Immediately after surgery, the patient will be observed in a recovery area for one to several hours depending on the time duration of the surgery. This is to monitor body temperature, pulse, blood pressure, and heart function.
There maybe a small drain from inside the wound to collect secretions for a day or more.
The surgical wound will be observed for undue bleeding or swelling.
The patient may then be transferred to a regular room.
Laparoscopically done cases will usually be discharged on the day of the surgery but more complex hernias such as those with incarcerated or strangulated intestines will require overnight hospitalization.
Open surgical cases may stay for 4 to 5 days or longer.
Some patients may have prolonged suture-site pain, which may be treated with pain medication or anti-inflammatory drugs.
Antibiotics may be prescribed to help prevent postoperative infection.
You can eat a regular diet without any restrictions after surgery. This, of course, will be limited by other illnesses you have, such as diabetes, heart disease or hypertension.
On the first day, eat small, light, meals and liquids. Progress to a normal diet as tolerated.
Nausea and vomiting from anesthesia are not uncommon for 24 hours. If you feel nauseous, take clear liquids only. Contact your doctor if nausea and vomiting persist for greater than 36 hours.
Do not take any alcoholic drinks for at least 24 hours and while you are taking narcotic painkillers with codeine.Activity
You can do whatever you are comfortable doing, except heavy lifting, after you are discharged.
For 24 to 48 hours after surgery you may resist movement due to pain. Although you should get rest during this time, it is equally important to get up and walk.
Do not drive while you are taking narcotic pain medicines and while your incisions hurt. This may reduce your ability to move quickly.
Your thought processes may take 24 to 48 hours to return to normal because of anesthesia. Do not make any important business or personal decisions during this time.
It is okay to go up and down stairs, and it is encouraged.
You can return to work when you feel comfortable you can perform your job safely and at the level you and your employer expect. Usually this is a minimum of one week. If your job involves heavy lifting you should stay out of work for 2-4 weeks.
Most people find they fatigue easily during the second and even the third week, so don’t overload your schedule.
Do not return to exercise or strenuous activity until you are seen for a follow-up appointment.Pain and Discomfort
It is normal to have pain after the operation. How much pain a person experiences usually depends on the individual and not on the operation. Pain normally is located over the incision. Narcotics and painkillers are prescribed for relief from pain.
Keeping ice on the area of surgery for 24 to 48 hours will minimize postoperative swelling and reduce pain. There is no benefit to using ice after the first 48 hours.
Care of the Incision
Surgical incisions are covered with a gauze pad. It is not uncommon for the pad to become saturated with blood during the first 24 hours. Do not become alarmed; just change the bandages as needed.
You can take a shower 24-36 hours after surgery. Be sure to gently dry your incisions and replace the bandage.
After 2-3 days, it is not necessary to keep your incisions covered but it will usually make you more comfortable to do so as you increase your activity.
If you do not see metal clips or sutures, the sutures are in the skin itself and will dissolve. This occurs 3-4 weeks after surgery and may be associated with a little drainage from the incision.
It is common for patients to notice some black and blue or maroon discoloration around the incision. This represents a small amount of blood and is normal. It should not alarm you. It is also common for this to only become apparent 2-3 days after surgery as blood in the tissues moves to the surface.
Contact the doctor if your incision is red, hot and tender; you may have an infection.
You have been given antibiotics in the operating room prior to surgery. Unless discussed with you, you do not need them after surgery.
You may also notice black and blue discoloration near your incision. This is not cause for alarm, even if it occurs a few days after the surgery. It will usually resolve in 7 to 10 days.
It is normal for the incisions and the hernia site to be hard and swollen following surgery. This is called a healing ridge and represents wound healing. It is not a hernia and will go away in eight to twelve weeks.
Do not tan your incision for one year after surgery, as it will darken your scar.
Some people believe Vitamin A and Vitamin E applied to the incision helps wound healing.Bowel habits
Following your surgery you may notice alterations in your bowel habits.
Diarrhea can occur from the surgery itself or from the antibiotics you received.
Constipation is very common and results from the narcotic pain medicine you are taking.
If you or your family were not informed of anything unusual after surgery, rest assured that everything is fine and went according to plan.Contact your doctor if you experience:
Persistent light headedness
Chills and/or fever greater than 101°F
Pus or infection at the incisions
Inability to pass urine
Any worrisome conditionIncisional Hernias - Risks & Complications
The risks and complications include those related to general anesthesia and those related to the surgery.
Risks of general anesthesia
include nausea, vomiting, urinary retention, cut lips, chipped teeth, sore throat and headache. More serious complications include heart attacks, stroke and pneumonia.Postoperative complications
Fluid buildup at the site of mesh placement, sometimes requiring aspiration (draining off)
Postoperative bleeding, though seldom enough to require repeat surgery
Prolonged suture pain, treated with pain medication or anti-inflammatory drugs
Injury to intra abdominal organs like the intestines, liver etc.
Fever, usually related to surgical wound infection
Intra-abdominal (within the abdominal wall) abscess
Blood clots can form in the legs due to inactivity after surgery
Blood clots can get dislodged from the legs and can get embedded in the lungs leading to respiratory distressIncisional Hernias - Recurrent hernia
A recurrent hernia is one that occurs at the site of a previous hernia repair.
The risk of recurrence is greater with obese patients or those who have had multiple earlier operations or the prior placement of mesh patches.
Some of the factors that cause incisional hernias to occur in the first place, such as obesity and nutritional disorders, will persist in certain patients and encourage the development of a second incisional hernia and repeat surgery.
The risk of complications has been shown to be about 13%.
Each subsequent time, the surgery will become more difficult and the risk of complications greater.
Postoperative infection is higher with open procedures than with laparoscopic procedures.
To prevent recurrence of hernia a few precautions maybe advised–
Using an abdominal corset in the early post-operative period
Treating any chronic cough before treating hernia,
Avoid straining during bowel movement or passing urine.Incisional Hernias - Prognosis
The prognosis for Incisional hernia surgery and its success is good if done early.
Good outcomes are expected with incisional hernia repair, particularly with the laparoscopic method.
Patients will usually go home the day of surgery and can expect a one- to two-week recovery period at home, and then a return to normal activities.
The American College of Surgeons reports that recurrence rates after the first repair of an incisional hernia range from 25–52%.
Recurrence is more frequent when conventional surgical wound closure with standard sutures (stitches) is used.
Recurrence after open procedures has been shown to be less likely when mesh is used, although complications, especially infection, have been shown to increase because of the larger abdominal incisions.
Laparoscopy repair of incisional hernia (repair with mesh) has shown rates of recurrence as low as 3.4%, with fewer complications as well.
Deaths are not reported resulting directly from the performance of Herniorrhaphy for incisional hernia.Incisional Hernias - Lifestyle Changes
Lifestyle Changes which, reduce undue abdominal pressure, can help prevent Incisional hernias.
The alternatives to first-time and recurrent incisional hernia repair begin with preventive measures such as: Losing weight;
maintaining suitable weight for age and height. Strengthening abdominal muscles
through regular moderate exercise such as walking, tai chi, yoga, or stretching exercises and gentle aerobics. Reducing abdominal pressure
by avoiding constipation and the buildup of excess body fluids, achieved by adopting a high-fiber, low-salt diet. Avoiding undue pressure-
Learning to lift heavy objects in a safe, low-strain way using arm and leg muscles. Controlling diabetes
and poor metabolism with regular medical care and dietary changes as recommended. Eating a healthy, balanced diet
of whole foods, high in essential nutrients, including whole grains, fruits and vegetables, limited meat and dairy, and eliminating prepared and refined foods.Incisional Hernias - FAQs
Who treats an incisional hernia?
A general surgeon or a plastic surgeon treats Incisional hernia.Who gets an incisional hernia?
Incisional Hernias can occur in anyone who has an incision, most commonly an incision through the abdominal wall. It represents a failure of the layer that gives strength to the abdominal wall (the fascia) to heal.Can an Incisional hernia go away by itself?
No. Once a hernia has developed it will not go away. In fact it will get worse with time. The constant pressure on the area makes the hernia get bigger. This leads to more frequent, more intense and longer periods of discomfort.Is it related to work?
It is likely that all Incisional hernias do not result from work, since many factors can lead to a hernia. However, it is impossible to say with certainly that the hernia is not from, work if you did not have one when you started your job. Furthermore, even if other factors were involved in the development of your hernia, lifting could have contributed. Therefore, all hernias are usually treated as worker’s compensation injuries.Are there any tests I need to undergo to confirm I have an Incisional hernia?
No. Physical exam and history are the two best ways to diagnose an Incisional hernia. Fortunately, or unfortunately, there is no test, including a CT scan and MRI, that is better than your history and a physical examination. The reason it is unfortunate is that occasionally there are patients with a history that may indicate a hernia but none can be detected on physical exam. These patients may require a surgical exploration of the area to exclude a hernia, as a last resort.What can I do before surgery to feel better?
Limiting your activity and any lifting may offer temporary relief. You should avoid exercise, especially any that places strain on the anterior abdominal wall muscles. A truss may also offer temporary relief but should not be used for a long time.Do all surgeons perform both the laparoscopic and open approaches?
No. All surgeons perform the open approach but only some surgeons perform the laparoscopic approach.Is there any treatment for an Incisional hernia other than surgery?
An abdominal corset maybe used to keep the hernia reduced during the daytime. For smaller hernia a truss maybe used. However this is only a temporary solution.
A truss is a belt with a large pad on it that applies pressure to the site of the hernia with the aim of keeping the bulge from popping out. Overall, a truss is not a good idea even though it may at times work. The truss does nothing to repair the hernia. It just minimizes symptoms by preventing significant herniation through the defect in the abdominal wall. As a result, the hernia will continue to get larger. In addition, there will be scar tissue formed that provides no strength to the area. Both of these factors, enlargement of the hernia and scarring, make the surgical repair of the hernia more difficult and later recurrence more likely. Therefore, a truss should only be used as a short-term measure until surgery can be performed.Incisional Hernias - Glossary
Abdominal wall -
The layers of muscle and fatty tissue that surround the abdomen.Anesthesia -
A substance that prevents pain from being felt, given before an operation.Complications -
Secondary problems that can result from surgery.Hernia -
A weakness or rupture of the wall or cavity containing an organ, with the resulting protrusion of that organ or part of the organ though it.Incision -
A cut into the skin or abdominal wall.Intra-abdominal -
Inside the abdomen.Non-reducible hernia -
A hernia that cannot be flattened out by applying pressure or by lying down.Recurrent hernia -
A hernia that occurs at the same location as a previous hernia.Reducible hernia -
A hernia that can be flattened out either by applying pressure or by lying down.Surgical Staples -
U-shaped metal surgical fasteners.Surgical Tacks -
Metal surgical fasteners.Sutures -
Fine thread or other material used to surgically close a wound or join tissues.Synthetic Mesh -
A synthetic material resembling a flat, pliable thin screen, which is used to repair a hernia.Incisional Hernias - References
Dr. Paderla Anitha.Edited by:
Dr. Sunil Shroff, Dr. Reeja Tharu.