76-year-old Ray needs surgery to remove a large hernia which has developed following liver transplant surgery. Ray has been married to his wife June for 46 years and his main concern before his surgery is June worrying about him and although he seems relaxed June knows the prospect of major surgery is daunting: “I think he’s full of bravado sometimes but I think he’ll be quite nervous and he’ll just want to get it over with.” Says June.
A hernia develops when internal organs push through a breech in the abdominal wall and following Ray’s recent liver transplant surgery his bowel is forcing its way through the thin layer of scar tissue.
Ray’s hernia repair will be carried out by surgical clinical director Jeremy French who explains that Ray’s recent surgery makes this procedure slightly more challenging: “Doing an operation such as this on someone who has had a liver transplant – the stakes are higher. He is on immunosuppressive drugs, these drugs reduce the immune system to stop rejection of the liver however what they do is they reduce the immune system and therefore means he is more susceptible to operation.
“If a mistake is made then actually the consequence is more dire for the patient.”
In the episode we see Jeremy in theatre 5 beginning the operation to repair Ray’s hernia. The challenge with a large hernia like Ray’s is that there is a risk of other organs becoming attached to the underside of the defect.
In Ray’s case, because of his previous surgery some of his bowel is stuck, Jeremy carefully peels this away: “What we don’t want to do is cause inadvertent damage for example to some small bowel because that would release infection which then would compromise recovery” Jeremy explains.
With the edges defined it’s time for Jeremey to move on to the most crucial part of the operation – repairing the hole itself.
Typically hernias over a few centimetres would normally be reinforced with mesh, the mesh provides mechanical and structural support. Ray’s hernia is so large that it requires the biggest size mesh available – just over the size of an A4 pad.
It takes an hour for Jeremy to position the mesh across the hernia and explains why this part of the procedure is so important: “The crucial part of a hernia operation such as Raymond’s is to make sure that we get the mesh at the right tension in the right position to provide support for repair of the hernia.”
With the mesh in place Jeremy begins to close and once he’s out of surgery he calls Ray’s wife June to let her know everything has gone well: “When you get to make phone calls like that and the patients are thankful, their relatives are thankful, it’s a privilege to do that job.” Following surgery Ray made a full recovery he is now enjoying getting out and about with June!
