Hernia Repair

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Preoperative Care

Most hernia repairs are same day surgeries, which means that patients can go home on the same day that they undergo the operation. If a patient needs to remain in the hospital, they are usually discharged the following day.

The most common preoperative tests are blood and urine tests, but a chest x-ray and EKG may also be required, depending on the patient's health history. These tests are normally done a few days prior to surgery.

Medications that "thin" the blood, including aspirin, are usually discontinued before a scheduled surgery. Some drugs, such as the prescription medication Coumadin® (warfarin), usually are discontinued at least 3 or 4 days prior to a surgical procedure. This is done to avoid abnormal or excessive bleeding during the surgery.

On the day of surgery, other prescription drug regimens may also be interrupted. The anesthesiologist may instruct the patient to take regular medications with a sip of water. The proper timing of discontinuing medications needs to be discussed with the physician before the operation.

Dietary Restrictions

If general anesthesia is going to be used, nothing is permitted to be eaten from midnight on the evening before surgery until the procedure is completed. This includes food, water, chewing gum, and candy. This necessary precaution is taken to decrease the possibility of vomiting during and after surgery.

For local and spinal anesthetics, dietary restrictions may vary. Some doctors require their patients to follow the guidelines for general anesthesia, regardless of which anesthetic they are receiving. One reason for this is that it may be necessary to switch to a general anesthetic during surgery. Dietary preparations should be discussed with the physician in advance.

Check-in is usually the same day as the surgery, and at this time the patient must sign an informed consent form. By signing this legal document, the patient acknowledges that they understand the procedure, that the doctor has discussed the operation and its potential risks, and that they know what medications they will be receiving.

The anesthesiologist (the doctor who administers the anesthesia) performs a brief physical examination and takes a patient history. It is important the anesthesiologist is aware of all medications that the patient is taking, any allergies, and if there has been a prior adverse reaction to anesthesia. This information helps the anesthesiologist select the most suitable anesthetic agents and dosages and avoid possible complications.

Hospitals usually have an area reserved for same day or ambulatory surgical patients. Instead of checking into a room, all same day patients go to this unit prior to and after their procedure.

In preparation for surgery, patients have an intravenous line put in to receive both fluids and medication during and after surgery. They also receive a sedative, by injection or through the intravenous line, to help them relax.

Same day surgical patients may go directly from this area to the operating room, or they may be taken to the preoperative or holding area for a short time. Sometimes the intravenous is started here, depending on hospital protocol. Anesthesia, regardless of type, is administered in the operating room.

Postoperative Care

After the operation, the patient is taken to the postanesthesia care unit (PACU). Patients are closely monitored by the nursing staff and remain there until they are stable. The amount of time spent in the PACU depends on the patient's progress and on the type of anesthesia they received. Those given general anesthesia must be awake and coherent before they leave the PACU.

Ice chips are offered to the patient in the PACU, and if those are tolerated, water is given. The intravenous line remains in place until clear liquids can be taken and tolerated. This may occur almost immediately following surgery, especially if a local anesthetic was used. Sometimes general anesthesia can induce nausea, which may delay taking oral fluids. Once clear liquids are tolerated, the diet progresses to solid foods.

Patients are transferred from the PACU to the outpatient or ambulatory unit, where recovery is completed. Inpatients return to their room. Most patients go home once they are up and walking around. Even though the anesthesia has worn off, most patients remain groggy for the rest of the day. Patients must make arrangements for a family member or friend to be with them upon discharge, if they are going home the day of surgery.

Spinal anesthesia usually wears off within a few hours. In the first hour following surgery, patients usually lie flat on their back to decrease the chance of an anesthetic-induced headache, which can be painful and prolonged. A patient must regain full sensation in the region of their body that was numbed before being discharged.

Patients experience pain at the incision site, especially conventional procedure patients. Medication is prescribed and taken as directed. Swelling and discoloration usually develops around the incision and eventually disappears in the healing process. Some soreness can be expected during the first 24 to 48 hours.

The tiny incisions made during laparoscopic surgery are held together by steri-strips that fall off in about a week to 10 days. Patients can take a shower within two days after surgery. Regular sutures or staples usually hold together the large incision made in the open procedure. The wound must be kept dry until it begins to heal, so patients may have to take sponge baths for the first few postoperative days to avoid getting the wound wet.

Resuming Activity

The laparoscopic hernia repair allows patients to return to their normal routine much more quickly. Some people can return to work in just a few days. Recovery from the conventional surgery takes a little longer because there is more pain and soreness around the wound. Generally, a patient can be guided by the amount of discomfort they feel. Any activity, such as driving, that causes pain and puts a strain on the incision should be avoided until it can be comfortably tolerated. The same holds true for work. People with desk jobs usually can return to work within a week or two. People whose jobs require strenuous activity or heavy lifting may need several more weeks of healing before they return to work.

Straining during a bowel movement also puts strain on the incision. It is therefore important that patients eat a high-fiber diet and drink plenty of fluids to avoid constipation. A stool softener may be prescribed by the physician.

Most doctors ask that their patients to return in about a week for a follow-up visit. At this time, all stitches will be removed.

Postoperative Complications

Any surgical procedure carries the risk for complications. Only a small percentage of patients who undergo hernia repair surgery have postoperative complications, which include:

• Black and blue scrotum and shrunken testicles in men following an inguinal hernia repair
• Bleeding
• Inability to urinate
• Infection
• Recurrence of the hernia
• Respiratory problems, usually resulting from general anesthesia

The surgeon should be notified immediately if the patient cannot urinate after several hours; experiences severe pain that is unrelieved by medication and/or comfort measures; develops a fever of 101°F or higher; or has bleeding, discharge, or severe swelling at the incision site.

Hernia Repair, Preoperative Care, Postoperative Care, Complications reprinted with permission from surgerychannel.com
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