Postoperative hernia repair instructions-Hernia came back after surgery

Postoperative Hernias

This problem concerns a patient who has already been operated on. He notices a swelling in, about or through the operative incision. He observes that the lump becomes big and hard. Sometimes when he lies down or wakes up, the lump is less prominent or gone. Often it is difficult to push the contents back through the scar.

What is this lump? 

This is a hernia. That is, part of the abdominal contents have come out through a defect in the operative scar.

What is in it? 

This hernia usually contains part of the intestine and portions of the fatty abdominal apron (called the omentum). The gurgles and the movements you notice in the area are due to the moving contents and motion (peristalsis) of the intestine. But other organs can also be present, including the liver or stomach.

Why did it happen? 

The internal scar has a defect in it. There can be several reasons for this. Perhaps the edges of the incision were so far apart that they could not be put together properly. A defect may also result from an infection in the wound or from excessive abdominal straining or coughing, causing some of the sutures to open prematurely. In a desperately sick patient or difficult problem, the surgeon may have, correctly, decided that perfect stitching of the abdominal wall was less important than some other factors involved.

What happens if I let it go? 

This hernia usually increases in size with time, and it becomes increasingly difficult to put the contents back where they belong.

Will a special girdle or corset help? 

That depends partially on where the defect is and how well it can be restrained by the garment. It certainly should be tried. See if it will make you comfortable and control the protrusion. Wear it all the time you are up and about. It can be taken off at night when you go to bed. Be sure you push back (reduce) the hernial bulge before you put the girdle on.

If I wear a girdle, can I do everything? 

You will find that out after you've tried it. Your comfort and experience are the best judge of its effectiveness.

I'm tired of this girdle. It causes itching. It doesn't hold the lump back. I perspire under it so badly that I get little pus points in the area. Can you fix me up? 

It is possible to repair the majority of these hernias, although they can be difficult if one end of the defect lies high under the ribs or to the side of the hipbone.

Do you mean that some of them can't be fixed? 

Sometimes the hernia is so large that there is no room left in the abdomen to put things back. This is a factor in the long-neglected case. There is a surgical axiom that hernias of this type, which have been out so long, have lost their right to be domiciled in the abdomen. At other times the general condition of the patient may be too poor, so the operation should not be undertaken unless it becomes an emergency because the intestine is caught.

What is to prevent the hernia from coming back again after this second operation? 

What can you do to insure that it will be OK this time? There can be no absolute assurance. But this time an effort will be made to avoid any problem that could have been responsible for the initial defect. If required, some strong tissue will be taken from the thigh to reinforce the closure. It may be wise to use a plastic material for increased security. This will be determined at the time. You're young and in good condition. It's worth doing.

How serious is it if the hernia gets caught and can't be pushed back and becomes painful?
This is an urgent and serious problem. It means that the contents are incarcerated. If not relieved they can become gangrenous. When incarceration occurs, it is absolutely necessary to correct the situation to prevent gangrene or to remove the intestine if this has already taken place.

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