The Oregon Clinic - Hernia Surgery specialty provides advanced hernia care solutions with emphasis on quick recovery and aggressive pain control.
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There are several different techniques used in hernia repair. Your surgeon will discuss these techniques with you and use the technique best suited for your situation.
Inguinal Hernia (Groin)
- Open Repairs- a small incision is made in the groin and the repair is performed from the “front”. This is typically outpatient surgery.
Laparoscopic Repairs - small incisions are made in the lower abdomen and the repair is made from the “inside”. This is typically outpatient surgery.
Ventral Hernia (Abdominal)
- Open Repairs - a small incision is made above the hernia and the repair is performed from the “front”. This is usually outpatient surgery for smaller hernias and inpatient for larger hernias.
Laparoscopic Repairs - small incisions are made in the abdomen and the repair is made from the “inside”. This is usually outpatient surgery for smaller hernias and inpatient for larger hernias.
Complex Ventral Hernia Repairs (Abdominal Wall Reconstruction)
- Some patients will have hernias which require advanced techniques to repair. Very large or multiple hernias are often challenging to repair. Hernias associated with infection risk (obesity, diabetes, smoking, prior wound infection, etc.) are also complex.
- A technique referred to as "component separation" is used for larger and more complex hernias. The hernia is repaired by moving the patient's own muscle and abdominal tissue together to repair the hernia. The hernia is repaired by closing the defect with the patient's own tissue and a mesh is used to reinforce the repair. This leads to a more functional long term repair. This technique requires inpatient surgery.
- Hernia repairs were traditionally performed using a series of sutures to close the hernia opening. This type of repair has a very high failure rate and has been abandoned by most hernia repair experts. Modern hernia repairs use a reinforcing “mesh” to give the repair strength and durability. Mesh comes in two broad categories: synthetic and biologic.
- Synthetic mesh is made from a variety of products including sterile plastics, gortex and polyester. These are permanent implants that the body incorporates into the repair. Biologic mesh is derived from animal and human collagen tissue. These products are incorporated into the repair and are slowly remodeled into the patients own tissue.
Pain management is very important after hernia surgery. The surgeons of the Pacific Northwest Hernia Center will work hard to manage your pain effectively. There are generally two types of pain, Acute Pain and Chronic Pain. Understanding the type of pain you have will help in your recovery process. Pain after a surgical procedure is also acute pain. Acute pain is temporary and may last from a few seconds to several months. It usually goes away as part of the normal healing process. This type of pain is called post-operative pain. Pain after surgery is not something you have to just “put up with.” We want you to be comfortable after surgery. Controlling your pain after surgery is important to your recovery. With less pain you can start walking sooner, do your breathing exercises easier, and may even leave the hospital earlier. Patients whose pain is well controlled after surgery may avoid some complications, such as pneumonia and blood clots.
- Local anesthetic is injected at the time of surgery to "numb" the area during and after surgery.
- Pain pumps are implanted at the time of surgery to provide continuous surgical site pain relief for the first 2-3 days. Continuous surgical-site pain relief involves giving a constant infusion of a local anesthetic medicine directly into the surgical site. You experience pain relief directly at the incision site without the side effects of narcotics. Because the medicine is given continuously at a safe and slow rate, you do not have to worry about the medicine wearing off. As a big plus, being comfortable after surgery may actively speed your recovery.
- The system works by providing a small balloon-like pump that is filled with local anesthetic medicine. The pump is attached to a catheter (tiny tube) that the doctor places near your incision site. The system is very easy to use. The pump automatically delivers the medicine at a slow rate. The pump may last anywhere from two to five days. The pump is completely portable, lightweight and can be attached to your own clothing or placed in a carrying pouch. When the infusion is complete, the catheter is removed and the pump thrown away. Depending on your surgery, you may go home with one of these pain relief systems. You will be shown how to remove the pump at home. We will also provide you with a 24/7 resource regarding the pump.
- Narcotics are taken by mouth to ease the pain after surgery. They are taken every 3-4 hours as needed. Follow the directions on your individual prescription.
- These medicines include ibuprofen and Alleve. They will help as a pain reliever and reduce inflammation after surgery. It may be taken with narcotics and may help to increase the effect of the narcotics. Follow the directions on your individual prescription
- Tylenol will help as a pain reliever after surgery. It may be taken with narcotics and may help to increase the effect of the narcotics. Follow the directions on your individual prescription.
Post Surgery Information
Day 1. When you leave the hospital you will have a wound closure type and wound covering type. Staples, sutures, steri-strips or medical glue may be used. Whatever closure type is used it is important to keep the wound clean and dry. Spend the day relaxing and take your medications as prescribed.
Day 2. Return to a normal diet and resume any medications you normally take unless specifically told otherwise by your surgeon. Normal swelling and bruising may start to occur on this day. You may remove plastic covering and replace gauze bandage. Try to keep wound covered with clean dressings.
Day 3. You may shower but not bathe. Try to keep the wound from being soaked and pat dry as necessary. If you have not had a bowel movement by this day you may want to try a mild laxative such as milk of magnesia. Continued swelling and bruising is normal. Some people may feel well enough to return to work on this day. Activity should be based on your body. If an activity is causing pain discontinue. Continue pain medications as prescribed.
Day 4-14. Continue to let your body heal and follow prescribed medication courses. Changing your coverings and allowing air to your wound will help with the healing process. When the steri-strips start to curl at the ends this will indicate they are ready to be removed. They should be easy to remove and not require much manipulation. Your stitches will most likely be self dissolving and will not require assistance to be removed. Try new activities and gauge how your body responds.
Day 15-30. You should have a post-op appointment in this time to make sure that the incision is healing well and that your return to normal activity is in progress. Swelling, bruising and pain management should be minimal at this time.
Instruction for post operative care:
- Resume a regular diet after release from the hospital.
- Resume normal medication after release from the hospital unless specifically instructed by the surgeon.
- You may shower the day after surgery. Avoid soaking bandage or taking baths for the first 2 weeks.
- Driving should be restricted if you are taking narcotic pain medications.
- Activity as tolerated. Let your body be your guide and refrain from activities that cause pain.
- Return to work when you feel able. This will be typically 3-5 days and depending on the work you do.
- Avoid constipation (Milk of magnesia works well)
- It is common to have swelling and bruising around operative sites.
- Take prescriptions as prescribed.
- Use tylenol and Ibuprofen if you can tolerate these medications.
- Sexual relations as tolerated.
- Call the office if your incisions are red or draining fluid. (Clear or straw colored fluid is typically not concerning)
- Call the office if you have extreme pain or nausea.
UP TO 1
|Hiking, strenuous exercise||B||C||D||D|
|Lifting, < 25 lbs||B||C||D||D|
|Lifting, > 25 lbs||B||C||D||D|
|A. Do not engage in this activity|
|B. Proceed cautiously, stop immediately if discomfort occurs|
|C.Essentially no restriction, but don't really push it|
D. No restrictions, resume normal activity in this area