Procedures

Ventral hernia repair

• Description
• Risks
• Pre operative information

• Information about the day of surgery

• Length of recovery
• Post operative information

Description:

Ventral hernia repair can be done either laparoscopically or by the open approach.
The laparoscopic approach does have a quicker recovery rate. The surgeon will make three or four small incisions in which to insert laparoscopes. The laparoscopes will be attached to the equipment needed to perform the surgery. The surgeon can view the surgery by monitors. The hernia is repaired from behind the abdominal wall. A piece of surgical mesh is placed over the hole in the muscle that caused the hernia. The mesh is held in place by several small staples.

If the surgery cannot be performed laparoscopically, it will be done in a open approach. The surgeon will make a 3 to 4 inch incision in the affected area and then proceed to repair the defect, sometimes using surgical mesh. The incision will then be closed up using either sutures or surgical staples.

Risks:

Any operation or procedure involves some risks and hazards. The more common risks for this procedure include: infection, bleeding, nerve injury, chronic pain, blood clots, heart attack, allergic reactions, and pneumonia. These risks can be serious and possibly fatal. The significant risks of this procedure were discussed with emphases on:
Recurrent hernia, urinary tract or bowel injury, vascular injury, prosthetic mesh related complications, urinary retention, cosmetic deformity.

Pre operative information:

Before your surgery, you will be required to have a pre admission testing appointment. At this appointment, you will be registered at the hospital; you will have lab work done and possibly a x-ray. You will also meet with an anestheologist.

Information about the day of surgery:

No food starting midnight the night before surgery. Solid food must be avoided the day of surgery-regardless of the surgery time. Clear liquids must be stopped four (4) hours before your surgery.

Clear liquids are considered: water, apple juice, cranberry juice, black coffee (no cream), tea, and soda (7-UP, pepsi, ect).

Length of recovery:

Most patients will be allowed to leave the hospital the same day as the procedure. You should expect some swollenness and soreness for the next 24 to 48 hours and it is a good idea to have a ice bag on hand.

Post operative information:

General Abdominal Surgery Post-Surgery Guide

The following information is intended to guide you through your post-op recovery:

Diet:

For the first few days after your return home you should eat foods that you easily tolerate normally.

Medications:

Follow the directions on any new prescriptions that your doctor has given you. You will be instructed prior to your discharge about what daily medications you will need to take when you return home.
Pain management is an important part of your post-surgery care. You should expect some discomfort after your surgery. You may be sent home with a prescription for pain medication. It is important to take your pain medicine prior to your pain becoming intense in severity.

PLEASE NOTE: No pain medication refills will be authorized on the weekends. If a refill is needed, the request must be made before 12:00 on Friday.

Some side effects from the pain medications include nausea and constipation. If you experience nausea or vomiting related to your pain medications, you should stop the medication and take ibuprofen or acetaminophen for pain management.

Bowel Care:

To prevent constipation you should drink plenty of fluids and take a stool softener daily.

If you have not had a bowel movement within 48 hours after your return home, you should increase your fluid intake. You may take one single dose of Milk of Magnesia, as long as you have no abdominal distention.

Incision Care:

Please leave your dressings on for 48 hours after your surgery. Unless your doctor specified otherwise you may then remove your dressing and shower. Remove the outer dressing and leave the strips of tape that cover your incision.

You may remove the gauze dressing over your incision 48 hours after your surgery. Please leave the skin tapes in place for approximately 7-10 days.

If your clothes irritate the incision or if you have some drainage you may leave a dry gauze dressing over your incision.

You must observe your incision daily for signs or symptoms of infection. These signs would include: increased swelling, redness or smelly wound drainage. It is normal to have some swelling and bruising around your incision.

It is normal to have a firm lump directly beneath your incision line. This will disappear within a couple of months.
If you have staples or stitches, they will usually be removed 2 weeks after your surgery. You will need to make an appointment to come to the office for that.

After the staples are removed you will have skin tapes / steri-strips across the incision. Those strips should remain in place for 5 to 10 days. The strips will gradually loosen and come off. If they do not come off within two weeks you may remove them yourself.

Physical Activity/ Restrictions

Upon your return home you should begin a daily walking program that will gradually increase. You should start walking inside your home initially and then gradually increase to walking around your neighborhood. Every patient will have to individualize their walking according to their general status.

You may resume sexual activity when it is comfortable.

Bathing and Showering:

You may start showering 48 hours after your surgery. You may shower with your steri-strips and staples or stitches in place. Do not scrub across your steri-strips or staples. Do not bathe in a tub for 10-14 days after your surgery. This includes a “hot tub”.

Driving:

You may drive when you no longer are taking narcotic pain medications and you feel you can quickly respond to situations that will not place others in jeopardy.

Return to Work:

Your doctor should inform you of when you might return to work. Please notify our office if you need a return to work letter to your employer. It may take up to 48 hours for the letter to be completed. Please leave a fax number for your employer so we can fax your release.

The following will give you a guide for when you might be able to return to work or school:
Light lifting or no lifting type jobs: No lifting over 10-20 lbs. for 4-6 weeks after surgery.
Heavy lifting or physical type jobs: You may return to this type of activity 6-8 weeks after surgery.
Usually you can begin to increase your lifting weight gradually 4-6 weeks after

Follow-up Appointments:

You will need to return to the office for a follow-up visit usually within 2 weeks after your surgery. Please make sure you have your appointment scheduled.

Problems to Observe For:

Call the office for the following:
1. Fever >101.0
2. Uncontrolled pain. That is on a scale of 1-10 (10 being the worst pain imaginable) your pain is a level 7 or above.
3. Nausea and / or vomiting that continue for 12-24 hours.
4. Diarrhea that continues for 12-24 hours.
5. Signs of a wound infection.
6. Chest pain or difficulty breathing
7. Your incision separates or opens up.

If you have further questions after reading this handout, the office is open from 9:00AM to 5:00PM Monday through Friday. For emergencies after office hours, the answering service will be available when you call the office number.