fasting prior to surgery  -Anaesthesia and pain medications  -Decreased ability to create pelvic pressure temporarily due to hernia surgery. Therefore I recommend all patients take an aperient for 7 days post surgery to help bowel function return to normal. This will be supplied to you upon discharge.

After Laparoscopic Inguinal Hernia Repair it is common to have the sensation that the Hernia are still present. This is especially noticeable after repair of large hernia. This is almost certainly not a recurrence of your hernia but Post operative fluid in the space that was previously occupied by your Hernia. This is known as a Hernial Sac Seroma. This is expected after laparoscopic repair of large inguinal hernia. It will usually gradually disappear over 6-8 weeks post surgery. The surgeon will review it at your post operative visit . On the rare occasion it does not resolve spontaneously, your surgeon will see you at 6 weeks post surgery to aspirate the fluid with a fine needle through the groin. It is distinguishable from a failed hernia repair in that the swelling is not particularly tender and not reducible. If you are concerned about any swelling post operatively you should call your surgeon. Bruising and discolouration of the Scrotum after laparoscopic and open hernia surgery is common, often spectacular and resolves spontaneously over a week. It is of no concern unless associated with pain and redness.

There should be minimal groin swelling after Open Inguinal Hernia Surgery. If there is Groin swelling the size of the original hernia or larger this may represent a wound haematoma and you should call your surgeon. There is always a firm ridge that can be felt in the abdominal wall for 8-12 weeks after surgery. This is associated with the mesh repair and will resolve after 12 weeks. Your surgeon will check this at the time of the post-operative visit. Bruising and discolouration of the Scrotum after laparoscopic and open hernia surgery is common, often spectacular and resolves spontaneously over a week. It is of no concern unless associated with pain and redness.

 -Persistent fever over 38.5 C  -Bleeding  -Increasing abdominal or groin swelling  -Pain that is not relieved by your medications  -Persistent nausea or vomiting  -Inability to urinate  -Chills  -Persistent cough or shortness of breath  -Purulent drainage (pus) from any incision  -Redness surrounding any of your incisions that is worsening or getting bigger  -You are unable to eat or drink liquids

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Gallstones range in size from grains of sand to 3-4cm in Size. Occasionally much larger Stones can form. It is often the smaller stones that will cause more significant Complications such as Stones in the main duct (choledocholithiasis) or inflammation of the pancreas (pancreatitis).

The purpose of the gallbladder is to store and concentrate bile. It then releases bile into the gut when food enters the stomach to help digest the fatty components of the meal. Most Patients with Gallstones and complications of Gallstones will not miss their Gallbladder. Some patients experience loose bowel motions and/or abdominal discomfort with rich or fatty food in the early postoperative period. These symptoms seem to settle within 6-8 weeks of surgery. For 1-2% of patients these symptoms are permanent.

There are several popular “home” remedy’s and natural remedy’s purported to help ‘flush’ gallstones through the gastro-intestinal system. To our knowledge, none of these remedies have been proven to work. As the most serious complications of gallstones occur when stones migrate or ‘flush’ out of the gallbladder and into the main biliary system, we don’t recommend patients try these methods.

Surgery is usually done as a keyhole or ‘Laparoscopic’ procedure. This usually requires a 12mm incision near the umbilicus (belly button) and three 5mm incisions and the upper abdomen. Through these small incisions the Gallbladder and stones are removed. Its routine to use an x-ray with dye during the operation to make sure there are no gallstones in the main duct system and to confirm the main duct anatomy. If there are stones in the main system they can often be removed at the same time. The gallbladder is placed in a plastic bag to decrease the risk of wound contamination and is removed through the 12mm incision (this incision is sometimes enlarged if the stones are bigger than 12mm in diameter) The wounds are closed and occasionally a drain is left inside the abdomen for 12-24 hours. Usually, an overnight stay in hospital is required and 90% of patients are discharged within 24 hrs

Gallbladder surgery has a very low complication rate. There are some serious complications that can occur. 1. Leakage of Bile from the liver bed or Cystic Duct (the Duct that connects the Gallbladder to the main system) – This may require further procedures such as a re-operation or an ERCP (an endoscope procedure through the mouth) 2. Significant Bleeding requiring re-operation or Blood transfusion 3. Injury to the biliary system requiring re-operation or reconstructive surgery 4. Deep seated infection in the abdomen requiring drainage 5. Inadvertent injury to other organs Complications that can occur with any surgery: 1. Deep Vein Thrombosis – (Blood Clot in the leg) 2. Chest Infection 3. Heart Attack / Arrythmia 4. Stroke 5. Anaphylaxis 6. Wound Infection

You will leave hospital with 2 layers of dressings on your wounds. The Outer layer is waterproof and allows you to shower from day 1 after your surgery. It can be removed after Post-operative Day 5. Beneath this dressing will be small strips (Steristrips) directly applied to the wounds. You should leave these intact until they curl up and virtually fall off. This can take up to 4 weeks. After removing the Waterproof (top) dressing the steristrip dressings can be treated like normal skin and washed over in the shower.

In the first 24 hours post surgery there are often 2 types of discomfort. Firstly, there is often some referred shoulder tip pain from residual gas from the laparoscopy irritating the diaphragm. This can vary from irritating to severe and you will be given pain medication for this. The referred pain does not usually last for more than 24 hours. The other pain is at the incision sites (often called wound pain) This is less severe and usually is worst on day one and rapidly improves. One in ten patients also suffer from post-operative nausea and vomiting which is related to the anaesthesia and the post-operative pain relief. You will be given anti-nausea medication as needed. You will be given pain medication upon discharge. Usually 2-3 days post surgery, the discomfort should be easily controlled with paracetamol alone. Whilst the stronger pain medication is useful in the early post –operative period, prolonged use will result in constipation, nausea and episodes of light headedness. Therefore, we strongly recommend to stop the stronger medications as soon as the pain starts to subside.

A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is also called a hiatus hernia. There are two main types of hiatal hernias: sliding and paraesophageal. Ordinarily, your oesophagus (food pipe) goes through the hiatus and attaches to your stomach. In a sliding hiatal hernia, your stomach and the lower part of your oesophagus slide up into your chest through the diaphragm. Most people with hiatal hernias have this type. A paraesophageal hernia is more dangerous. Your oesophagus and stomach stay where they should be, but part of your stomach squeezes through the hiatus to sit next to your oesophagus. Your stomach can become squeezed and lose its blood supply. Your doctor might call this a strangulated hernia. Many people with hiatal hernia don’t notice any symptoms. Others may have: Heartburn from gastroesophageal reflux disease (GERD) -Chest pain -Bloating -Burping -Trouble swallowing -Bad taste in your mouth -Upset stomach and vomiting -Backflow of food or liquid from your stomach into your mouth -Shortness of breath -Get medical care right away if you have a hiatal hernia and: -Severe pain in your chest or stomach, Upset stomach, vomiting. Can’t pass bowel motion or gas (These could be signs of a strangulated hernia or an obstruction).

Doctors don’t know why most hiatal hernias happen. Causes might include: -Being born with a larger hiatal opening than usual, Injury to the area, changes in your diaphragm as you age. -A rise in pressure in your belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet -Hiatal hernias happen more often in women, people who are overweight, and people older than 50.

To diagnose a hiatal hernia, your doctor may do tests including: -Barium swallow. You drink a liquid that shows up on an X-ray so your doctor can get a better look at your oesophagus and stomach. -Endoscopy. Your doctor puts a long, thin tube called an endoscope down your throat. A camera on the end shows inside your oesophagus and stomach. -Oesophageal manometry. A different kind of tube goes down your throat to check the pressure in your oesophagus when you swallow. If you don’t have any symptoms, you might not need treatment. If you have acid reflux, your doctor may suggest medications to treat those symptoms, including: -Antacids to weaken your stomach acid -Proton pump inhibitors or H-2 receptor blockers to keep your stomach from making as much acid -Prokinetics to make your oesophageal sphincter – the muscle that keeps stomach acid from backing up into your oesophagus -- stronger. They also help muscles in your oesophagus work and help your stomach empty. Your doctor might do surgery if you have a paraesophageal hernia (when part of your stomach squeezes through the hiatus) so your stomach doesn’t become strangled. Many hiatal hernia surgeries are done by laparoscopy. Your doctor will make a few small (5 to 10mm) cuts in your belly. They insert a tool called a laparoscope through these incisions, and it sends pictures to a monitor so your doctor can see inside your body. These “minimally invasive”procedures have smaller cuts, less risk of infection, less pain and scarring, and faster recovery than traditional surgeries. Some changes to your daily life can help with acid reflux symptoms. They include: -Don’t exercise or lie down for 3 or 4 hours after you eat. -Avoid acidic foods like orange juice, tomato sauce, and soda. -Limit fried and fatty foods, alcohol, vinegar, chocolate, and caffeine. -Eat smaller meals, lose weight, don’t smoke -Lift the head of your bed about 6 inches. -Don’t wear tight belts or clothes that put pressure on your belly.

Mastectomy surgery can be very overwhelming, there are a few things to expect after your surgery. If you have any questions please do not hesitate to call our nurses, Skye & Jayne. You will wake up after your operation with a Prevena or PICO dressing. These dressings apply negative pressure to the incision line, decreasing risk of bleeding and swelling. It will stay on for approx. 7 days after your surgery. You must not remove this dressing yourself; it will be removed 7 days after your surgery in our rooms by one of our nurses. Dr will come to see you & you will be able to get up shower, dress in your own clothes (It is helpful to bring along button up clothing/pajamas to wear during your stay in hospital and to wear home. This makes it easier for you to get dressed while you have drains and also easier to move your arms into) sit in the chair & get plenty of rest. The Breast Care Nurse, Lesley, will introduce herself and give you some information regarding your surgery. You will be seen by the hospital Physiotherapist who will assist you with exercises that you can continue to do at home. You may have drains inserted during your surgery; these will also be removed by our nurses in our rooms at one of your follow up appointments. The hospital nurses will educate you prior to your discharge on how to care for them. Community Nurses will be arranged if required to assist in your care. If you have problems with the dressing or drains please call our rooms or if after hours and surgery done at JohnFlynn - Ward 3B. Please ensure you have someone to drive you home from hospital and to your follow up appointments as you are not allowed to drive whilst drains are in place. At your follow up appointment with Nurse & Dr please make sure you bring all of your Drain Charts. Should you develop a fever or the wound becomes hot, red, sore to touch or any discharge please contact the rooms.

Please leave all dressings intact until your follow up appointment with the Dr. If dressings become severely blood stained or wet, they can be replaced. If you have a reaction to the dressing please also remove and leave steri strips intact (under waterproof dressing). There are no sutures that need to be removed as they are all internal and dissolvable. Do not swim in a pool, ocean or spa for 4 weeks. Do not rub creams or oils into wound for 4 weeks.

You can shower as normal however be careful not to soak the area. Pat dry area with towel and when waterproof dressing has been removed you can dry off area with a cool hairdryer.

Regular Panadol is advisable for pain also an ice pack may help if bruising and swelling evident. Wearing a soft bra (without underwire) may also be more comfortable for a few weeks. Bra can be worn day & night for comfort.

Should you develop a fever or the wound becomes hot, red, sore to touch or any discharge please contact the rooms.