Abdominal wall (ventral, incisional, umbilical, flank) hernias can occur anywhere in the abdomen, but most often through previous incisions and at the belly button. Many hernias are repaired as elective operations, sometimes as outpatient surgery. They can be done either laparoscopically or open and sometimes need a more extensive surgery to reconstruct the abdomen.
For more complex abdominal wall hernias, we have a multidisciplinary team of laparoscopic, general and plastic surgeons who specialize in the different techniques of hernia surgery and work together as a team to make sure you get the best repair possible.
For simple hernias, an examination by your surgeon is usually enough to diagnose the problem and plan for repair. For more complex hernias or for hernias that have come back after a previous repair, you may need a CT scan to help us see the hernia and plan your operation.
Prior to hernia repair, you will be asked not to eat or drink anything after midnight prior to your surgery. You will be given specific instructions from your surgeon or anesthesiologist about which medications you should or should not take prior to your surgery. You should not take any blood thinning medications at least 5 days prior to your operation. This should be discussed with your surgeon at your preop visit.
Your recovery will vary depending on the type of hernia you had repaired and the method used for repair.
Activity
You can resume most usual activities gradually beginning shortly after surgery. You
should begin walking the night of surgery or the following morning and continue to
increase as you are able. Increased activity reduces the risk of blood clots, and
improves breathing to prevent pneumonia.
Avoid lifting more than 10 pounds for 4 weeks and excessive bending or twisting for 1-2 weeks following surgery. This is to allow healing of the incisions, specifically the fascia (the strongest layer of the abdomen wall) and decrease the risk of your hernia coming back. This is especially important if you had an open hernia repair or a repair of a hernia of your abdominal wall. You will be given a binder to wear around your abdomen. This helps to support the area repaired and may help decrease pain from any sudden movements. The binder should be worn during activity, but can be taken off at night. If the binder is irritating to your skin or causes itching, placing the binder over another T-shirt may help.
You should avoid sexual intercourse for 10-14 days or until cleared by your doctor.
Avoid driving until you no longer need narcotic pain medication. Driving while taking them can impair your ability to drive safely.
You should be able to return to work 1-3 weeks after surgery if your job does not involve any heavy lifting. If your job involves heavy lifting and light duty is not an option, you may need up to 4 weeks off work to fully recover.
Wound Care
A small gauze and clear tape dressing or a small white dressing is typically placed over each incision. These dressings can be removed 48 hrs (2 days) after the operation. Below this dressing are small brown or white pieces of tape (called Steri-Strips); these will fall off on their own within 1-2 weeks or be removed at your follow-up visit with your surgeon. If your surgeon gives you specific instructions other than this, please follow those instructions.You may shower after 48hrs (after the gauze and clear tape dressing is removed). It is okay to get soap and water on the incisions. Pat the area dry. It is not recommend that you submerge underwater (in a bathtub, pool, or hot-tub) for at least 2-3 weeks post-op.
Following repair of large hernias, fluid can sometimes build up in the space where the hernia was. This may look like the hernia has come back or cause some discomfort, but there is usually no treatment needed and the fluid will go away on its own. Hernias rarely come back soon after surgery. Occasionally these fluid collections can become infected, so watch for redness over the area, drainage or fever. If this occurs, call your doctor.
Some large ventral hernias require a procedure called component separation, which involves separating layers of the abdominal wall to slide them over one another to close the hernia. This usually requires several drains to be placed in the spaces where the tissue is separated to prevent a large amount of fluid from building up. These are commonly referred to as JP drains. You will be given specific instructions before leaving the hospital on how to care for you drains. Drains are usually in place for 1-4 weeks, depending on the amount and character of the drainage.
- For more information on drain care
If you notice drainage from your incisions, particularly if it is thick and foul-smelling or associated with a fever, you should contact your surgeon.
If you notice redness around your incisions, especially if it is getting worse or associated with drainage or a fever, you should contact your surgeon.
If you had to have a larger incision (open surgery) and the incision was left open, or if you developed an infection in one of your incisions, you may need to change a gauze dressing twice a day until the wound heals.
- More information on dressings.
Pain Management
Pain after a large open or laparoscopic abdominal wall hernia repair can be significant.
You will probably be admitted to the hospital at least overnight. You will most likely
be placed on IV narcotics using a pump (PCA � patient controlled analgesia), which
allows you to press a button for additional medication when you need it. This will
be weaned off within a few days of your operation and you will start oral pain medications.
It is very important to us that your pain be well controlled. Your pain should be
controlled well enough for you to begin getting out of bed the morning after surgery
and for you to perform deep breathing exercises. If you have pain that is not well
enough controlled to allow you to walk or breathe deeply, talk to your surgery team.
You may need to have your pain medications changed or increased.
You will be discharged with pain medication, typically a mild to moderate strength narcotic. Take as needed and as prescribed. You may also take over-the-counter medications such as ibuprofen for pain. Most narcotic medications prescribed are combined with Tylenol (acetaminophen) and you should not take additional Tylenol if you are taking a narcotic medication that already contains Tylenol.
Other Medications
You may be prescribed a stool softener when you go home. Pain medications can cause
constipation and a stool softener may help. You may also be given nausea medication
if you have experience nausea or vomiting from taking your pain medication.
It is common to have some constipation after surgery, especially when taking narcotic pain medications. You will probably be prescribed a stool softener when you are discharged. If you are having trouble moving your bowels after surgery (if your stool is hard or you have to strain excessively) you may need a laxative. Over the counter medications can treat this well. Senna, Miralax, or dulcolax are some of the most common and are available at most drug stores or grocery stores. Take as directed.
If you are having trouble having a bowel movement AND have abdominal bloating, nausea or vomiting, and not passing gas, you should call your doctor.
Home Medications
Unless otherwise instructed, you should be able to resume your usual home medications
the night of or the morning following your surgery.
Diet & Bowel Care
You may resume your usual diet as you feel able unless otherwise instructed. You may
have some abdominal bloating or mild nausea after your operation, so eat slowly and
only what you can tolerate. Your appetite may be less than usual but typically returns
to normal within a week or two. Be sure to drink plenty of liquids (6-8 glasses of
water or juice each day) if your appetite is not very good.
Follow Up
You will be given a date and time to see your surgeon following surgery, usually in
10 days to 3 weeks. If you are having outpatient surgery, this appointment will be
made for you at the time you visit your surgeon for preop. If you are discharged late
in the day or over the weekend, you will be given a number to call the following business
day for an appointment. If you are having trouble making an appointment, you should
call your doctors' office directly for assistance.
Your surgeon may require you to have long-term follow-up to check for recurrence of the hernia. This is usually done every twelve months for up to a period of 5-years.
Call Your Doctor If
Daytime hours:
Call 706-721-4686 or 7597
After hours and weekends:
Call 706-721-8400