Recovery

What to Expect after Hernia Surgery

Recovery After Hernia Repair
Most patients undergoing hernia surgery for the first time will safely and comfortably go home the same day. Patients who need an abdominal wall reconstruction for large hernias or have advanced medical conditions will remain in the hospital.

Many factor inform the rate of recovery, such as the type of surgery, pre-existing pain, cultural expectations, personal pain threshold, and the complexity of surgery. We focus on these factors as it applies to you, and develop a multi-pronged Enhanced Recovery and Comfort (ERC) Program to help you recover as quickly and comfortably as possible. Our ERC Program focuses on the three stages of surgery: pre-operative, operative and post-operative.

Pre-Operative Pain Management
Studies have shown that medications and nerve/field blocks can blunt the pain signals transmitted to the brain. This is called pre-emptive analgesia. By blunting the pain signal transmission, patients usually experience less pain during and after surgery. With our ERC Program, we can use several medications including (oral or IV) acetaminophen, Cox-2 inhibitors (e.g. Celebrex), gabapentinoid (e.g. Lyrica) and/or opioid-receptor agonists (e.g. Tramadol).

Operative Pain Management
One of the best ways to improve the speed of recovery is to perform surgery through small incisions using laparoscopy or advanced robotic surgical systems. As part of our ERC Program, we usually perform nerve or field blocks prior to incision or early in the surgery to blunt the pain signals. Our anesthesiologists are trained in performing advanced nerve and field blocks such as TAP (transversus abdominis plane), Quadratus Lumborum, or Rectus Sheath blocks.

Post-Operative Pain Management
Most patients are concerned about pain after surgery. We will ensure that you are comfortable after surgery, but it is important to remember that pain is a way for the body to guide you. Pain is one way of telling you to take it easy, especially if you’ve overexerted yourself after surgery, and pain will tell you when you are potentially harming the repair. We do not want to completely eliminate pain. Also, to completely eliminate pain after surgery would require narcotics that can lead to severe constipation, dizziness and nausea. Constipation after hernia surgery is usually worse than the incisional pain itself.

The most important thing to do after surgery is to rest. After most hernia surgeries you will need 2-3 full days of rest. When you get home after surgery, plan to sleep a lot or rest on the couch. You will be able to walk around the house or in the yard, but mostly, focus on relaxing and resting. Many patients find herbal teas to be very soothing and relaxing. Icing the incisions during the first 2 days is also recommended.

For the first 2 days following surgery, we recommend alternating Ibuprofen and Tylenol. When you get home, start by taking Ibuprofen. Three hours later, take Tylenol. Continue alternating each medication every six hours. This way every three hours you’re are taking a pain reliever. With this regimen, narcotic pain pills are not necessary.


BELOW IS THE EXPECTED RECOVERY FOR EACH TYPE OF SURGERY

Laparoscopic or Robotic Inguinal, Umbilical, & Small Ventral

Comfort
Almost all patients are discharged home the same day. Ibuprofen and Tylenol work well together. Placing an ice pack over the incision during the first 48 – 72 hours also helps. Remember, the goal is to be comfortable at rest and with movement, but not to have no pain at all.
Constipation is very common after surgery. You should have a bowel movement by the third day after surgery. Take stool softeners and drink lots of fluids after surgery. If necessary, take an over the counter laxative such as Milk of Magnesia or use a fleet enema.

Showering
If your incisions are dry, you may shower 48 hours after surgery. If your incisions are seeping or if you have a drain, ask your surgeon before showering.

Activities & Restrictions
You will be able to walk and use the stairs right away. Do not perform chores or drive for at least one week following surgery. Most patients can return to normal activities, including non-strenuous work about 1 week after surgery. If you perform strenuous work or activities, your surgeon may restrict those activities for up to six weeks.

Open Inguinal, Umbilical, & Small Ventral Hernia Repairs

Comfort
Almost all patients are discharged home the same day. Ibuprofen and Tylenol work well together. Placing an ice pack over the incision during the first 48 – 72 hours also helps. Remember, the goal is to be comfortable at rest and with movement, but not to have no pain at all.  Narcotics may be needed for the first few days.
Constipation is very common after surgery. You should have a bowel movement by the third day after surgery. Take stool softeners and drink lots of fluids after surgery. If necessary, take an over the counter laxative such as Milk of Magnesia or use a fleet enema.

Showering
If your incisions are dry, you may shower 48 hours after surgery. If your incisions are seeping or if you have a drain, ask your surgeon before showering.

Activities
You will be able to walk and use the stairs right away. Do not perform chores or drive for at least one week following surgery. Most patients can return to normal activities, including non-strenuous work about 1 week after surgery. If you perform strenuous work or activities, your surgeon may restrict those activities for up to six weeks.
Laparoscopic, Robotic or Open Incisional Hernia Repair

It is more difficult to describe an expected recovery pathway for this group of surgeries since incisional hernias can range in size from as small as a pea to larger than a watermelon. Your surgeon will give you more details before and after surgery.

Diaphragmatic (Hiatal, Paraesophageal) Hernia Repair

Nausea and difficulty swallowing can occur after these repairs. Therefore, most patients are observed in the hospital overnight. An UGI – an x-ray where you swallow contrast dye – may be performed the following morning (before you are discharged) to examine the condition of the esophagus, tightness of the wrap and to rule out any leaks.

Comfort
You will be given liquid pain medication or medications that come in very small pills. Because there will be swelling in your esophagus and the wrap, larger pills may have trouble passing the first week or two after surgery.

Retching and vomiting can cause serious problems after surgery. It may cause the wrap to slip or the repair to fall apart. You will be prescribed anti-nausea medications after surgery.
Liquid Ibuprofen and Tylenol work well together. Icing the incisions during the first 48 – 72 hours will help. Remember, the goal is to be comfortable at rest and with movement, but not to have no pain at all.

Shoulder pain is very common after diaphragm surgery. Frequent gentle shoulder/back massages and/or warm compresses help. Narcotic pain medications do not help for the shoulder pain.

Showering
If your incisions are dry, you may shower 48 hours after surgery. If your incisions are seeping or if you have a drain, ask your surgeon.

Activities & Restrictions
Continue walking often. Do not perform chores or drive for at least one week. Most patients can return to normal activities, including non-strenuous work, about 3-4 week after surgery. The diaphragm is a very strong sheet of muscle and is used in strenuous work, vigorous exercise, coughing and sneezing. Since the repair involves suturing the diaphragm, any strenuous activity can damage the repair. Your surgeon will likely recommend avoiding heavy labor and sporting activities for several months.

Diet
Post-operative swelling can make swallowing large items difficult and potentially dangerous as they may get lodged in the esophagus. Most patients will be required to start on a liquid diet for a week or two. If there are no swallowing problems, the diet is then gradually progressed from soft to regular food.