dr daniel mafi
Hernia Surgery Tauranga
hernia surgery
What is an abdominal hernia and why do we get them?
A hernia occurs when there is a weakness in the muscles of the abdominal wall that allow abdominal contents (such as intestines or fatty tissue) to protrude through the muscles. This can result in a visible bulge under the skin and may also cause pain. Occasionally the weakness may have resulted from a specific traumatic event.
Alternatively, it might have been caused by previous surgery (Incisional hernia). More likely, however, it happens due to a combination of naturally-occurring anatomical points of weakness (such as the belly-button), everyday “wear and tear”, and inherited minor genetic changes. Hernias can occur anywhere in the abdomen but most commonly occur in the groin (75%).
hernia surgery
How are hernias treated?
Hernias are structural problems so can only be repaired with surgery. Essentially, the surgery involves firstly, isolating the hernia (which is contained within a hernia sac) and the weakened area of abdominal wall from surrounding tissues.
The hernia is then pushed back into the abdomen and the weakened area of the abdomen wall repaired. This repair might be with stitches (if it is a very small area) or more likely, the area will be reinforced with a piece of surgical hernia mesh.
hernia surgery
Laparoscopic (keyhole) or Open repair?
Hernia surgery can be safely and effectively performed in Tauranga via either a laparoscopic or open technique – and Dr Mafi is proficient in both. The technique that is better for you will depend on several different factors which can be discussed in detail during your consultation.
In general though, a laparoscopic repair is better if:
- you have a hernia on both the left and right groins (bilateral inguinal hernia)
- you have previously had an open hernia repair (recurrent hernia)
- you have previously had an open hernia repair (recurrent hernia)
hernia surgery
Hernia repair under Local Anaesthetic
If you decide that you want to proceed with a hernia repair in Tauranga, there may be several different anaesthetic options available to you. The two most common are:
- General anaesthesia: medication is used to put the patient to “sleep”, rendering them fully unconscious and unaware of the procedure
- Local anaesthesia*: the patient remains awake but injections are used around the site of surgery to numb the area and allow the operation to proceed comfortably and safely
There are several benefits to having surgery performed under local anaesthetic. Large clinical studies have demonstrated that inguinal hernia repair under local anaesthesia (compared to general anaesthesia) is associated with less time spent in hospital (more likely to get home the same day), less postoperative pain, and fewer respiratory and urinary problems after surgery. Hernia surgery under local anaesthetic is especially ideal for the patient for whom a general anaesthetic might carry additional risk. This might include those patients with other medical conditions.
Additionally, if you are funding your own operation, hernia repair under local anaesthetic avoids the cost of the anaesthetic and other hospital costs, thereby drastically reducing the overall price. In the appropriate person, hernia repair under local anaesthetic may be able to be performed in the Locals operating theatre at the consultation rooms (Tauranga Specialist Centre).
*Hernia repair under Local Anaesthetic must be via an Open approach. Laparoscopic surgery requires a general anaesthetic.
Large hernias after abdominal surgery (Complex abdominal wall reconstruction)
Hernias that occur after major abdominal surgery are called incisional hernias. These type of hernias can become fairly large and repairing them carry significant challenges. Surgery for a large incisional hernia can take several hours and often draws on additional techniques more common to Plastic Surgery (the use of Botox injections, component separation, limited “tummy-tucks”).
Dr Mafi has a special interest in these types of hernias. His four years of additional experience in Plastic Surgery, and his 2-year subspecialty training in Scotland with experts in complex incisional hernia surgery, has given him special expertise in managing this difficult problem.
Each person (and each hernia!) is different. The specific management plan appropriate for each individual will be discussed during the consultation. Sometimes cross-sectional imaging such as CT scans may be required prior to deciding on the definitive operation.
Repairing a large incisional hernia is a significant undertaking. But often these hernias are also significantly affecting people’s quality of life. Deciding whether surgery is right for you can be a tricky decision – but a thorough discussion with Dr Mafi will certainly make that decision easier!
Potential Complications of groin hernia surgery
All surgery carries some risk of complications. For hernia surgery these risks are very low. Possible complications include:
- Bleeding and Infection: The risk of serious bleeding or infection is very low (< 0.5%). Some bruising around the groin area can occasionally occur.
- Recurrence: the risk of the hernia returning within the next 10 years is approximately 1 – 2%
- Urinary retention: Occasionally men (especially if they have preexisting prostate problems) can find it difficult to pass urine in the first 24hours following surgery.
- Chronic pain: “Chronic” here means long term (>6months), not necessarily (or even commonly) severe. Chronic pain occurs in approximately 5-7% of cases. Its incidence is less in Laparoscopic surgery and may also be less in open surgery under Local Anaesthetic. Of the small percentage of people who experience chronic pain after hernia surgery, most eventually improve although this may take more than 12 months.
- Testicular artery injury: This is a rare complication – but can cause the testicle on the same side to stop working and atrophy.
Recovery after Hernia surgery
Most people go home a few hours after their surgery. Any wound will be dressed with a waterproof dressing that should be left on for at least 3 days (and no more than 5 days). After this no dressing is required. Wounds are closed with dissolving stitches.
Mobility and activity is encouraged – within reason! Take a graded approach to return to normal activity. Walking during the first week is fine. You will be able to do most activity by the end of the second week. If you have had open surgery (rather than laparoscopic) heavy lifting (>5kg) should be avoided until the end of the 4th week.
Driving should be avoided until an emergency brake can be performed without hesitation. This would typically be at least 7 – 10 days post-op. Your insurance company may also contain restrictions and may not cover any claims for a specific period post-op.
Return to work: Usually 1 week is reasonable. Request a work certificate if required.
What about Mesh?
The use of surgical mesh in hernia repair is well established, and the internationally accepted best-practice technique for repairing hernias. Without mesh the rate of hernia recurrence is unacceptably high.
Controversy has arisen in the media regarding the use of mesh in surgery. Much of this pertained to complications that arose through the use of mesh in gynaecological procedures (eg transvaginal prolapse repair). Unfortunately however, this promoted the incorrect idea that mesh was therefore undesirable in all types of surgery.
The use of mesh in hernia surgery is safe and effective. Chronic pain can occasionally occur after hernia surgery (5-7% of patients) – but this risk is similar whether or not mesh has been used.
The New Zealand Association of General Surgeons’ position statement regarding the use of mesh in Hernia surgery can be accessed below:
https://www.nzags.co.nz/wp-content/uploads/2018/11/Final-version-mesh-hernia-repairlogo.pdf
paying by insurance
I am a Southern Cross affiliated provider
If you are insured by Southern Cross then your surgery may well be covered under you plan. We can discuss options with you when we have our first consultation. Dr Mafi is a Southern Cross affiliated provider.