MR ADAM SKIDMORE
MBBS, FRACS
Upper Gastrointestinal and General Surgeon
Patient’s Name: (AFFIX PATIENT LABEL)
CONSENT FOR HERNIA OPERATION
You have been diagnosed with an inguinal hernia. As I have mentioned in our consultation, inguinal hernia is an
outpouching or protrusion of the internal lining of the gut through a hole in the abdominal wall. In the case of an
inguinal hernia, this hole is either at a point where the blood vessels and vas deferens to the testicle go through
the abdominal wall or where the abdominal muscles converge on the pubic bone.
I have explained to you that the consequences of this are either that you will experience no symptoms at all, in
which case we call it an asymptomatic hernia, or it may be that it is a symptomatic hernia. Symptomatic hernias
may present with pain in the region of the groin or perhaps even in the inner thigh. Some people complain of pain
in the testicle region. The worst-case scenario of having a complication with a hernia is that you may develop
what is called an incarcerated or strangulated hernia where bowel loops can become caught in the hernia and, if
left long enough, the bowel may die. This may require an emergency operation. This will have been explained to
you in your consultation.
I have also given you some literature and you should read that before signing this form.
Essentially, there are two ways of managing a hernia and you have been offered conservative treatment which
means watching it and perhaps using a hernia belt. We can arrange for a hernia belt to be fitted by OAPL. The
other method of treatment is through surgery.
SURGERY
The surgery that I will perform for this procedure will have been discussed with you and the options of open
surgery and laparoscopic surgery will have been discussed. I will give you a brief overview of both open and
laparoscopic surgery below.
Open Surgery
Open surgery for an inguinal hernia involves a 5-10 cm incision in the groin just above the pubic bone. It will then
involve an incision through the fat and opening of the muscle to expose the vas and the blood vessels of the
testicle. This will also expose the back wall of what we call the inguinal canal where the hernia is present. In
doing this, we may divide a nerve called the ilioinguinal nerve which will result in numbness of the inner thigh.
Once the hernia has been identified, it will be either removed or pushed back through the abdominal wall and a
mesh placed over the muscle. The mesh will be secured with either absorbable tacks or stitching. The stitching I
use is dissolvable. The reason we use dissolvable material is that there is a chance that more permanent
material can catch a nerve called the iliohypogastric nerve. In this instance, there is a chance of developing
chronic pain in the area. Approximately 2% of patients who have an open repair end up with chronic pain and will
require either temporary or permanent treatment by a pain clinic. This is the most severe complication following a
hernia repair. The other complication of open repair would be bleeding. Significant bleeding can occur,
particularly from small vessels going to the testicle. This may result in either bruising which can be minor to more
significant. Significant bruising may extend all the way up to the umbilicus and down to the scrotal region. This
always settles but may take up to two months. If you have an acute bleed, it may require a return to the operating
theatre the following day and this will be to wash the blood away to see if we can identify the bleeding source.
This will no doubt slow your recovery. It will also result in extra time in hospital, perhaps another day or two.
Other complications of this surgery include infection of the wound which does tend to be minor. More significant
infections can occur involving the mesh although this is very unlikely. If the mesh is infected, it may need to be
removed and this would need to be discussed further with you.
If you are having an open hernia repair and, after reading this, wish to proceed with surgery, please sign below.
2.
Laparoscopic Repair
A laparoscopic hernia repair is my favoured option for surgery. Laparoscopic repair involves three small incisions
in the lower part of the abdomen, the largest one being 1.0 cm adjacent to the umbilicus. There will always be
two smaller incisions in the case of a hernia repair involving both sides, i.e. left and right. You will find that the two
5 mm incisions are in the middle. In the case of a one-sided hernia, the two holes will always be on the opposite
side to the hernia. Therefore, it is important that you do not worry when you wake up that the dressings are on
the opposite side to that for which you have consented.
Laparoscopic hernia repair involves going behind the muscle in the layer between the lining of the gut which forms
the hernia and the muscle. We then can expose the blood vessels and the vas which are going through the
abdominal wall and towards the testicle. This way we can also see the hernial sac which can be pulled
backwards off these structures and a mesh placed between the layer of the gut called the peritoneum and the
muscle. This mesh is not dissolvable and will stay there forever. It is a soft mesh and you will not feel it. The
mesh is secured with an absorbable tacking device. These tacks take about three months to dissolve. There is a
small chance one of these tacks can cause irritation, particularly of the abdominal wall where they can cause
some bruising in the muscle layer.
The specific risks of this procedure include bleeding. This is often only minor bleeding. There is a very small
chance of more major bleeding. Significant vessels do go through the space in which we are operating and if
these are damaged, it may require an open operation at the time you are asleep and it may require repair of these
vessels. Fortunately, this risk is very low. The bleeding that we find with this operation tends to be more bruising.
The bruising is more marked in older people and also in people who have been taking Warfarin, Clexane or
Plavix. Bruising can occur the next day but tends to occur 4-5 days later and is usually around the region of the
scrotum and the penis. The bruising can extend up towards the belly button level and can be quite noticeable.
This bruising is rarely painful but, in general, settles after 4-6 weeks.
Another complication that can occur is that of a seroma. This is a collection of fluid that forms in the site of the
previous hernia. What you will notice is a lump where the hernia was. This lump will not be like the previous
hernia in that it will not be able to be pushed back in and will be firm. This contains fluid and always resolved after
6-8 weeks.
Pain is not usually an issue after this operation although you will be a little uncomfortable. People generally
complain of discomfort, particularly in the abdominal muscles. This is because we use a balloon to open up the
space between the layer of the gut and muscle in which we are operating. There can be some discomfort in the
testicle region, particularly in the first six weeks. It is not unusual to have the odd twinge in the testicle which can
be described as painful. This will generally settle down.
The chance of developing chronic pain after a keyhole or laparoscopic repair is much lower than open repair.
Although there are nerves in this space, it is rare for them to be caught up in stitch or tacks. Nonetheless, there
may be a very small percentage of patients who do develop pain post-operatively which is not relieved by the
surgery. You will be given an information pamphlet containing diagrams regarding keyhole repair and we
encourage you to read this prior to signing this form.
If you are happy to proceed with laparoscopic or keyhole hernia repair, please sign the form below.
Signed …………………………………………………………………..
Saved: AS Documents.Consent for Hernia Surgery 26.11.10
Date ……………………………………….