This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.
Overview of Procedure
There are several types of abdominal hernia, the most common being inguinal, femoral, and umbilical.
Umbilical hernias are often small with a narrow neck and are therefore at high risk of incarceration +/- strangulation. Due to this risk, all adult patients with umbilical hernias should be offered surgical repair.
For the procedure, the hernia sac is dissected out and freed from the defect in the sheath. The hernia is reduced and any redundant sac excised, before the defect is closed.
In patients with defects >4cm, the repair should be reinforced with a mesh, this can be on-lay (over anterior rectus fascia), in-lay (in between fascial edges), sub-lay/under-lay (posterior to rectus muscle), or intra-peritoneal.
Complications
Intraoperative
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Haemorrhage | Typically there is minimal blood loss with this procedure* | |
| Injury to surrounding structures including bowel | Contents of the hernial sac may include these structures or may be adherent to peritoneum | |
| Anaesthetic Risks | Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications | Forms a part of the anaesthetist assessment before the operation |
*In chronic liver disease patients with para-umbilical hernias, the bleeding risk is high as any portal hypertension present will cause dilatation of the umbilical veins, alongside any potential coagulopathy, and any damage can be potentially life-threatening
Early
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Pain | The patient will most likely have a local anaesthetic at the hernia site and require only simple analgesia post-operatively | |
| Bleeding | There is a small chance of bleeding and bruising in the abdomen post-surgery. | Ensure appropriate ligation of vessels and good haemostasis at every stage of the procedure |
| Infection | Superficial wound infection is possible. An infected mesh is a fortunately rare but serious complication | Peri-operative antibiotics will reduce the risk of wound infections |
| Scarring | A midline or transverse incision will result in a scar, which may form a keloid scar, particular in high risk ethnicities | |
| Seroma | A swelling of lymphatic fluid may occur in redundant subcutaneous space following surgery | |
| Blood Clots | DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. | The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate. |
| Stroke, MI, Kidney Failure, Death | Although small, this is always a risk in any major surgery |
Late
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Adhesions | Abdominal surgery may cause adhesions as a reaction to the procedure. | |
| Recurrence | There is always a potential for further surgery due to recurrence of the hernia. For umbilical hernia, it is 10-20% at 5 years | Request the patient avoids strenuous activity for a few weeks post-operatively |