Procedures

Umbilical hernia repair

• Description
• Risks
• Pre operative information

• Information about the day of surgery

• Length of recovery
• Post operative information

Description:

A umbilical hernia repair can be performed with either a laparoscopic or open approach.
The purpose of umbilical hernia repair is to fix the hole that the abdominal sac is pushing through.

With a laparoscopic umbilical hernia repair, the surgeon will make small incisions in the abdomen near the umbilicus. A nozzle is inserted into one of the incisions and carbon dioxide is used to fill the abdomen with gas. The gas allows the surgeon to see the more easily. The surgeon will then insert a laparoscope through another port. The laparoscope has a light at the end as well as a camera for the surgeon to see. Other surgical instruments are inserted through other ports. The abdominal contents of the hernia defect are brought back into the abdominal cavity, the defect is closed using either sutures or mesh, the carbon dioxide is released through the incisions, and the incisions are closed. The incisions are closed with sutures, staples, or with a glue like substance called a steri strip. The total surgery takes about 1 to 2 hours. There is a chance that the surgeon will need to switch to a open umbilical hernia repair. This change is for your safety.

In an open umbilical hernia repair, the surgeon will make an incision close to the umbilicus. The abdominal tissue is pushed back into the abdominal cavity. If the hernia defect is small, the surgeon may decide to stitch the defect shut. If the defect is large, the surgeon will close it with a piece of mesh. The incision will be closed with sutures, staples, or with a glue like substance called a steri strip.

Risks:

The more common risks 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:

You will be allowed to go home the same day of your surgery.

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.