With aging population and longer survival of patients with cardiac problems, many medications are in use, which may require modification pre-operatively. This in particular refers to the use of Aspirin, which is commonly stopped 10 days pre-operatively. Many patients are on Warfarin so require modification prior to surgery. Another hazard to consider is the patient with a heart murmur or valve where prior cover with antibiotics is desirable. Some would recommend the use of antibiotics, where foreign material is used such as a mesh. However this is not a usual case but should be certainly considered where there are extra risks such as use of steroids or diabetes.

Diabetes, anaemia, liver disease and smoking are all factors, which may lead to local or general complications as well as impairing the strength of the repair.

Assessment – Pre Operatively:

A.                 Factors which might influence local complications, such as:

B.                 Factors, which might cause general complications.

C.                 Factors influencing the strength of the repair

A previous history of deep venous thrombosis, or factors which might increase the risk of such an occurrence, should be noted and measures taken to reduce the risk.

These might include such steps as low dose Heparin, calf stimulators when under GA or compression stockings. The use of local anaesthetic is thought to be a significant factor in reducing this occurrence.

Obesity makes the surgery more difficult and increases risk of complications and recurrence.

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Hernia apparent on physical examination

Each patient is an individual. No single approach is suitable for all and each case should be treated on its merits and the options discussed with the patient before obtaining informed consent. This is all part of the risk management process which is so important today.  

In many countries hernias are operated upon by primary care physicians, and not specifically trained surgeons.  

When assessing pre-operatively, or in the office, look for factors which might influence local complications, for example,  infection and bleeding, factors which might cause general complications; factors which might cause general complications and factors influencing the strength of the repair. Look for predisposing factors which may need to be corrected, like bladder obstruction, use of steroids or obesity.

A previous history of deep venous thrombosis, or factors which might increase the risk of such an occurrence, should be noted and measures taken to reduce the risk.

Diabetes, anaemia, liver disease from alcohol and heavy smoking are all factors which might lead to either local or general complications as well as impairing the strength of the repair.