Proper preoperative evaluation should be done. A detailed history should be taken regarding cough, constipation snd straining while passing urine. Any factor which predisposes to increased intra abdominal pressure can jeopardise the repair and should be treated beforehand. The patient’s lab tests done with particular attention to hemoglobin levels, blood sugar and serum proteins all of which have a role in wound healing. An ultrasound of the abdomen is mandatory in all cases to know about the defect size , contents of the hernia and coexistent pathology. A CT scan may be required in cases of large hernias with loss of domain.
A meticulous intra operative technique should be followed. Since hernia repair is not a resectional but rather a reconstructive operation, particular care should be taken towards proper tissue handling, accurate suture placement and perfect hemostasis. Modern hernia surgery advocates a tension free repair to minimise the chances of recurrence. A mesh is used in all cases and the type and size of mesh is determined by the intra operative conditions and surgeon’s preference. Drains are particularly avoided in hernia repairs but in cases of extensive dissection of the subcutaneous space, suction drains may be left to avoid Sedona formation.
In the postoperative period, adequate pain relief and proper antibiotic cover is mandatory. Patient are allowed light activity but sudden jerky movements and heavy exertion is to be avoided for 4-6 weeks. Patients can take a soft, easily digestible diet for the first 2 weeks to avoid constipation and straining at stools. Timely follow up with the surgeon will help in early detection and proper treatment of potential complications.