COMMONLY
ASKED QUESTIONS & ANSWERS
You
can usually be seen within one week. Surgery can then be arranged
within one to two weeks if needed. If the problem is urgent (for
example strangulated or obstructed hernia) you would be seen on the
same day and surgery arranged as necessary.
We are able to provide this prompt service because our practice is
mainly confined to hernia surgery. As well we have several Surgeons
available. Thus you can be fitted in with the Surgeon and listed
hospital of your choice. This service applies to both insured and
non-insured fee paying patients. WorkCare patients will need time to
have their claim assessed.
There
is a fee for the initial consultation, which is partially covered by
Medicare - approximately 50%.
The fee for the surgery or operation depends on whether you are insured
or non-insured.
INSURED
PATIENTS:
HOSPITAL:
These people have hospital cover and may be liable to pay a hospital
excess depending on the type of insurance they have taken out. Most of
our operations are as a day case, so the excess can be determined by
contacting your health fund and asking for a day case excess fee. The
types of item numbers we use are 30614, 30615, 30403 or 30405 depending
on the type of hernia.
All the hospitals we operate in are approved hospitals and will obtain
maximum cover including the cost of the mesh.
SURGICAL:
There is an out of pocket surgical fee, anaesthetic fee and an
assistant's fee. You will receive a quote for this if you phone 03 9525
9077 or email us. You need to identify the particular type of hernia
you have. We may take into account particular circumstances such as
pensioners. It is simplest to discuss all of these details at the first
visit.
The health insurance you have taken out is really a hospital insurance
and is not really a medical insurance. It is not in keeping with the
real cost of providing a private surgical practice. We believe the fees
we are charging are reasonable.
NON-INSURED
PATIENTS:
There is a fee for the initial consultation, which is partially covered
by Medicare - approximately 50%.
When you call 03 9525 9077, you will be given an estimated cost
depending on the type of hernia you have.
This covers the hospital for a day case, including the provision of the
mesh. It also covers the Surgeons' fee, Anaesthetists' fee, and
Assistants' fee.
An allowance is made for Medicare, as the medical fees are partially
refundable from Medicare to the tune of several hundred dollars.
The total fees are paid prior to surgery - usually with a credit card.
You can then claim the Medicare rebate for the medical fees provided.
We do take into consideration pensioners and disadvantaged. This can be
raised at the time of consultation.
The
Assistant makes the operation easier for the Surgeon by pulling
retractors and thus giving the Surgeon a better view of the operating
field. In addition he cuts sutures and will "follow" that is hold one
end of the suturing. He allows the Surgeon to concentrate on doing the
operation rather than having to try to move things around. There is a
saying - many hands make light work - and it is the same in surgery.
For a hernia operation it probably decreases the operating time by at
least five or ten minutes.
The
referral process has two aims in our opinion.
1. Your referring General Practitioner provides us
usually with details about your medical condition, medication and an
overview of your health. This is an advantage and does make our
consultation easier. However these are not always provided and with
every patient we need to go through all of the details to ensure
appropriate management is undertaken. For example we need to know
whether you are on blood thinning medication prior to surgery, have any
allergies to medication or need antibiotics during surgery.
2. The referral allows you to claim back part of the
medical fees. Without this referral you are unable to claim these back.
In Australia the system works so that the patient does not go directly
to the Specialist but is seen by the General Practitioner to assess the
necessity for Specialist referral.
We do have some patients who have problems getting a referral for a
variety of reasons - such as in a remote area, not having a regular
General Practitioner, waiting times etc.
We prefer you to have a referral from your regular General
Practitioner. However we are able to suggest a General Practitioner in
our area for you if necessary.
This
can be made by telephone, fax or email, as you prefer. The details are
on our Website. Our main office can be contacted by calling 03 9525
9077 or 1300 HERNIA.
You
will be given a Registration Form to fill out with all your personal
details.
You will also be given an Information Sheet to read regarding hernias
in general, the possible risks of surgery and the post-operative care
following surgery.
You will also be asked to fill out details regarding your medical
history.
WHAT HAPPENS AT THE CONSULTATION:
The Surgeon will introduce himself and will ask you to tell him about
your hernia. He will then ask you a series of questions such as: how
long you have had pain or swelling. He will want to know whether you
have had any x-rays or ultrasounds,
blood tests and their results.
As well as identifying your hernia problem, the Surgeon will want to
assess your general condition and fitness for surgery should it be
required.
EXAMINATION:
You will be asked to stand and be examined whilst standing and also on
the couch whilst lying down. Both sides of the groin are examined. Your
abdomen will be examined, as will all possible sites in the abdominal
wall for a hernia. In men, the scrotal area is checked as hernias can
descend into the scrotum. The testes are also checked.
You will be asked to cough and strain as this demonstrates the hernia
better in most cases.
ASSESSMENT FOR SURGERY:
It is a Surgeon's duty to assess all of this and balance the severity
of the problem against any possible risks associated with the surgery.
Hernia repair is usually a low risk operation but there are factors
that require careful consideration. These will be discussed before any
decision to operate is made.
Additional investigations are usually not required for the diagnosis of
a hernia.
ARE THERE ANY OTHER POSSIBILITIES:
We see an increasing number of patients who come along with the
diagnosis of a hernia who may in fact have other problems causing the
pain or swelling. That is, not all lumps in the groin are hernias.
We do not always rely on the ultrasound to determine whether you have a
hernia or not.
Other conditions which can cause pain in the groin region are, sporting
related injuries such as adductor tendonitis, groin strain or osteitis
pubis.
In addition there are other causes of pain in the groin such as
osteoarthritis of the hip or referred pain from the back.
Other causes of a lump in the groin can be lymph nodes or even an
abscess.
In a similar manner not all swellings in the scrotum are due to a
hernia. Other common conditions are a hydrocele, epididymal cyst or
varicocele.
These conditions can usually be diagnosed by taking your history and
examining you with occasional other investigations.
We also always like to check your abdomen and bowels. Many patients
with a groin hernia may get bowel symptoms such as abdominal pain or
bloating due to the bowel being caught in the hernia. Nonetheless we
cannot always assume this and need to assess further at times.
OTHER
COMMONLY ASKED QUESTIONS
There
are several problems when you fly with a hernia. If the hernia does
happen to become painful and strangulate whilst you are in flight or in
a foreign country it may be difficult to get assistance.
Another problem is that if you have not notified your insurance company
you may not be covered for surgery in a foreign country.
There are factors when travelling and being on an airplane can
aggravate a hernia and cause it to strangulate e.g. different air
pressure and also lifting and carrying cases in awkward positions.
The
hernia may come and go depending on your activities. It is very unusual
for a hernia to disappear permanently.
It
can strangulate. It may strangulate at any time.
Some types of hernias are more prone to strangulate than others. For
example femoral hernias where there is a narrow hole through which the
hernia is protruding. With the most common - inguinal - hernias do
strangulate from time to time especially with a narrow hole through
which they protrude. They may strangulate soon after they develop or
even many years later. Recently we operated on a strangulated hernia
where the hernia had been present for thirty-five years.
The strangulation may occur suddenly or there may be warning where the
hernia gets more difficult to push back in and there is increasing
pain. This may take place over one or two days or over a few weeks. The
actual strangulation however, is sudden and can progress rapidly even
after a few hours. Treatment for this is initially for the patient to
lie down with the feet up in the air and try to see if the hernia can
be gently massaged back in. If this cannot be done then you need to
proceed to hospital immediately for assistance. Sometimes the hernia
will just reduce by itself with some painkillers. However it is
dangerous to push too hard as this can damage the bowel.
Not
all hernias require an operation.
Hernias are operated on because of:
a) They may cause discomfort,
b) They may become complicated, e.g.
obstructed, painful and strangulated,
c) They tend to enlarge. The larger they are
the more technically difficult they are to repair.
These
do not play any significant role. The exercising actually increases the
pressure and causes the hernia to enlarge. However, unless you have
severe discomfort you should continue on your normal activities prior
to surgery. You should not let the hernia interfere too much with your
life. It is best however to avoid heavy lifting. Hernias are thought to
develop as you get older because the connective tissues in your body
undergo changes, which are not actually related to your muscle bulk.
If your hernia suddenly becomes painful and cannot be pushed back in
the best thing to do is to lie down and try to gently massage it back
in with your legs up in the air. If this does not work then you need to
contact an Emergency Department or our clinic and present quickly.
ARRANGING
YOUR OPERATION
The
date and venue of the hospital are usually chosen at the time of the
first consultation. If there are complicating factors such as other
conditions, heart problems, and blood thinning medications, allowances
may be made for these. In addition we sometimes get you to check out
with other Specialists whose care you have been under. We will arrange
this as necessary.
You will need to fill in the hospital pre-admission form, which is then
submitted to the hospital on your behalf.
We also need you to sign an informed financial consent to ensure you
understand all of the different costs.
If you are insured you need to check with the hospital or fund you are
covered with as to whether you have an excess to pay. If you have taken
out your insurance less than one year previously you may not be covered
because of the pre-existing rule. You should let us know so that we can
help with this matter.
Once the formalities have been completed the Surgeon will speak to you
again to ensure that you understand the process and to answer any
specific questions you have thought of. You must ensure that we know
about your allergies and medications.
The
possible risks are outlined on the Website. You are also given a form,
which explains the risks, and the post-operative care and return to
normal activities. We will discuss all of these issues with you.
Generally the risks of surgery for hernia operations are low. If
however, if you have a specific risk, which worries you, you should ask
about it.
A
non-absorbable mesh is used to make your hernia repair strong. We have
been using the mesh since it was developed in the 1980's. We have been
very pleased with its use. It is extremely rare for the mesh to be
rejected or become infected and need removal. Many types of mesh have
come into use. We mostly use a Polypropylene flat mesh, which is placed
between the muscles and is fixed into position with non-magnetic
staples (no worry at airports or MRI machines).
It has been shown recently that staples give a better result than
sutures in terms of recurrence. They also cannot become infected.
The meshes come in various strengths, weights and pore size. They can
be fashioned or supplied as a variety of plugs. We choose the
appropriate mesh for each case. The use of the mesh means that
stitching is minimal and muscles do not have to be pulled tightly
together - thus there is less pain and less chances of the stitches
pulling out. The technique used means that almost all patients go home
the same day whereas years ago they might have stayed in, for several
days at least.
Our
audit shows an infection rate of less than 1% for inguinal hernias. It
is also very low for other types of hernias. Antibiotics are thus not
routinely used for inguinal hernias but are routinely used for
umbilical hernias, as the belly button is considered non-sterile.
An infection in the wound is treated usually in the office by drainage
under Local Anaesthetic and an antibiotic cover. It is our experience
despite the very occasional wound infection, that the mesh does not
become infected or require removal.
You
will have had nothing to eat or drink from midnight if your operation
is in the morning.
It is difficult to give you an exact time as to when your operation
will start. We like to get you in early to allow you to settle down, to
go through the admission process and for the Anaesthetist to see you in
a relaxed atmosphere. You may bring a newspaper with you. We do try to
reduce waiting time but if you may recall patients used to always come
into hospital the day before surgery to settle down. It is much more
convenient now.
The Anaesthetist will come and see you and go over your details. If
there is something you would like to discuss with the Anaesthetist
prior to surgery, you may contact them privately by obtaining their
phone number from us. This might include such things as allergies,
previous anaesthetic problems and even the anaesthetic fees.
The Surgeon and Anaesthetist will introduce themselves again prior to
the surgery. In theatre, the side will be marked and all consents
checked. You will need a shave at the time of surgery.
The Anaesthetist will discuss with you the type of anaesthetic you are
to have. Our standard is to give you intravenous sedation through a
needle, and then insert Local Anaesthetic into the operative field. You
will not feel the injections, but are awake enough during the procedure
to cough and strain to demonstrate the hernia and to demonstrate that
the hernia repair is sound. In over 10,000 cases we have had no
complaints regarding this technique and it is proved to be by far the
safest way in our opinion of having a hernia repair carried out. Our
Anaesthetist will cater to your special requirements about anxiety -
some patients will be kept deeper. It is rare for a General Anaesthetic
to be required.
You
will go to what is called the first stage recovery where you are lying
down and monitored. Because you have had such a light sedation you only
need to stay there for a short time to have your observations taken to
ensure all is well. The wound will be inspected to ensure there is no
bleeding. You are then moved to the next stage where you are lying down
but can have some light refreshments. Because you have not had a
General Anaesthetic you are able to mobilise promptly and have
something to eat and drink. You will then be asked to sit in the
recovery area and the process of going home is commenced.
The whole time from "go to wo" might only be three or four hours. The
standard time for an inguinal hernia operation is approximately 35
minutes but we have to allow an hour of theatre time for preparation
and recovery.
You
will need to be driven home and should rest the first day. You will be
able to get out of bed and go to the toilet. You should have somebody
with you, as occasionally patients can feel faint. There is no pain for
the first four to six hours because of the Local Anaesthetic in place.
You will be given instructions regarding painkillers.
You are instructed to ring the Surgeon the following day on his mobile
number to ensure all is well and you can ask any relevant questions. If
he does not answer, leave a message or try again but he will definitely
return your call. Most Day Surgery Centres will also be in touch with
you the following day to ensure all is well. You can always ring the
office during office hours.
Usually
there are no problems. The type of phone calls we get relate to some
swelling or bruising in the area. This usually subsides within one week
and does not signify any particular complication. We do review you
within one week of the surgery and you are welcome to ring on any day
if you have any concerns. Some patients complain about the effects of
the painkillers, such as feeling light-headed or a little nauseated.
The painkillers may require adjustment. You should be careful when
going to the toilet or bathroom, as you may feel faint. You should have
somebody accompany you.
You will have instructions regarding your dressing. Basically we prefer
just to leave this alone as it is waterproof and rarely becomes
disturbed. It is a see through dressing so sometimes some blood can be
seen. Do not be alarmed it is usually only a small amount. However if
the blood actually trickles from under the dressing onto your leg then
you should let us know. If you wish the dressing can be changed for you
by attending the hospital earlier.
This
is a commonly asked question as the painkillers and the operation may
slow your bowels down. You may take some medication for this or adjust
the painkillers as required. In occasional cases suppositories or
enemas may need to be used. However patients never come to harm because
of their bowels. If you have any concerns, ask about different
medications even prior to the procedure.
It
is very unusual to develop any severe problems. Rarely acute retention
of urine, rarely clots in the leg and rarely lung problems. They are
rare complications, which are associated with any operation not just
specifically a hernia operation.
This
varies enormously. We have audited our patients to find that many
patients do not need painkillers whatsoever. However the majority
require some type of painkiller for a day or two whilst other require
painkillers for a longer period. Some patients do not tolerate some
painkillers and the painkillers are sometimes altered if not working
well.
The
quicker you mobilise the better. However if you have undue pain then
just be careful. The most painful time appears to be getting out of bed
the next day so you may like to take a painkiller before you do so and
just get out of bed very slowly. This also reduces the risk of fainting
as your blood pressure adjusts. If you live upstairs it is preferable
not to have to walk up and down stairs for the first couple of days as
you may find this difficult.
We usually advise you not to drive for the first four or five days.
You
will be seen within six to ten days of the surgery.
At that visit you will be asked a few questions to complete our audit.
A letter will be dictated for your General Practitioner so he is aware
of what has transpired. He will also be sent a copy of your operation
report.
The dressing will be changed. This is usually not painful. Usually
dissolving sutures have been used in the wound and this reduces the
risk of infection and usually leaves a very neat scar.
There may be some residual swelling and bruising. This will be checked.
It is rare that any other measures will need to be taken.
Your post-operative recovery will be discussed and your return to work
plan assessed. Many patients ask about their sporting activities and we
also discuss this.
For example we usually say not to play golf for about four to six weeks
- tennis etc the same. We also ask you to avoid heavy lifting for four
to six weeks.
This
is up to you. Many patients prefer not to have to come again but we
offer you the choice of ringing up at any time or making an appointment
to see us within a few weeks if necessary.
Pain may come and go a little but usually there is a downward trend.
Some patients are concerned about thickening under the wound - this
ridge becomes apparent a week or so after the residual swelling has
subsided. There may or may not be a ridge. The ridge is due to the
tissues healing as we suture the underlying tissues well to prevent any
bleeding. This will disappear completely within a few weeks.
All
rights reserved © 2008 Sydney Hernia Centre
Most hernias apart from incisional and hiatus can be treated
surgically under local anaesthesia together with light sedation.
The aim is a safe operation with a quick recovery and minimal
short or long term after effects or recurrence (that is - the hernia
coming back).
Most hernias can be treated in a day procedure centre. Thus
the cost for non-insured patients is not such a prohibitive factor. It
avoids long waiting lists, the patient can have the surgeon and
technique of their choice.
All surgeons can be consulted by calling +61 3 95259077. The
staff are happy to discuss details with you over the phone.
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