Hernia Repair

WHAT YOU SHOULD KNOW

Hernias erupt when a weakened abdominal muscle tears open, permitting the organs inside to push
through. Typically, a hernia will pouch out, looking like a balloon beneath the skin. Two areas are
especially vulnerable. Inguinal (IN-gwih-null) hernias appear at the point where the leg joins the
abdomen. Men feel this type of hernia as a lump in the scrotum. Umbilical (um-BILL-ih-kull) hernias crop
up at the navel. Surgical scars present yet another opportunity for hernias---in this case called incisional
hernias. A hernia repair is known medically as a herniorrhaphy (HER-nee-OR-uh-fee). Two techniques are
in use today:
Open Herniorrhaphy: In this approach, the doctor makes a single long incision over the hernia,
removes the protruding sac if necessary, and sews the torn muscle closed. Man-made mesh may
be applied to the inside of the muscle wall to further strengthen it. The operation typically takes
between 1 and 2 hours.
Laparoscopic Herniorrhaphy: This version of the procedure is accomplished through two
small incisions, one in the abdomen, the other close to the hernia. With the aid of a tiny lighted
scope, the surgeon uses miniature, remote-controlled surgical instruments to make the repair
from within the abdomen. Like an open herniorrhaphy, the procedure lasts 1 to 2 hours.
Risks
There are always risks with surgery. You might develop internal bleeding or get an infection. Blood clots
could form and lodge in the lungs, making it difficult to breath. However, if the hernia isn't repaired,
there's a chance that a portion of the intestine will get stuck in it. Starved of adequate circulation, this
tissue could eventually die, leading to a life-threatening case of gangrene.
IF YOU'RE HEADING FOR THE HOSPITAL...
Before You Go
1. The Week Before Surgery:
2. You'll probably need to stop taking aspirin and ibuprofen; the doctor will tell you when. If you're
taking aspirin for your heart, don't stop without asking the doctor first. Also ask whether you can take
any over-the-counter medicines.
3. Your doctor will tell you whether you need to have blood drawn.
4. The Night Before Surgery:
5. Your physician may suggest you take a sleeping pill.
6. Just before surgery, you should not eat or drink anything (even water). Your doctor will tell you
when to begin fasting.
When You Arrive
1. Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills,
or any other medication on the day of surgery.
2. Do not wear contact lenses to the hospital. You may wear glasses.
What to Expect While You're There
You may encounter the following procedures and equipment during your stay.
1. Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your
heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and
lungs. Your blood pressure is taken by wrapping a cuff around your arm.
2. Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or
from the bend in your elbow. Several samples may be needed.
3. Chest X-ray: The doctor will check this picture of your lungs and heart to make sure you're
ready for surgery.
4. Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically,
three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to
a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
5. IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing
connected to it.
6. Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures
the oxygen in your blood.
7. Anesthesia: You'll need a pain-killer during the operation. For this type of surgery, the following
options are available:
8. Spinal Anesthesia: This type of anesthesia requires an injection in the spine. You will be awake
during surgery but will be numb below the waist. Feeling will return in about 2 hours.
9. Epidural Anesthesia: For this type, a tiny tube is positioned near the spine, allowing
administration of additional medication during the operation. You will be awake during surgery but will
be numb below the waist. Feeling will return to your legs when the anesthesia wears off.
10. General Anesthesia: This alternative puts you completely to sleep throughout the operation.
The anesthetic is given either as a liquid in your IV or as a gas through a face mask or endotracheal
(END-o-TRA-kee-ull) tube placed in your mouth and throat.
After Surgery:
The incision will be bandaged to keep the area clean and prevent infection. (A nurse may briefly remove
the bandage and check the stitches shortly after surgery.) You'll need to stay in bed until the doctor says
it's safe to get up. As you begin your recovery, you can expect the following:
1. Oxygen: At times during your stay, your body may need extra oxygen. It is given either through
a plastic mask over your mouth and nose or through nasal prongs. If the oxygen dries out your nose or
the nasal prongs bother you, tell your nurse, but don't take off the oxygen on your own.
2. Deep Breathing and Coughing: These exercises help prevent a lung infection after surgery.
Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs
and keep them clear. You should deep breathe and cough every hour while you are awake, including any
time you spend awake during the night.
3. Hold a pillow tightly against your abdomen to help reduce pain from your incision. Take a deep
breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put
any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while
awake. Remember to follow each deep breath with a cough.
4. Incentive spirometer (spy-ROM-uh-tur): This piece of equipment helps you take deeper
breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible.
Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while
awake. Remember to follow each deep breath with a cough.
5. Drains: Thin rubber tubes may be put into the area around your incision to drain off excess
fluid. They will be taken out when no longer needed.
6. Swelling: After an inguinal hernia repair, men tend to develop a red and swollen scrotum.
Wearing a scrotal support (jock strap) will help to relieve the discomfort. An ice pack can also help. Put
ice in a plastic bag, cover it with a towel, and place it over the area for 15 to 20 minutes out of every
hour as long as necessary. Do not sleep on the ice pack.
7. After the first 24 to 48 hours, switch to heat for pain or swelling. Use a heating pad (turned on
low) or a hot water bottle, or sit in a warm water bath for 15 to 20 minutes out of every hour as long as
needed. Do not sleep on the heating pad or hot water bottle. Heat brings blood to the area or the
surgery and helps it heal faster.
8. Activity: You may need to rest in bed for a while. But even if you are confined to bed, it's
important exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw
big circles with your toes, then repeat with the other leg. You can also try lying on your side and
pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you
the first time you try. If you feel weak or dizzy, sit or lie down right away.
9. Medicines:
10. Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a
shot, or by mouth.
11. Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication
to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or
keeps coming back.
12. Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor
may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
13. Stool Softeners: These medications make bowel movements softer so you won't need to
strain.
After You Leave
1. Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know,
but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up,
even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous
machinery.
2. When you are allowed to bathe or shower, carefully wash the stitches or staples with soap and
water. Then put on a clean, new bandage. Change your bandage any time it gets wet or dirty.
3. Regular bowel movements can be difficult after surgery. Don't strain if the stool is too hard.
Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and
beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool
softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
4. You'll need extra rest while you recuperate. Try to gradually increase your activity each day,
resting whenever you feel it's needed.
5. Avoid any heavy lifting until you get the OK. If you have to lift heavy objects at work, as the
doctor for the best way to go about it.
Call Your Doctor If...
1. Pain from the surgery won't go away or gets worse.
2. You have trouble urinating.
3. Your incision is swollen and red, or you see any pus. These are signs of infection.
4. Your stitches come apart.
5. Your bandage becomes soaked with blood.
6. You develop a high temperature.
Seek Care Immediately If...
1. You develop chest pain or suddenly have trouble breathing.

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