RISKS OF SURGERY - LAPAROSCOPIC VENTRAL/UMBILICAL/INCISIONAL HERNIA REPAIR
In recommending the procedure, your doctor believes that the benefits to you from having the procedure exceed the risks involved. There are risks and possible complications associated with the procedure which can occur with all patients and are set out below. There may also be additional risks and possible complications specific to your condition and circumstances which Dr Daoud will discuss with you. If you have further concerns, please ensure you raise them with Dr Daoud prior to giving consent to the procedure.

COMMON RISKS & COMPLICATIONS:

• trouble passing urine after the operation due to spasm of the bladder sphincter.
• there is a low risk of chronic pain/discomfort at the site of the hernia repair. For example, nerve entrapment: the scars can thicken, turn red and may be painful. This is permanent and can be disfiguring. 
• infections can occur, requiring antibiotics and further treatment. Infections necessitating removal of mesh/stitches may require antibiotics or further treatment/surgery.
• the hernia may come back. People who smoke, are obese or have diabetes are at increased risk of recurrence. Further surgery may be needed to repair the hernia. 
• bleeding could occur and may require a return to the operating room.
• bleeding is more common if you have been taking blood thinning drugs, such as Warfarin, Aspirin, Clopidogrel, Prasugrel, Dipyridamole, Ticagrelor, Apixaban, Dabigatran, Rivaroxaban or complementary/alternative medicines such as fish oil and tumeric. 
• a pocket of clear serous fluid called a seroma can sometimes develop in the body after surgery. This usually resolves without intervention. 
• small areas of the lung can collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
• increased risk of wound infection, chest infection, heart and lung complications, and blood clot in the leg or lungs for people who are obese, smokers or have diabetes. 
• iatrogenic injury (injury to organs during surgery) may occur. Additional treatment, including further surgery to repair the hole, may be neeed.

UNCOMMON RISKS AND COMPLICATIONS:

• adhesions (bands of scar tissue) can form and lead to bowel obstruction or long-term pain.
• infections necessitating removal of mesh/stitches may occur and require antibiotics or further treatment/surgery.
• the laparoscopic surgery may not be possible and the surgeon may need to change technique to open surgery.
• damage to large blood vessels, gut or bladder may occur during surgery.
• rarely gas, which is fed into the abdominal cavity, can cause heart and lung complications.
• the testicle may sit a little higher in the scrotum after surgery. This may occur over time due to scar tissue.
• injury to the testicular blood supply resulting in either shrinkage or death of the testicle on that side.
• hernia formation where instruments were passed into the abdomen.
• infections can occur, requiring antibiotics and further treatment.
• heart attack or stroke could occur due to the strain on the heart.
• blood clot in the leg causing pain and swelling. In rare cases, part of the clot may break off and go to the lungs. 

RARE RISKS AND COMPLICATIONS:

• death from this procedure is rare.

RISKS OF SURGICAL MESH:
This procedure may require the use of surgical mesh. Surgical mesh is classified by the Therapeutic Goods Administration (TGA) as a class III medical device (high risk device). For more information about surgical mesh and the risks involved, please discuss with Dr Daoud. Risks and possible complications include: chronic (long-term) pain can be caused by the mesh or the surgery. This could require further surgery to remove mesh, to revise the hernia repair, or pain medication to manage the pain; mesh migration means mesh could move around inside the body. This can cause pain; mesh can become infected at the time of surgery, even months or years later. If mesh becomes infected, you may require antibiotics and/or further surgery to have it removed; mesh is a foreign body (not a natural part of the body) and can lead to autoimmune or inflammatory syndromes; bowel can adhere to mesh product, this may cause a bowel obstruction or fistula that requires a further operation(s) to correct.

This procedure requires an anaesthetic. For more information about the anaesthetic and the risks involved, please speak with your scheduled Anaesthetist. 

WHAT ARE THE RISKS OF NOT HAVING THE HERNIA REPAIR?
There may be adverse consequences for your health if you choose not to have the proposed procedure. Please discuss these with the Doctor. If you choose not to have the procedure, you will not be required to sign a consent form. If you have signed a consent form, you have the right to change your mind at any time prior to the procedure. Please contact our rooms to discuss.

ARE THERE ALTERNATIVES:
Making the decision to have a procedure requires the patient/decision maker to understand the options available. Sometimes watchful waiting or close monitoring of the hernia for signs of growth is possible. This can be discussed with your Doctor. Some patients may wear a hernia support belt or corset garment to support the hernia. These cannot treat hernias, but some find they relieve discomfort. Depending on the circumstances, surgical repair can sometimes be done with mesh or without mesh (using stitches instead). Your hernia repair may be able to be done via open surgery instead of keyhole surgery. Please discuss any alternative procedure options with your doctor before signing consent forms. 

WHAT SHOULD I EXPECT AFTER THE PROCEDURE?
You will be given a patient implant card (PIC) with the specific details of any surgical mesh used. The information on the card enables improved traceability of the device if there are any issues or recalls. Your healthcare team will talk to you about what to expect after your procedure and upon discharge from Hospital. If you become unwell, experience any of the complications listed or are concerned about your recovery, contact your GP or our rooms immediately.

POST OP CARE:

Carer's Instructions

Any patient who has had sedation, a general anaesthetic, or a procedure will need a Carer.

Carer's Responsibilities - Your Carer is responsible for the following:

• Taking you home from the Hospital either by car or Taxi/Uber
• Staying with you for 24 hours after the procedure
• Helping with your medications if necessary
• Assisting with toileting, showering and dressing if necessary
• Getting medical assistance for you if required (by telephoning the doctor or calling an ambulance)
• Carer should be aware of post-operative needs. Please ensure your Carer has read through this information

Please discuss all of the above responsibilities with your Carer prior to your admission and ensure they have our contact details.

Pain
Post-operative pain is normal but the intensity can differ between individuals. Analgesia will be given to you during your hospital stay and made available to you on your discharge if still required. Please refer to the Medications section below.

Wound
The wound site is kept clean and dry. The stitches are usually dissolvable but if not they will be removed in 7-9 days. A waterproof dressing will be applied to your wound before discharge. This is to be kept on for 7-10 days. If the dressing falls off before this time you will need to have this re-dressed. Keep your wound dry during this time to avoid infection.

Swelling
Bruising or swelling is to be expected after surgery. This can be eased by wearing firm underwear.

Food
You will be able to drink 4 hours after your operation and have a light diet if you desire. A normal diet and fluid intake is usually started on the day following your operation.

Nausea and Vomiting
Some people are very sensitive to surgical procedures. Nausea and vomiting may occur as a result of the general anaesthesia, the procedure performed or the medication prescribed.

If you have nausea and vomiting, please do the following:

• Keep well hydrated with frequent small drinks of clear fluids. It is recommended that you drink water, lemonade or diluted fruit juice. Avoid milk.
• Cease your medications, as in most cases the nausea and/or vomiting is related to the antibiotics prescribed. Once these have been ceased the nausea and/or vomiting will usually resolve.
• Contact Dr Daoud’s office at Greenslopes if the nausea and/or vomiting persists.

Activities
You will be able to get out of bed later on the day of the surgery to go to the toilet. You will be able to walk short distances the next day and increase this slowly as you feel fit. 24 hours after surgery you must not drive any motor-vehicles or operate machinery. You must not drink any alcohol, as alcohol and prescribed medication is a dangerous mix. You must also check with your car insurance to ensure you follow their guidelines as well.

Medication
You will generally be prescribed pain killers. It is imperative that you notify Dr Daoud of any allergies you have to medications. If you are taking medications prescribed by your doctor you need to return to your normal dosage schedule as soon as possible after surgery unless directed otherwise.

Post-operative review
You will need to contact Dr Daoud’s office when you are discharged from hospital, to make a post-operative review for two weeks after your surgery.

Infection
If you develop a post-operative infection, remember it will not generally appear until 1-2 weeks after your operation. If this does occur, please contact Dr Daoud’s office to book an appointment. You will normally be prescribed a course of antibiotics after your surgery. It is important that the full course of antibiotics is completed. 

Problems
Post-operative complications are uncommon, but if they do occur please contact Dr Daoud’s office for advice.

Please feel free to call our rooms during office hours or mobile after hours if any doubt arises as to your progress or recovery, especially if any of the following occur:

• Increasing or persistent pain after 4 or 5 days.
• Any swelling around the wound site.
• Redness or heat around the wound site.
• Persistent nausea or vomiting.
• Persistent discharge from the wound site..

Please do not call your referring doctor, or local GP before you contact Dr Daoud’s office. Our office number is 07 3397 8499 and we are open from Monday-Friday 8:30am-5:00pm.

Return to work/school
You will need to be off work for 2 weeks after surgery. If you require a medical certificate, please call Dr Daoud’s rooms and one will be arranged. During this time, you will not be able to do any heavy lifting, straining, bending, pushing or pulling. Dr Daoud will review you after these two weeks at your post-operative appointment. If you have been cleared to return back to work from Dr Daoud you are to be on light duties only. This has a 5kg lifting restriction with no bending, straining, pulling etc. 4 weeks after surgery you should be right to resume to full activities.

As always, if you have any questions or concerns about anything regarding

your procedure, please call our rooms on

(07) 3397 8499.