It has been determined that you have an Incisional Hernia. Because of your current symptoms and/or findings, and the potential for complications arising from the presence of this hernia, surgical repair has been recommended. An Incisional Hernia occurs due to a weakness, separation, gap or opening in the muscles or supporting structures of the abdominal wall directly at, or in the region of a prior surgical incision (including a prior hernia repair). This may cause a bulge of intra-abdominal contents and/or pain or discomfort. This pain and discomfort are the result of nerves in this area being irritated or stretched as the surrounding tissue is also stretched. If these hernias enlarge, intestine may become trapped within the hernia, potentially leading to intestinal blockage or damage (Strangulation or Incarceration). This may be an emergency surgical situation.
Surgery involves repair of the area of the weakness and return of the abdominal contents back into their normal intra-abdominal position. We utilize a plastic screen or mesh made mopst often from non-reactive polypropylene on rare occasions Gortex® or at times both may be used) to safely reinforce the area in repairing the overwhelming majority of incisional hernias (both primary and recurrent hernias). The decision on which type, size and specific manufacturer of mesh to be utilized will be made by your surgeon at the time of surgery. Surgical repair of hernias is called a HERNIORRHAPHY. Since muscle is not cut nor sewn together under tension, this technique is called a
TENSION FREE REPAIR TECHNIQUE.
Most often in adults, small to moderate sized incisional hernia repair surgery will be performed under local anesthesia. What this means is that although you are somewhat sedated by our Department of Anesthesia, you will not be put to sleep. Rather, the area will be numbed with the use of several injections of Novocaine-like medication. You will be kept relaxed, comfortable and pain-free during the short procedure. After surgery, you will be observed in our ambulatory surgery center where you will be active and able to walk, and offered a light snack. Most patients with small or moderate size, non-complex Incisional Hernia repairs are discharged on the day of surgery Safely and Comfortably. A prescription for pain medication will be provided, or you will be instructed in taking over-the counter pain medication.
In patients with larger, multiply recurrent or complex incisional hernias, general anesthesia may however be necessary. This can only be determined after a comprehensive evaluation and examination by your surgeon before surgery. Under certain circumstances, over-night hospital stay may also be advised, especially in large and complex Incisional Hernia repairs.
Also in these patients, a temporary drain may need to be placed to prevent unwanted fluid collection at the site of surgery. If placed, this will need to be removed by your surgeon in about 4 days, so you must plan on being available to your surgeon at that time for drain removal. Although the drain can be removed by your personal physician if you wish, this must be arranged with him/her in advance. We do not however recommend this.
We have extensive experience in the repair of Incisional Hernias, hundreds of such repairs annually (and nearly 1000 hernia repairs overall annually). The surgeons of the North Penn Hernia Institute have received special training in hernia repair, and truly "Specialize" in this field of surgery. This permits us to provide our patients with the safest, most advanced and most effective hernia repair available. Our success rate is extremely high, equal to or better than the national average. Additionally, our complication rate is extremely low, again comparable to or below the rates which are reported nationally.
So that you may be fully informed, as required by Pennsylvania law, we have listed below the possible major complications of Incisional Hernia surgery, based on national averages. Again, we believe our success is better than these averages, but they are listed for your information.
All surgical incisions may be associated with some local numbness, as virtually invisible nerves within the skin and lower layers are divided during the initial incision process. Most of this will be temporary. However, a very small area of residual numbness around the incision may persist. This is generally well tolerated, minimally noticeable and creates no functional problems. This mild numbness may be located in a small area of skin at or below the incision.
- Recurrence of the Incisional Hernia...................About 1/2% (1 in 200 patients)
- Infection of Incision...........................................Less than 1%
- Bleeding (controlled in OR)..............................Less than 1%
- Swelling and black/blue......................................................About 5% (temporary)
- Injury to intestine or other intra-abdominal organs..........Less than 1 in 1000
- Numbness or Chronic Incisional Pain**..............................1-2%
(*Generally mild, non-debilitating and resolves over time)
Source: Nyhus and Condon, (2002), HERNIA, 5th Edition
Chronic incisional pain or discomfort occurs in approximately 1-2% of all surgical procedures including all hernia repair techniques. With our method, because muscle is neither cut nor pulled together under undue tension, this discomfort is generally mild and usually temporary, lasting 2-3 months or less. More chronic pain is less likely. Severe and long lasting pain at the area of the incision can occur, but is extremely rare (less than 1/2%).
If your hernia is being repaired for the second or more time, the chance of recurrence and other complications listed above may be only slightly higher. We also have extensive experience in the repair of multi-recurrent and large hernias which have been especially referred to us. We will take every available precaution and use contemporary technique to reduce these complications for you.
While the over-whelming majority of small to moderate size Incisional Hernias are both safely and effectively repaired using just local anesthesia and mild sedation (over 95% of such patients here at NPHI), on rare occasions, because of hernia size and complexity, prior repair with recurrence, extreme obesity and/or even patient comfort, conversion to a safe, light form of mild general anesthesia under the supervision of a Board Certified Anesthesiologist may be required. This need can at times be anticipated on initial physical examination. Our Anesthesiologists, therefore, must reserve the right to such a conversion during surgery if, in their opinion, patient safety so dictates.
According to Law, I attest that I have read and understand the three (3) pages presented here, and have been informed as to the complications associated with Incisional Hernia Repair. I understand the nature of my problem, based on the discussion with my physicians and the above information. Additional questions have been answered and I agree to the surgery as planned.