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
The hernia may come and go depending on your activities. It is very unusual for a hernia to disappear permanently.
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.
He obtained a Fellowship of the Royal Australian College of Surgeons
in 1978 and then did 3 years of academic study in America.
He has a special interest in laparoscopic surgery and in particularly
laparoscopic hernia repair in which he has extensive experience. He is
also experienced in Local Anaesthetic infiltration with mesh
reinforcement, the tension free technique of Lichtenstein as described in
the British Hernia Clinic site.
He is experienced in abdominoplasty "tummy tuck" and
incisional hernia repair.
He consults at Bondi Junction.
