HERNIA INSTITUTE OF PENNSYLVANIA
North Penn Hernia Institute
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INGUINAL HERNIA SURGERY
WHAT TO EXPECT ONCE YOU ARE HOME




Once you are home, many “normal” postoperative symptoms may occur which you will want to better understand, or questions may arise that you may want to have answered prior to your next contact with your surgeon. Here is a discussion regarding events that you can expect, and answers to questions that may arise once you are home.

Do not hesitate to call us (215) 368-1122 if the symptoms are severe or you feel any concern.

1. Dizziness: This is not unexpected. You had sedation during your surgery, and you may have already taken some narcotic pain medication. This may cause intermittent waves of dizziness for the next 24 hours. If it does occur, sit down and rest for a short while. The symptoms should gradually subside.

2. Nausea: The combination of sedation and pain medication may cause intermittent episodes of nausea (and rarely vomiting). To minimize this, eat small, frequent meals and liquids during the 1st day, especially if this does occur. It generally last only 6-8 hours and rarely persists for more than 24 hours. Continued use of the narcotic Rx pain medication may cause any nausea and vomiting to persist. If so, limit is use to only as absolutely needed, or if instructed by your surgeon, cut Rx in half. This helps!

3. Incision Pain: Although your surgery was done as an outpatient, it is still considered major surgery and pain is to be expected. Your prescription Rx is designed for this discomfort. Take it only as directed. Continue to be active as directed by your surgeon. Activity, including short (2-3 minute) walks every 1-2 hours on the day/evening of surgery, and especially frequent, progressively longer walks beginning the day after surgery, and continuing through the next several days/weeks is the most important "KEY" to a shorter, smoother, less complicated recovery process.
WALK towards RECOVERY !!!

4. Swelling/Discoloration: Swelling and/or "black and blue" discoloration at the area of the incision is not unusual. This may even spread down towards your genitalia (scrotum in males). This may increase slightly during the first 3-5 days. Keep ice on the area at least 24 hours after surgery, especially while sitting or lying down (Ice is not necessary while walking). The swelling, which may increase slightly over the first 3-5 days, will gradually resolve over the following 7-10 days or so. Swelling and discoloration is not an indication of a problem. Swelling of the scrotum and genitalia can be quite dramatic in approximately 5-7% of patients. While this appears alarming, it is temporary and will resolve.
Please inform us if you are concerned about the degree of swelling.

5. Numbness: As with all surgery, slight and temporary numbness in and around the incision is not unusual. This may extend towards the genitalia and into the upper leg. This gradually subsides in most all cases, and is not problematic.

6. Bleeding: A small amount of blood-tinged drainage on the gauze (seen beneath the waterproof plastic bandage) is not unexpected. If it becomes excessive, with free ‘puddling’ of liquid blood under the dressing, or oozing out from the edges of the plastic dressing, please let us know. This usually only requires a dressing change, and is not generally cause for undue concern.

7. Constipation: Constipation is not uncommon after any surgery, and can be particularly problematic after some hernia repairs. You should not “Strain” at the stool, or while having a BM (nor in fact during any activity in the first 2-3 weeks after surgery). After 48 hours, if you have not had a relatively normal and natural BM, we suggest the use of Milk of Magnesia, following the dosage instructions on the label, repeating the does every 8-12 hours until there is a good result. Restart the clock and repeat the Milk of Magnesia if further constipation occurs. Early ambulation, progressively decreasing use of narcotic pain Rx and normal, liberal fluid intake will usually prevent protracted constipation.

8. Fever: A low grade fever for 5-7 days is not unusual. It is a normal response to the healing process. It does not require treatment unless it is symptomatic, and then Acetaminophen (Tylenol) or Ibuprofen can be utilized. If the fever is associated with any other abnormal symptoms, or you are overly concerned, Please notify our office.

Later on, over the next several days and weeks, additional concerns may arise. Here again are some of the occurrences that you can reasonably expect, explanations, and answers to potential questions.

1. The Healing Ridge: This is an area of swelling and firmness (approximately the size of a roll of quarters or small cucumber) around and along the area of the incision. It develops slowly and becomes more evident as the early surgical swelling described above gradually subsides. This hard, mildly tender area is called the "Healing Ridge ". This Healing Ridge represents the region of normal tissue ingrowth into the mesh. The Healing Ridge is actually making the repair both stronger and more resilient; it is a GOOD THING! It is this process which makes our repair technique more effective, with infrequent recurrences. Although it may last for up to 4-6 weeks on average (the duration varies patient to patient), it does gradually softened and flatten thereafter as this area returns to a normal contour.

2. Twinge. For many months after hernia surgery an occasional and usually mild twinge or minor discomfort in the area is not unusual. The overall healing process actually continues for several (2-4) months. Although the hernia repair itself is immediately quite strong and remarkably resilient, irritation of this slowly ongoing healing process may cause intermittent mild discomfort. This is generally of no clinical significance or concern. Since the repair is strong, it is hard for you to damage anything, even with normal activity. If this discomfort does occur, rest and the judicious use of over-the-counter pain medications (e.g., such as ibuprofen or acetaminophen if tolerated) is usually helpful.
Call us if the discomfort is severe and last more than 3-4 days.

If these or any symptoms are bothersome to you, do not hesitate to contact us. We will be happy to talk to you again or see you in the office for evaluation if necessary. We will also discuss any concern you may have during any postoperative visit or telephone discussion with your surgeon and our office.

POSTOPERATIVE INSTRUCTIONS
Summary of Post Hernia Instructions


Many of our patients ask "How much physical activity can I now do, and when can I increase my activity to normal?”, and “When can I return to work?" These are very good and important questions for you to understand. Some patients have specific needs and these will be discussed individually with you at the time of your discharge. Please do not hesitate to call us if you have any concerns. We do believe that for most cases in general, the hernia repair is Immediately Strong, and able to tolerate most normal day-to-day activity without adversely harming the surgical area. This includes walking (inside and outside weather permitting), bending, reaching and stooping, climbing stairs, riding in cars, fixing meals and even mild-moderate lifting (20-30 pounds) immediately after surgery. (See Guidelines on Comfort, Safety and Proper Body Mechanics below.)

Mild exercise such as a treadmill or stationary bike (2-4 minutes only, on low resistance, slower than normal pace) can be started on the evening after surgery, and such activity is in fact encouraged. Similar activity, including frequent short walks is also encouraged. The following day, continued walking with progressively longer duration per walk (and perhaps increased interval rest period duration) is an important component for a smooth and progressive recovery. Light swimming is permissible after 7-10 days (chest deep, clean water only however please!). Jogging and sports such as golf or tennis can be started after only a few days to a weeks. The rate of speed and resistance needed to safely enjoy these recreational activities can gradually be increased based on your level of Comfort, Safety, and the use of Proper Body Mechanics (see 3 Guidelines below). Let the incision and surgical area "tell you" if you're doing too much, and listen to it! If you use these 3 basic guidelines for recovery, you cannot, nor will not in general harm the repair.
Be safe! Be comfortable, and enjoy your activity and recovery.

After 2-3 weeks, most physical activity can be gradually resumed to a normal pre-surgical level, and eventually to all desired levels without restrictions. Aggressive contact sports can be resumed in about 3-6 weeks assuming safety and comfort. Driving can be resumed (licensed drivers only please!) after 2-3 days in most cases assuming that you are (1) off of the prescription pain medication and (2) you can safely and responsibly operate the vehicle with normal reaction time (e.g., normal gas to break time, etc.) in response to the events on the road. Safety First!

If it is required that you perform lifting at any time during your postoperative period (which we limit to a strongly suggested 20-30 pounds in the first 2 weeks), you must use proper body mechanics and detailed attention to comfort and safety in the process (see 3 guidelines below). Although the hernia is strong, poor body mechanics may cause injury to backs, knees, etc. If you are unsure, get assistance for any required lifting.


ACTIVTY GUIDELINES


Throughout your early recovery period (first 2-3 weeks), and even beyond as your activity level gradually increases in scope and intensity, we recommend
3 GUIDELINES
for you to consider and always keeping in mind. If you remember these guidelines, your recovery will be progressively positive and safe, and it is extremely unlikely that he will in any way arm the repair of your hernia.

1. COMFORT. Although there will be some degree of discomfort following surgery, this should gradually resolve over the next 5-7 days. Use your Comfort Level as the best guide to determine what you should or should not do in terms of physical activity. You should avoid any activity that causes significant increased discomfort (immediate or delayed) in the area of your surgery. In the early postoperative period, this would likely include heavy lifting or pulling, straining at stool, sit-ups or similar abdominal core exercises, etc. However, low-impact, low-resistance aerobic or cardiovascular type physical activity, which can be performed with a reasonable degree of comfort such as walking or even treadmill and stationary bike, also at low resistance, is generally permissible. This “COMFORT” guideline is important regarding resumption of sexual activity also.

2. SAFETY. Your activity over the next 2-3 weeks should certainly be guided by a reasonable concern for safety, both for yourself and for those around you. You should avoid any activity that is in any way considered unsafe (climbing ladders or trees, walking on rooves, and even cycling on the road, etc.). This is an important guideline, and any activity you resume must be guided by a concern for Safety.

3. PROPER BODY MECHANICS. You have already been instructed to limit weight and resistance to approximately 20-30 pounds over the next 2-3 weeks. But even under these circumstances, it is important to use proper body mechanics in you activity. This includes lifting with your knees (not your back), and carrying any weight directly in front of you (in the Power Zone) and not over head or out to the side.
The POWER ZONE for lifting is close to the body, using the legs to lift, and then to carry objects between mid-thigh and mid-chest height. Comparable to the strike zone in baseball, this zone is where arms and back can lift and carry the most with the least amount of effort. Any lifting or carrying that creates increased discomfort in the area of your recent surgery should, however, be avoided (See “Comfort” above)

RETURN TO WORK GUIDLINES



1. Rx PAIN MEDICATION: Pain medication, prescribed specifically for you is designed to minimize discomfort, and allow you to resume normal activity, especially walking at the earliest possible time. Your surgeon may have given you specific instructions as to its use. Many of the prescriptions are for narcotic pain medication. NOTE: You may not drive, nor drink alcohol if you're taking any prescription pain medication.

Your Surgeon (Dr. Goodyear, or another member of the NPHI Surgical Faculty) may have instructed you to begin by taking only one half (1/2) of the Prescription tablet every 4-6 hours if needed for pain. (You may need a “pill cutter”, available at the pharmacy, to cut the Prescription tablet in half.) If this is insufficient to effectively control the postoperative discomfort, you may add either 1 extra strength Acetaminophen (Tylenol), or 1 ibuprofen 200 mg (as tolerated) to each ˝ tablet of the prescription medication, taking them together every 4-6 hours as necessary for pain. If a full prescription tablet is necessary however, please be aware that this may cause lightheadedness, dizziness, nausea and/or vomiting in many patients. It is best therefore to begin with the lower ˝ tablet dose, and increase the medication dose gradually; but only if necessary.

2. WOUND DRESSING. The incision is covered with a clear plastic, waterproof dressing. You may shower over this dressing after 24 hours as long as you are not lightheaded or dizzy. (Hot showers in patients who are light headed or dizzy may cause patients to pass out. So please Be Cautious). The dressing will be usually stay on, and intact and usually does not need to be changed. We request that you remove the outer dressing in ~10 days. Do not leave the plastic dressing on beyond this point. The small paper strips across the incision (steri-strips) can either be removed at this time also, or retained if you wish, and allowed fall off on their own over time. Sutures are dissolvable (unless otherwise stated), and do not need to be removed later.

3. DIET. For the first 24 hours small, light meals as frequently as tolerated, and drinking plenty of fluids are the best ways to stay nourished and properly hydrated, and to avoid nausea or vomiting. After 24 hours, resumption of normal diet as desired and tolerated is fully permitted. No special diet is required.

4. SLEEP. You may sleep in any position in which you are comfortable. Most people do not need to sleep in a chair, and are permitted and in fact encouraged to sleep in bed in any position that they find satisfactory and comfortable. Rest and Sleep are a normal part of a quality recovery. Be Comfortable!

5. PRESCRIPTION MEDICATIONS. Unless otherwise instructed, most regular prescription medications can and should be resumed at their regular dose, and at the regular time schedule once you are home that applied preoperatively. For those patients on Rx blood thinners however (e.g., Coumadin, warfarin, Lovenox, Xeralto, Eliquis, etc., or even Aspirin), withholding such medications for a brief period of time (1-2 days max.) after surgery may also be recommended. Your surgeon will discuss this with you specifically, including when/what dose these medications can be safely resumed (blood thinners usually, but not always, can be resumed the next day).


North Penn Hernia Institute
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