Groin Hernia Repair

Inguinal and Femoral

The Condition 

A hernia occurs when tissue bulges out through an opening in the muscles. Any part of the abdominal wall can weaken and develop a hernia, but the most common sites are the groin (inguinal), the navel (umbilical) and a previous surgical incision site. 

Common Symptoms 

• Visible bulge in the scrotum or groin area, especially with coughing or straining 
• Pain or pressure at the hernia site 

 

Treatment Options 

Surgical Procedure 

Open hernia repair: An incision is made near the site and the hernia is repaired with mesh or by suturing (sewing) the muscle closed. 

Laparoscopic hernia repair: The hernia is repaired by mesh or sutures inserted through instruments placed into small incisions in the abdomen. 

Benefits and Risks of Your Operation 

Benefits: An operation is the only way to repair a hernia. You can return to your normal activities and in most cases will not have further discomfort. 

Possible risks include: Return of the hernia; infection; injury to the bladder, blood vessels, intestines or nerves, difficulty passing urine, continued pain, and swelling of the testes or groin area. 

Risks of not having an operation: Your hernia may cause pain and increase in size.
If your intestine becomes trapped in the hernia pouch you will have sudden pain, vomiting, and need an immediate operation. 

Expectations 

Before your operation: Evaluation may include blood work and urinalysis. Your surgeon and anesthesia provider will discuss your health history, home medications, and pain control options. 

The day of your operation: You will not eat or drink for 6 hours before the operation. Most often you will take your normal medication with a sip of water. You will need someone to drive you home. 

Your recovery: If you do not have complications you usually will go home the same day. 

Call your surgeon: If you have severe pain, stomach cramping, chills, or a high fever (over 101°F or 38.3°C), odor or increased drainage from your incision, or no bowel movements for 3 days. 

The Hernia 

A groin hernia occurs when the intestine bulges through the opening in the muscle in the groin area. A reducible hernia can be pushed back into the opening. When intestine or abdominal tissue fills the hernia sac and cannot be pushed back, it is called irreducible or incarcerated. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. This is a surgical emergency.

There are two types of groin hernias: 

An inguinal hernia appears as a bulge in the groin or scrotum. Inguinal hernias account for 75% of all hernias and are most common in men.

A femoral hernia appears as a bulge in the groin, upper thigh, or labia (skin folds surrounding the vaginal opening). Femoral hernias are ten times more common in women. They are always repaired because of a high risk of strangulation. 

Herniorrhaphy is the surgical repair of a hernia. Hernioplasty is the surgical repair of a hernia with mesh. 

Symptoms 

The most common symptoms are: 

• Bulge in the groin, scrotum, or abdominal area that often increases in size with coughing or straining. 
• Mild pain or pressure at the hernia site. 
• Numbness or irritation due to pressure on the nerves around the hernia.
• Sharp abdominal pain and vomiting can mean that the intestine has slipped through the hernia sac and is strangulated. This is a surgical emergency and immediate treatment is needed. 

Surgical Treatment 

The type of operation depends on hernia size and location, and if it is a repeat hernia (recurrence). Your health, age, and the surgeon’s expertise are also important. An operation is the only treatment for a hernia repair. Your hernia can be repaired either as an open or laparoscopic approach. The repair can be done by using sutures only or adding a piece of mesh. 

Open Hernia Repair 

The surgeon makes an incision near the hernia site and the bulging tissue is pushed back into the abdomen. Most inguinal hernia repairs use mesh to close the muscle. An open repair can be done with local anesthesia. 

For an open mesh repair: The hernia sac is removed. Mesh is placed over the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia site. Mesh plugs can also be placed into the inguinal or femoral hernia space. The mesh plug fills the open site and is sutured to the surrounding tissue. 

An additional mesh patch is applied and may or may not be sutured. Mesh is often used for large hernia repairs and may reduce the risk that the hernia will come back. The site is closed using sutures, staples, or surgical glue. 

For a suture-only repair: The hernia sac is removed. Then the tissue along the muscle edge is sewn together. This procedure is often used for strangulated or infected hernias or small defects (less than 3 cm)

Laparoscopic Hernia Repair 

The surgeon will make several small punctures or incisions in the abdomen. Ports (hollow tubes) are inserted into the openings. The abdomen is inflated with carbon dioxide gas
to make it easier to see the internal organs. Surgical tools and a laparoscopic light are placed into the ports. The hernia is repaired with mesh and sutured or stapled in place. The repair is done as a Transabdominal Preperitoneal (TAPP) procedure, which means the peritoneum (the sac that contains all of the abdominal organs) is entered, or the repair is done as a Totally Extraperitoneal (TEP) procedure. 

Nonsurgical Treatment 

Watchful waiting is an option if you have an inguinal hernia with no symptoms. Hernia incarceration occurred in 1.8 per 1,000 men who waited longer than 2 years to have a repair. Femoral hernias should always be repaired because of the high risk (400 of 1,000) of incarceration and bowel strangulation within 2 years of diagnosis. Trusses or belts can help manage the symptoms of a hernia by applying pressure at the site. A truss requires correct fitting and complications include testicular nerve damage and incarceration may result 

 

Preparing for Your Operation 

Home Medication 

Bring a list of all of the medications, vitamins, and any over-the-counter medicines that you are taking. Your medications may have to be adjusted before your operation. Some medications can affect your recovery and response to anesthesia. Most often, you will take your morning medication with a sip of water. 

Anesthesia 

Let your anesthesia provider know if you have allergies, neurologic disease (epilepsy, stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), or loose teeth; use alcohol or drugs; take any herbs or vitamins; or if you have a history of nausea and vomiting with anesthesia. 

If you smoke, you should let your surgical team know, and you should plan to quit. Quitting before your surgery can decrease your rate of respiratory and wound complications. 

The Day of Your Operation 

• Do not eat or drink for at least 6 hours before your operation. 
• Shower and clean your abdomen and groin area with a mild antibacterial soap. 
• Brush your teeth and rinse your mouth out with mouthwash. 
• Do not shave the surgical site; your surgical team will clip the hair nearest the incision site. 

What to Bring 

• Insurance card and identification 
• List of medicines 
• Loose-fitting, comfortable clothes 
• Slip-on shoes that don’t require that you bend over 
• Leave jewelry and valuables at home 

 

After Your Operation 

You will be moved to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be closely watched. Be sure that all visitors wash their hands. 

Preventing Pneumonia and Blood Clots 

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. 

When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and, for high-risk patients, taking a medication that thins your blood. 

Your Recovery 

Thinking Clearly 

If general anesthesia is given or if you are taking narcotics for pain, it may cause you to feel different for 2 or 3 days. You may have trouble remembering and feel tired. You should not drive, drink alcohol, or make any big decisions for at least 2 days. 

Nutrition 

• When you wake up from the anesthesia, you will be able to drink small amounts of liquid. If you do not feel sick, you can begin eating regular foods. 
• Continue to drink about 8 to 10 glasses of water each day. 
• Eat a high-fiber diet so you don’t strain while having a bowel movement. 

Activity 

• Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clot formation. 
• Patients usually take 2 to 3 weeks to return comfortably to normal activity.7 
• You may go home the same day after a simple repair. If you have other health conditions or complications such as nausea, vomiting, bleeding, or difficulty passing urine, you may stay longer. 
• Persons sexually active before the operation reported being able to return to sexual activity in 14 days (average). 

Work 

• You may return to work after 1 to 2 weeks after laparoscopic or open repair, as
  long as you don’t do any heavy lifting. Discuss the timing with your surgeon. 
• Do not lift items heavier than 10 pounds or participate in strenuous activity for at least 4 to 6 weeks. 
• Lifting limitation may last for 6 months after complex or recurrent hernia repairs 

Wound Care 

• Always wash your hands before and after touching near your incision site. 
• Do not soak in a bathtub until your stitches, Steri-Strips, or staples are removed.
  You may take a shower after the second postoperative day unless you are told not to. 
• Follow your surgeon’s instructions on when to change your bandages. 
• A small amount of drainage from the incision is normal. If the dressing is soaked with blood, call your surgeon. 
• If you have Steri-Strips in place, they will fall off in 7 to 10 days. 
• If you have a glue-like covering over the incision, just allow the glue to flake off on its own. 
• Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for them to heal. 
• Protect the new skin, especially from the sun. The sun can burn and cause darker scarring. 
• Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year. 

Bowel Movements 

Avoid straining with bowel movements by increasing the fiber in your diet with high- fiber foods or over-the-counter medicines. Be sure you are drinking 8 to 10 glasses of water each day. 

 

When to Contact Your Surgeon 

Contact your surgeon if you have: 

• Pain that will not go away 
• Pain that gets worse 
• A fever of more than 101°F or 38.3°C 
• Continuous vomiting 
• Swelling, redness, bleeding, or bad-smelling drainage from your wound site 
• Strong or continuous abdominal pain or swelling of your abdomen 
• No bowel movement by 2 to 3 days after the operation 

 

 

 

What Is a Mastectomy?

A mastectomy is a way to treat breast cancer by surgically removing a breast and sometimes nearby tissues. For a while, the standard treatment for breast cancer was a radical mastectomy, with total removal of the breast, lymph nodes in the underarm, and some chest muscles under the breast. But surgical advances have given people more options than ever. Less-invasive breast-conserving treatments are available to many women.

The type of mastectomy that’s best for you depends on several things, including your:

• Age
• General health
• Menopause status
• Tumor size
• Tumor stage (how far it’s spread)
• Tumor grade (its aggressiveness)
• Tumor’s hormone receptor status
• Lymph nodes and whether they’re involved

What Is a Partial Mastectomy?

Women with stage I or stage II breast cancer may have this procedure. It’s a breast-conserving method in which the doctor removes only the tumor and the tissue around it.

The surgery is often followed by 6 to 8 weeks of radiation therapy, with powerful X-rays that target the breast tissue. The radiation kills cancer cells and prevents them from spreading or coming back.

There are two kinds:

• A lumpectomy removes the tumor and a small area of normal tissue surrounding the tumor.
• A quadrantectomy removes the tumor and more of the breast tissue than a lumpectomy.

In some cases, you may need more surgery after a partial mastectomy . Sometimes, if cancer cells are still in breast tissue, your doctor may have to remove the entire breast.

What Is a Radical Mastectomy?

A less traumatic and more common procedure is the modified radical mastectomy (MRM). The doctor removes your breast, including the skin, breast tissue, areola, and nipple, and most of the lymph nodes under the arm. The lining over the large muscle in the chest is also removed, but the muscle itself is left in place. This way, you aren’t left with a hollow in your chest as with a radical mastectomy.

You might get breast reconstruction afterward.

Depending on the size of your tumor and whether the cancer has spread to your lymph nodes, your doctor might recommend that you have radiation after your surgery.

What Is a Skin-Sparing Mastectomy?

The doctor removes breast tissue, the nipple, and the areola but saves most of the skin over the breast. It’s used only when breast reconstruction follows immediately after a mastectomy. It may not be a good choice if your tumors are large or near the skin’s surface.

What Is a Nipple-Sparing Mastectomy?

You might also hear it called a total skin-sparing mastectomy. The doctor removes all the breast tissue, including the ducts going all the way up to the nipple and areola. But they save the skin of the nipple and areola and cut out tissues under and around them. If these areas are cancer-free, they can be saved. This method also calls for reconstruction right after the mastectomy.

Before the procedure

Your doctor or nurse will tell you when to arrive at the hospital. A mastectomy without reconstruction usually takes one to three hours. The surgery is often done as an outpatient procedure, and most people go home on the same day of the operation.

If you’re having both breasts removed (a double mastectomy), expect to spend more time in surgery and possibly an additional day in the hospital. If you’re having breast reconstruction following a mastectomy, the procedure also takes longer, and you may stay in the hospital for a few additional days.

If you’re having a sentinel node biopsy, before your surgery a radioactive tracer and a blue dye are injected into the area around the tumor or the skin above the tumor. The tracer and the dye travel to the sentinel node or nodes, allowing your doctor to see where they are and remove them during surgery.

After a Mastectomy

• Lymph nodes that were removed will be sent to a lab to see whether the cancer  has spread to them.
• You’ll go to a recovery room where staff can keep an eye on your heart rate, body temperature, and blood pressure.
• After you wake up, you’ll be admitted to a hospital room. You’ll probably stay for 1 or 2 days, though it might be longer if you had reconstruction.
• Someone from your health care team will talk to you about:
  • • Medications. Your doctor will prescribe medication for any pain you feel after surgery. After a week or two, you can usually treat your discomfort with over-the-counter pain relievers.
    • How to care for:
      • • • • The incision. The bandage will probably stay in until your first follow-up visit.
            • Drains. Sometimes, they come out before you leave the hospital, but they might stay in for up to 3 weeks.
            • Stitches. Yours will probably dissolve on their own, but non-dissolving types and staples will be removed at your follow-up visit.

• • • Exercises. They’ll help prevent stiffness on the side where you had surgery. You’ll probably start the morning after surgery.
    • When you can wear a prosthesis or bra. Your surgery site needs to heal first. You’ll find out how long you have to wait.

 

Mastectomy Risks

A mastectomy is generally safe and effective, but like all surgical procedures, it can have risks.

They include:

• Bleeding
• Infection
• Swelling of the arm (lymphedema)
• Pockets of fluid under the incision (seromas)
• Risks from general anesthesia

Some people have numbness in the upper arm after surgery. It’s caused by damage to small nerves in the area where the lymph nodes are taken out. There’s a good chance that you’ll regain most of the feeling in your arm over time.

Tips for Mastectomy Recovery

Once you are home, make sure you follow the plan your doctor gave you. Also make sure that you:

• Rest: Get plenty of it the first few weeks after surgery. It takes a lot out of you.
• Take your meds: Don’t tough it out. Take the medication as prescribed. You’ll probably feel a mix of pain and numbness.
• Keep the site dry: Take sponge baths only (no tub baths or showers) until your drains and stitches are out.
• Do your exercises: They’ll keep your arm from getting stiff.
• Ask for help: Don’t be shy. It takes time to get better. Get all the help you can with meal prep, shopping, housework, childcare, pet care, rides to doctors’ appointments, and whatever else you aren’t ready to take on by yourself.

Results

The results of your pathology report should be available within a week or two after your mastectomy. At your follow-up visit, your doctor can explain the report.

If you need more treatment, your doctor may refer you to:

• A radiation oncologist to discuss radiation treatments, which may be recommended if you had a large tumor, many lymph nodes that tested positive for cancer, cancer that had spread into the skin or nipple, or cancer remaining after the mastectomy
• A medical oncologist to discuss other forms of treatment after the operation, such as hormone therapy if your cancer is sensitive to hormones or chemotherapy or both
• A plastic surgeon, if you’re considering breast reconstruction
• A counselor or support group to help you cope with having breast cancer

 

 

The Condition

A ventral hernia is a bulge through an opening in the muscles on the abdomen. If the hernia reduces in size when a person is lying flat or in response to manual pressure, it is reducible. If it cannot 

be reduced, it is irreducible or incarcerated, and a portion of the intestine may be bulging through the hernia sac. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. This is a surgical emergency.

A primary abdominal hernia occurs spontaneously at an area of natural weakness of the abdominal muscle. 

An incisional hernia bulges through a past incision site. This issue can be the result of scar tissue or weak muscles around the site. 

An epigastric hernia bulges midline above the umbilicus. 

Symptoms 

The most common symptoms of a hernia are: 

• Visible bulge in the abdominal wall, especially with coughing or straining 
• Hernia site pain or pressure 

Sharp abdominal pain and vomiting may mean that the intestine has slipped through the hernia sac and is strangulated. This is a surgical emergency and immediate treatment is needed. 

Surgical Treatment 

The type of operation depends on the hernia size, location, and if it is a repeat hernia. Your health, age, anesthesia risk, and the surgeon’s expertise are also important. An operation is the only treatment for a hernia repair. 

Open Hernia Repair 

The surgeon makes an incision near the hernia site. The bulging tissue is gently pushed back into the abdomen. Sutures, mesh, or a tissue flap is used to close the muscle. With complex or large hernias, small drains may be placed going from inside to the outside of the abdomen. The site is closed using sutures, staples, or surgical glue. 

Open Mesh Repair 

The hernia sac is removed. Mesh is placed over the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia site. Mesh is often used for large hernia repairs and may reduce the risk that the hernia will come back. The site is closed using sutures, staples, or surgical glue. 

Laparoscopic Hernia Repair 

The surgeon will make several small punctures or incisions in the abdomen. Ports or trocars (hollow tubes) are inserted into the openings. Surgical tools are placed into the ports. The abdomen is inflated with carbon dioxide gas to make it easier for the surgeon to see the hernia. Mesh is sutured, stapled, or clipped to the muscle around the hernia site. The hernia site can also be sewn directly together. 

What You Can Expect 

Home Medication 

Bring a list of all of the medications, vitamins, and any over-the-counter medicines that you are taking. Your medications may have to be adjusted before your operation. Some medications can affect your recovery and response to anesthesia. Most often you will take your morning medication with a sip of water. 

Anesthesia 

Let your anesthesia provider know if you have allergies, neurologic disease (epilepsy, stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), or loose teeth; use alcohol or drugs; take any herbs or vitamins; or if you have a history of nausea and vomiting with anesthesia. 

If you smoke, you should let your surgical team know, and you should plan to quit. Quitting before your surgery can decrease your rate of respiratory and wound complications and increase your chances of staying smoke-free for life. 

The Day of Your Operation 

• You should not eat or drink for at least 6 hours before the operation. 
• You should bathe or shower and clean your abdomen with a mild antibacterial soap. 
• You should brush your teeth and rinse your mouth with mouthwash. 
• Do not shave the surgical site; the surgical team will clip the hair near the incision site. 
• Let the surgical team know if you are not feeling well or if there have been any changes in your health since last seeing your surgeon. 

What to Bring 

• Insurance card and identification 
• List of medicines 
• Loose-fitting, comfortable clothes 
• Slip-on shoes that don’t require that you bend over 

After Your Operation 

Preventing Pneumonia and Blood Clots 

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour, take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. 

When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and for high-risk patients, taking a medication that thins your blood 

Your Recovery and Discharge 

Thinking Clearly 

If general anesthesia is given or if you need to take narcotics for pain, it may cause you to feel different for 2 or 3 days, have difficulty with memory, or feel more fatigued. You should not drive, drink alcohol, or make any big decisions for at least 2 days. 

Nutrition 

• When you wake up from the anesthesia, you will be able to drink small amounts of liquid. If you do not feel sick, you can begin eating regular foods. 
• Continue to drink about 8 to 10 glasses of water each day. 
• Eat a high-fiber diet so you don’t strain while having a bowel movement. 

Activity 

• Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clot formation. 
• You may go home the same day for a simple repair. If you have other health conditions or complications such as nausea, vomiting, bleeding, or infection after surgery, you may stay longer. 
• Do not lift items heavier than 10 pounds or participate in strenuous activity for at least 6 weeks. 

Work 

• After recovery, you can usually return to work  within 2 to 3 days. 
• You will not be able to lift anything over 10 pounds, climb, or do strenuous activity for 4 to 6 weeks following surgical repair of a ventral hernia. 
• Lifting limitation may last for 6 months for complex or recurrent repairs

Wound Care  

• Always wash your hands before and after touching near your incision site. 
• Do not soak in a bathtub until your stitches, Steri-Strips, or staples are removed.
  You may take a shower after the second postoperative day unless you are told not to. 
• Follow your surgeon’s instructions on when to change your bandages. 
• A small amount of drainage from the incision is normal. If the dressing is soaked with blood, call your surgeon. 
• If you have Steri-Strips in place, they will fall off in 7 to 10 days. 
• If you have a glue-like covering over the incision, let the glue to flake off on its own. 
• Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for them to heal. 
• Protect the new skin, especially from the sun. The sun can burn and cause darker scarring. 
• Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year. 

Pain 

The amount of pain is different for each person. The new medicine you will need after your operation is for pain control, and your doctor will advise how much you should take. You can use throat lozenges if you have sore throat pain from the tube placed in your throat during your anesthesia. 

Bowel Movements 

Avoid straining with bowel movements by increasing the fiber in your diet with high- fiber foods or over-the-counter medicines. Be sure you are drinking 8 to 10 glasses of water each day. 

When to Contact Your Surgeon 

Contact your surgeon if you have: 

• Pain that will not go away 
• Pain that gets worse 
• A fever of more than 101°F (38.3°C) 
• Repeated vomiting 
• Swelling, redness, bleeding, or foul- smelling drainage from your wound site 
• Strong or continuous abdominal pain or swelling of your abdomen 
• No bowel movement by 3 days after the operation 

 

What is a colectomy?

A Colectomy is the Surgical Removal of the Colon

Preparing for Your Operation 

Home Medication 

Bring a list of all of the medications, vitamins, and nutritional supplements that you are taking. Your medication may have to be adjusted before your operation. Some medications can affect your recovery, blood clotting, and response to the anesthesia. Most often you will take your morning medication with a sip of water. 

Anesthesia 

Let your anesthesia provider know if you have allergies, neurologic disease (epilepsy, stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), or loose teeth; if you smoke, drink alcohol, use drugs, or take any herbs or vitamins; or if you have a history of nausea and vomiting with anesthesia. 

If you smoke, you should let your surgical team know. You should plan to quit. Quitting before your surgery can decrease your rate of respiratory and wound complications and increase your chances of staying smoke-free for life. 

Length of Stay 

You may stay in the hospital for about 4 nights after an open colectomy.  You may have a catheter in place in your bladder to measure and drain your urine
for a few days. Severe nausea, vomiting, or the inability to pass urine may result in a longer stay. 

The Day of Your Operation 

• Do not eat for 4 hours or drink anything but clear liquids for at least 2 hours before the operation. 
• Shower and clean your abdomen and groin area with a mild antibacterial soap. 
• Brush your teeth and rinse your mouth out with mouthwash. 
• Do not shave the surgical site; your surgical team will clip the hair nearest the incision site. 

What to Bring 

• Insurance card and identification 
•  List of medicines 
• Loose-fitting, comfortable clothes 
• Slip-on shoes that don’t require you to bend over 
• Leave jewelry and valuables at home 

 

Fluids and Anesthesia 

An intravenous line (IV) will be started to give your fluids and medication. For general anesthesia, you will be asleep and pain-free. A tube will be placed down your throat to help you breathe during the operation. 

After Your Operation 

You will be moved to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be closely watched. Be sure that all visitors wash their hands. 

Preventing Pneumonia and Blood Clots 

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour, take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. 

When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and, for high-risk patients, taking a medication that thins your blood. 

Your Recovery 

If general anesthesia is given or if you need to take narcotics for pain, it may cause you to feel different for 2 or 3 days, have difficulty with memory, or feel more tired. You should not drive, drink alcohol, or make any big decisions for at least 2 days. 

Nutrition 

If you follow an enhanced recovery protocol, the aim is to return to a normal diet as soon as possible. Right after surgery, you will be able to drink water and be provided with anti-nausea medication if you need it. On postoperative day 1, you can eat a normal diet. IV fluids will continue for 1 to 2 days after the surgery. For up to 4 weeks, a low-residue/low-fiber diet
is recommended to reduce the amount and frequency of stools. This reduces trauma to the healing intestinal reconnection.  Continue to drink about 8 to 10 glasses of fluid per day. 

Activity 

• After surgery, you will sit in a chair. The next day, you should be up and walking the hallway. Your pain should be managed with pain medication. Get up and walk every hour or so to prevent blood clot formation. 
• You may be able to resume most normal activities in 1 or 2 weeks. These activities include showering, driving, walking up stairs, working, and engaging  in sexual activity.

Work 

• You may return to work after you feel healthy, usually 2 to 3 weeks for open procedures. 
• You will not be able to lift anything over 10 pounds, climb, or do strenuous activity for 4 to 6 weeks following surgery 

Wound Care 

• Always wash your hands before and after touching near your incision site. 
• Do not soak in a bathtub until your stitches, Steri-Strips, or staples are removed. You can usually shower within 2 days unless you are told not to. 
• A small amount of drainage from the incision is normal. If the dressing is soaked with blood, call your surgeon. 
• If you have Steri-Strips in place, they will fall off in 7 to 10 days. 
• If you have a glue-like covering over the incision, allow the glue to flake off on its own. 
• Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for them to heal. 
• Protect your new skin, especially from sun. The sun can burn and cause darker scarring. 
• Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year. 

Bowel Movements 

In the first 2 weeks, your bowel movements may be more frequent and looser than usual until you fully resume eating solid food. Avoid straining with bowel movements. Be sure you are drinking 8 to 10 glasses of fluid each day. 

Pain 

The amount of pain is different for each person. The new medicine you will need after your operation is for pain control, and your doctor will advise how much you should take. You can use throat lozenges if you have sore throat pain from the tube placed in your throat during your anesthesia. 

When to Contact Your Surgeon 

Contact your surgeon if you have: 

• Pain that will not go away 
• Pain that gets worse 
• A fever of more than 101°F (38.3°C) 
• Repeated vomiting 
• Swelling, redness, bleeding, or bad- smelling drainage from your wound site 
• Strong or continuous abdominal pain or swelling of your abdomen 
•  No bowel movement 2 to 3 days after the operation 

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If You Have a Stoma 

If you have a stoma constructed, your stool will pass through it into a special pouch that is attached to the skin around the stoma. The pouch will have an opening at the end for the stool to drain through. It will need to be changed daily. Before you leave the hospital, you will be shown how to care for your stoma and supplies. Some stomas may be temporary and closed at a later date, while others may be permanent, depending on your diagnosis and surgery. 

You can learn more about how to care for your stoma by reviewing the American College of Surgeons Ostomy Home Skills Kit available online at facs.org/adultostomy. You will continue to have support in the care of your stoma once you’re home and caring for it will become part of your routine if it is permanent. 

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The Condition 

A colectomy is the removal of a section of the large intestine (colon) or bowel. This operation is done to treat diseases of the bowel, including Crohn’s disease and ulcerative colitis, and colon cancer. 

Common Symptoms 

• Symptoms may include diarrhea, constipation, abdominal cramps, nausea, fever, chills, weakness, or loss of appetite and/or weight loss, or bleeding. 
• There may be no symptoms. This is why screening is essential.

Treatment Options 

Surgical Procedure 

• Open colectomy An incision is made in the abdomen and the section of the diseased colon is removed. The two divided ends of the colon are sutured (sewn) or stapled together in an anastomosis. If the colon cannot be sewn back together, it is brought up through the abdomen to form a colostomy. 
• Laparoscopic colectomy A light, camera, and instruments are inserted through small holes in the abdomen to remove the diseased colon or tumor. 

Nonsurgical Procedure 

• Some diseases of the colon are treated with antibiotics, steroids, or drugs
  that affect the immune system. 

Benefits and Risks of Your Operation 

Benefits 

Removal of diseased or cancerous sections of the intestine will relieve your symptoms and can reduce your risk of dying from cancer. 

Possible surgical risks include 

Temporary problems with the intestine that may require a stoma; leakage from the colon into the abdomen; lung problems including pneumonia; infection of the wound, blood, or urinary system; blood clots in the veins or lung; bleeding; fistula; or death. 

Risk of not having an operation Your symptoms may continue or worsen, and your disease or cancer may spread. 

Expectations 

Before your operation  

Evaluation may include a colonoscopy, blood work, urinalysis, chest X-ray, or CAT Scan (CT) of the abdomen. Your surgeon and anesthesia provider will discuss your health history, home medications, and postoperative pain control options. 

The day of your operation

You will not eat for 4 hours but may drink clear liquids up to 2 hours before the operation. Medication to clean out your intestines and an antibiotic may be started the day before. Most often you will take your normal medication with a sip of water. 

Your recovery  

The average length of stay is 3 to 4 days for a laparoscopic or open colectomy. The time from your first bowel movement to eating normally is also about 3 to 4 days. 

Call your surgeon 

If you have continued nausea, vomiting, leakage from the wound, blood in the stool, severe pain, stomach cramping, chills, or a high fever (over 101°F or 38.3°C), odor or increased drainage from your incision, a swollen abdomen or no bowel movements for 3 days. 

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The Condition 

There are different types of conditions and diseases that may affect the intestines: 

• Inflammatory bowel diseases include ulcerative colitis and Crohn’s disease. 
• Ulcerative colitis presents as ulcers (tiny open sores) in the inner layer of the colon and includes bloody diarrhea and abdominal pain.3 
• Crohn’s disease is the inflammation of the entire lining of the digestive tract, with 15% of cases in the colon only.4 This usually presents with continual diarrhea and abdominal pain.5 
• Diverticulitis is an inflammation or infection of small, bulging pouches (diverticula) located in the colon. 
• Colorectal polyp is any growth on the lining of the colon or rectum. 
• Colorectal cancer is a malignant (cancerous) tumor in the colon or rectum. 

 

The Procedure 

There are different procedures to treat diseases of the bowel and intestines: 

• A colectomy is an operation to remove a part of the intestine (bowel) that is diseased. The name of the procedure depends on what section of the intestine is removed. 
• Right hemicolectomy is the removal of the ascending (right) colon. 
• Left hemicolectomy is the removal of the descending (left) colon. 
• Sigmoidectomy is the removal of the lower part of the colon which is connected to the rectum. 
• Low anterior resection is the removal of the upper part of the rectum. 
• Segmental resection is the removal of only a short piece of the colon. 
• Abdominal perineal resection is the removal of the sigmoid colon, rectum and anus and construction of a permanent colostomy. 
• Total colectomy is when the entire colon is removed and the small intestine is connected to the rectum 
• Total proctocolectomy is the removal of the rectum and all or part of the colon 
• Symptoms 
• The most common symptoms are: 
• Diarrhea, constipation, abdominal cramps, nausea, loss of appetite, or weight loss 
• Fever, chills, or weakness 

Surgical Treatment 

A colectomy can be done by open or laparoscopic repair. The type of operation will depend on the condition, size of the diseased area or tumor, and location. Your health, age, anesthesia risk, and the surgeon’s expertise are also important. 

Open Colectomy 

An incision is made in the abdomen and the diseased section of the colon is removed. The healthy parts of the colon are then stitched or stapled together (anastomosis). If the colon cannot be sutured back together, the colon is brought up through an opening on the abdominal wall (stoma) to form an ostomy. Waste will empty through the ostomy into a pouch that is fixed around the stoma on the abdomen. 

*We provide procedure education for prospective patients and those who educate them. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. The American College of Surgeons (ACS) makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard. 

 

Is the surgical removal of the gallbladder. The operation is done to remove the gallbladder due to gallstones causing pain or infection. 

The Gallbladder 

The gallbladder is a small pear-shaped organ under the liver. The liver makes about 3 to 5 cups of bile every day. Bile helps in digesting fats and is stored in the gallbladder. When fatty foods are eaten, the gallbladder squeezes bile out through the duct and into the small intestine. 

Gallstones are hardened digestive fluid that can form in your gallbladder. The medical term for gallstone formation is cholelithiasis. Gallstones can leave the gallbladder and block the flow of bile to the ducts and cause pain and swelling of the gallbladder. A gallstone in the common bile duct is called choledocholithiasis. 

Cholecystitis is inflammation of the gallbladder, which can happen suddenly (acute) or over a longer period of time (chronic). 

Gallstone Pancreatitis is caused by stones moving into and blocking the common bile duct, the pancreatic duct, or both. A cholecystectomy may be recommended.1 

Cholecystectomy is the surgical removal of the gallbladder. Gallstones that cause biliary colic (acute pain in the abdomen caused by spasm or blockage of the cystic or bile duct) are the most common reason for a cholecystectomy 

Common Symptoms 

• Sharp pain in the upper right part of the abdomen that may go to the back, mid abdomen, or right shoulder 
• Low fever 
• Nausea and feeling bloated 
• Jaundice (yellowing of the skin) if stones are blocking the common bile duct1 

Treatment Options 

Surgical Procedure

Laparoscopic cholecystectomy: The gallbladder is removed with instruments placed into small incisions in the abdomen. 

Open cholecystectomy: The gallbladder is removed through an incision on the right side under the rib cage. 

Common Tests 

• Abdominal ultrasound is the most common study for gallbladder disease.1-2 You may be asked not to eat for 8 hours before the test. 
• Hepatobiliary iminodiacetic acid scan (HIDA scan) 
• Endoscopic retrograde cholangiopancreatography (ERCP) 
• Magnetic resonance cholangiopancreatography (MRCP) 
• Blood tests, including complete blood count
• Liver function tests
• Coagulation profile 

Laparoscopic Cholecystectomy 

This technique is the most common for simple cholecystectomy. The surgeon will make several small incisions in the abdomen. Ports (hollow tubes) are inserted into the openings. Surgical tools and a lighted camera are placed into the ports. The abdomen is inflated with carbon dioxide gas to make it easier to see the internal organs. The gallbladder is removed, and the port openings are closed with sutures, surgical clips, or glue. Your surgeon may start with a laparoscopic technique and need to change (convert) to an open laparotomy technique. The procedure takes about 1 to 2 hours. 

Open Cholecystectomy 

The surgeon makes an incision approximately 6 inches long in the upper right side of the abdomen and cuts through the fat and muscle to the gallbladder. The gallbladder is removed, and any ducts are clamped off. The site is stapled or sutured closed. A small drain may be placed going from the inside to the outside of the abdomen. The drain is usually removed in the hospital. The procedure takes about 1 to 2 hours 

Anesthesia 

Let your anesthesia provider know if you have allergies, neurologic disease (epilepsy, stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), or loose teeth; if you smoke, drink alcohol, use drugs, or take any herbs or vitamins; or if you have a history of nausea and vomiting with anesthesia. 

If you smoke, you should let your surgical team know, and you should plan to quit. Quitting before your surgery can decrease your rate of respiratory and wound complications and increase your chances of staying smoke-free for life. 

An intravenous line (IV) will be started
to give your fluids and medication. For general anesthesia, you will be asleep
and pain-free. 

Length of Stay 

If you have a laparoscopic cholecystectomy, you will usually go home the same day. You may stay overnight if you had an open removal of the gallbladder.

The Day of Your Operation 

• Do not eat for 12 hours or drink anything but clear liquids for at least 4 hours before the operation. 
• Shower and clean your abdomen and groin area with a mild antibacterial soap. 
• Brush your teeth and rinse your mouth out with mouthwash. 
• Do not shave the surgical site; your surgical team will clip the hair nearest the incision site. 

What to Bring 

• Insurance card and identification  
• List of medicines 
• Loose-fitting, comfortable clothes 
• Slip-on shoes that don’t require that you bend over 
• Leave jewelry and valuables at home 

Home Medication 

Bring a list of all of the medications and vitamins that you are taking, including blood thinners, aspirin, or NSAIDS, and inform your surgical team. Some medications can affect your recovery and response to anesthesia and may have to be adjusted before and after surgery. 

After surgery

Pain 

The amount of pain is different for each person. The new medicine you will need after your operation is for pain control, and your doctor will advise how much you should take. You can use throat lozenges if you have sore throat from the tube placed in your throat during your anesthesia. 

Preventing Pneumonia and Blood Clots 

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour, take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. 

When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and, for high-risk patients, taking a medication that thins your blood. 

Your Recovery 

If general anesthesia is given or if you are taking narcotic pain medication, it may cause you to feel different for 2 or 3 days, have difficulty with memory, or feel more fatigued. You should not drive, drink alcohol, or make any big decisions for at least 2 days. 

Wound Care 

• Always wash your hands before and after touching near your incision site.
• Do not soak in a bathtub until your stitches, Steri-Strips®, or staples are removed.
  You may take a shower after the second postoperative day unless you are told not to. 
• Follow your surgeon’s instructions on when to change your bandages. 
• A small amount of drainage from the incision is normal. If the dressing is soaked with blood, call your surgeon. 
• If you have Steri-Strips in place, they will fall off in 7 to 10 days. 
• If you have a glue-like covering over the incision, just let the glue to flake off on its own. 
• Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for them to heal. 
• Your scars will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year. 

Bowel Movements 

• Anesthesia, decreased activity, and pain medication (narcotics) can contribute to constipation. Avoid straining with bowel movements by increasing the fiber in your diet with high-fiber foods or over-the-counter medicines (like Metamucil® and FiberCon®).
  Be sure you are drinking 8 to 10 glasses of fluid each day. Your surgeon may prescribe a stool softener if necessary. 

Nutrition 

• When you wake up from the anesthesia, you will be able to drink small amounts of liquid. If you do not feel sick, you can begin eating regular foods. 
• Continue to drink about 8 to 10 glasses of water per day. 
• Eat a high-fiber diet so you don’t strain while having a bowel movement. 

Activity 

• Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clot formation. 
• Patients usually take 1 to 3 weeks to return comfortably to normal activity.16 
• You may go home the same day after a laparoscopic repair. If you have other health conditions or complications such as nausea, vomiting, bleeding, or difficulty passing urine, you may stay longer. 
• Persons sexually active before the operation reported being able to return to sexual activity in 14 days (average). 

WORK

You may usually return to work 1 week after laparoscopic or open repair, as long as you don’t do any heavy lifting. Discuss the timing with your surgeon. 

Do not lift items heavier than 10 pounds or participate in strenuous activity for at least 4 to 6 weeks. 

When to Contact Your Surgeon 

Contact your surgeon if you have: 

• Pain that will not go away 
• Pain that gets worse 
• A fever of more than 101°F or 38.3°C 
• Continuous vomiting 
• Swelling, redness, bleeding, or bad-smelling drainage from your wound site 
• Strong or continuous abdominal pain or swelling of your abdomen 
• No bowel movement 2 to 3 days after the operation 

 

The Condition 

Appendectomy is the surgical removal of the appendix. The operation is done to remove an infected appendix. An infected appendix, called appendicitis, can burst and release bacteria and stool into the abdomen. 

The Appendix 

The appendix is a small pouch that hangs from the large intestine where the small and large intestine join. If the appendix becomes blocked and swollen, bacteria can grow in the pouch. The blocked opening can be from an illness, thick mucus, hard stool, or a tumor. 

Appendicitis 

Appendicitis is an infection of the appendix. The infection and swelling can decrease the blood supply to the wall of the appendix. This leads to tissue death, and the appendix can rupture or burst, causing bacteria and stool to release into the abdomen. This is called  a ruptured appendix.  A ruptured appendix can lead to peritonitis, which is an infection of your entire abdomen. Appendicitis most often affects people between the ages of 10 and 30 years old. It is a common reason for an operation in children, and it is the most common surgical emergency in pregnancy. 

Appendectomy 

An Appendectomy is the surgical removal of the appendix. 

Symptoms 

• Stomach pain that usually starts around the navel and then moves to the lower right side of the abdomen 
• Loss of appetite
• Low fever, usually below 100.3°F
• Nausea and sometimes vomiting
• Diarrhea or constipation 

Treatment Options 

Laparoscopic appendectomy

The appendix is removed with instruments placed into small abdominal incisions. 

Open appendectomy

The appendix is removed through an incision in the lower right abdomen. 

Benefits and Risks 

An appendectomy will remove the infected organ and relieve pain. Once the appendix is removed, appendicitis will not happen again. The risk of not having surgery is the appendix can burst, resulting in an abdominal infection called peritonitis. 

Possible complications include abscess, infection of the wound or abdomen, intestinal blockage, hernia at the incision, pneumonia, risk of premature delivery (if you are pregnant), and death. 

Expectations 

Before your operation

Evaluation usually includes blood work, urinalysis, and an abdominal CT scan, or abdominal ultrasound. Your surgeon and anesthesia provider will review your health history, medications, and options for pain control. 

The day of your operation

You will not be allowed to eat or drink while you are being evaluated for an emergency appendectomy. 

Your recovery

If you have no complications, you usually can go home 1 day after a laparoscopic or open procedure. 

Surgical Treatment 

Acute appendicitis is an urgent problem requiring surgical consultation. 

Laparoscopic Appendectomy 

This technique is the most common for simple appendicitis. The surgeon will make 1 to 3 small incisions in the abdomen.
A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see the appendix more easily.
A laparoscope is inserted through another port. It looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to remove the appendix. The area is washed with sterile fluid to decrease the risk of further infection.
The carbon dioxide comes out through the slits, and then the slits are closed with sutures or staples or covered with glue-like bandage or Steri-Strips. Your surgeon may start with a laparoscopic  technique and need to change to an open technique. This change is done for your safety. 

Open Appendectomy 

The surgeon makes an incision about 2 to 4 inches long in the lower right side of the abdomen. The appendix is removed from the intestine. The area is washed with sterile fluid to decrease the risk of further infection. A small drainage tube may be placed going from the inside to the outside of the abdomen. The drain is usually removed in the hospital. The wound is closed with absorbable sutures and covered with glue-like bandage or Steri-Strips. 

Preparing for Your Operation 

Home Medication 

Appendectomy is usually an emergency procedure. You can help prepare for your operation by telling your surgeon about other medical problems and medications that you are taking. 

Be sure to tell your surgeon if you are taking blood thinners (Plavix, Coumadin, aspirin). 

Anesthesia 

You will meet with your anesthesia provider before the operation. Let him or her know if you have allergies, neurologic disease (epilepsy or stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), loose teeth, or if you smoke, drink alcohol, use drugs, or take any herbs or vitamins. Let your surgical team know if you smoke and plan to quit. Quitting decreases your complication rate. 

Length of Stay 

Your hospital stay may be longer for a ruptured appendix, if you have severe vomiting, or are unable to pass urine. 

Don’t Eat or Drink 

You will not be allowed to eat or drink while you are being evaluated for appendectomy. Not eating or drinking reduces your risk of complications from anesthesia. 

What to Bring 

• Insurance card and identification
•  List of medicines
• Loose-fitting, comfortable clothes
•  Slip-on shoes that don’t require you to bend over
• Leave jewelry and valuables at home 

Fluids and Anesthesia 

An intravenous line (IV) will be started to give you fluids and medication. For general anesthesia, you will be asleep and pain free during the operation. A tube may be placed down your throat to help you breathe during the operation 

After Your Operation 

You will be moved to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be closely watched. Be sure that all visitors wash their hands. 

Preventing Pneumonia and Blood Clots 

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour takes 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and for high-risk patients, taking a medication that thins your blood. 

Your Recovery

 Thinking Clearly

The anesthesia may cause you to feel different for 1 or 2 days. Do not drive, drink alcohol, or make any big decisions for at least 2 days. 

Nutrition 

• When you wake up, you will be able to drink small amounts of liquid. If you do not feel sick, you can begin eating regular foods. 
• Continue to drink lots of fluids, usually about 8 to 10 glasses per day. 
• Eat a high-fiber diet so you don’t strain during bowel movements. 

Activity 

• Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clots. 
• Do not lift or participate in strenuous activity for 3 to 5 days for laparoscopic and 10 to 14 days for open procedure. 
• You may go home in 1 day. If your appendix ruptured or you have other health issues or complications, you may stay longer. 
• It is normal to feel tired. You may need more sleep than usual. 

Work 

You can go back to work when you feel well enough. Discuss the timing with your surgeon. 

Children can usually go to school 1 week or less after an operation for an unruptured appendix and up to 2 weeks after a ruptured appendix. 

Most children will not return to gym class, sports, and climbing games for 2 to 4 weeks after the operation. 

Wound Care 

• Always wash your hands before and after touching near your incision site. 
• Do not soak in a bathtub until your stitches or Steri-Strips are removed. You may take a shower after the second postoperative day unless you are told not to. 
• Follow your surgeon’s instructions on when to change your bandages. 
• A small amount of drainage from the incision is normal. If the drainage is thick and yellow or the site is red, you may have an infection, so call your surgeon. 
• If you have a drain in one of your incisions, it will be taken out when the drainage stops. 
• Steri-Strips will fall off in 7 to 10 days or they will be removed during your first office visit. 
• If you have a glue-like covering over the incision, allow the glue to flake off on its own. 
• Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for them to heal. 
• Protect the new skin, especially from the sun. The sun can burn and cause darker scarring. 
• Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year. 
• Sensation around your incision will return in a few weeks or months. 

Bowel Movements 

• After intestinal surgery, you may have loose watery stools for several days. If watery diarrhea lasts longer than 3 days, contact your surgeon. 
• Pain medication (narcotics) can cause constipation. Increase the fiber in your diet with high-fiber foods if you are constipated. Your surgeon may also give you a prescription for a stool softener. 

Splinting your stomach by placing a pillow over your abdomen with firm pressure before coughing or movement can help reduce the pain 

 

When to Contact Your Surgeon

If you have: 

• Pain that will not go away 
• Pain that gets worse 
• A fever of more than 101°F (38.3oC) 
• Repeated vomiting 
• Swelling, redness, bleeding, or bad- smelling drainage from your wound site 
• Strong abdominal pain 
• Odor or increased drainage from your incision
• No bowel movement or unable to pass gas for 3 days 
• Watery diarrhea lasting longer than 3 days 

 

*We provide procedure education for prospective patients and those who educate them. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. The American College of Surgeons (ACS) makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard.

 

The Condition 

An umbilical hernia occurs when a tissue bulges out through an opening in the muscles on the abdomen near the navel or belly button (umbilicus).

Common Symptoms 

• Visible bulge on the abdomen, especially when coughing or straining
• Pain or pressure at the hernia site

Treatment Options 

Surgical Treatment 

The type of operation depends on hernia size and location, and if it is a repeat hernia (recurrence). Your health, age, and the surgeon’s expertise are also important. An operation is the only treatment for a hernia repair.

Your hernia can be repaired either as an open or laparoscopic approach. The repair can be done by using sutures only or adding a piece of mesh.

Open Hernia Repair 

The surgeon makes an incision near the hernia site, and the bulging tissue is gently pushed back into the abdomen. Sutures or mesh are used to close the muscle.

• For a suture-only repair: The hernia sac is removed. Then the tissue along the muscle edge is sewn together. The umbilicus is then fixed back to the muscle. This procedure is often used for small defects.6
• For an open mesh repair: The hernia sac is removed. Mesh is placed beneath the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia. The mesh extends 3 to 4 cm beyond the edges of the hernia. The umbilicus is fixed back to the muscle. Mesh is often used for large hernia repairs and reduces the risk that the hernia will come back again.
• For all open repairs, the skin site is closed using sutures, staples, or surgical glue.
• An open repair may be done with local anesthesia and sedation given through an IV.
•  Your surgeon may inject a local anesthetic around the hernia repair site to help control pain.
• With complex or large hernias, small drains may be placed going from inside to the outside of the abdomen.

Laparoscopic Hernia Repair 

The surgeon will make several small punctures or incisions in the abdomen. Ports or trocars (hollow tubes) are inserted into the openings. Surgical tools and a lighted camera are placed into the ports. The abdomen is inflated with carbon dioxide gas to make it easier for the surgeon to see the hernia. Mesh may be sutured or fixed with staples to the muscle around the hernia site. The port openings are closed with sutures, surgical clips, or glue.

Open hernia repair: An incision is made near the site. Your surgeon will repair the hernia with mesh or by suturing (sewing) the muscle layer closed.

Laparoscopic hernia repair: The hernia is repaired with mesh or sutures inserted through instruments placed into small incisions in the abdomen.

Nonsurgical Procedure: Watchful waiting is generally not recommended for adults with an umbilical hernia. You may be able to wait to repair umbilical hernias that are very small, reducible (can be pushed back in) and not uncomfortable. There is a risk of the intestines being squeezed in the hernia pouch and blood supply being cut off (strangulation). If this happens, you will need an immediate operation.

Expectations

Before your operation: Evaluation may include blood tests, urinalysis, and ultrasound. Your surgeon and anesthesia provider will discuss your health history, home medications, and pain control options. 

The day of your operation: You will not eat or drink for six hours before the operation. Most often, you will take your normal medication with a sip of water. You will need someone to drive you home. 

Your recovery: For a simple repair, you may go home the same day. You will need to stay longer for complex repairs.

Benefits and Risks of Your Operation 

Benefits

An operation is the only way to repair a hernia. You can return to your normal activities and in most cases will not have further discomfort.

Risks of not having an operation

Your hernia may cause pain and increase in size. If your intestine becomes squeezed in the hernia pouch, you will have sudden pain, vomiting, and require an immediate operation.

Possible risks include return of the hernia; infection; injury to the bladder, blood vessels, intestines, or nerves; and continued pain at the hernia site.

The Day of Your Operation 

• You should not eat or drink for at least 6 hours before the operation. 
• You should bathe or shower and clean your abdomen, especially around the umbilical area, with a mild antibacterial soap. 
• You should brush your teeth and rinse your mouth with mouthwash. 
• Do not shave the surgical site; the surgical team will clip the hair near the incision site. 

What to Bring 

• Insurance card and identification
• List of medicines 
• Loose-fitting, comfortable clothes 
• Slip-on shoes that don’t require that you bend over 
• Leave jewelry and valuables at home 

After Your Operation 

Preventing Pneumonia and Blood Clots 

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour takes 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. 

When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and, for high-risk patients, taking a medication that thins your blood. 

Your Recovery 

If general anesthesia is given or if you are taking narcotics for pain, it may cause you to feel different for 2 or 3 days. You may have trouble remembering and feel tired. You should not drive, drink alcohol, or make any big decisions for at least 2 days. 

Nutrition 

• When you wake up from the anesthesia, you will be able to drink small amounts of liquid. If you do not feel sick, you can  begin eating regular foods. 
• Continue to drink about 8 to 10 glasses of water each day. 
• Eat a high-fiber diet so you don’t strain while having a bowel movement. 

Activity 

• Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clot formation. 

Work 

• After recovery, you can usually return to work within 3 to 5 days. 
• You will not be able to lift anything over 10 pounds, climb, or do strenuous activity for 4 to 6 weeks following surgical repair of an umbilical hernia. 
• Lifting limitation may last for 6 months for complex or recurrent repairs.

When to Contact Your Surgeon 

Contact your surgeon if you have: 

• Pain that will not go away 
• Pain that gets worse 
• A fever of more than 101°F (38.3°C) 
• Repeated vomiting 
• Swelling, redness, bleeding, or foul- smelling drainage from your wound site 
• Strong or continuous abdominal pain or swelling of your abdomen 
• No bowel movement by 3 days after the operation 

 

Call Us  

If you have severe pain, stomach cramping, chills or a high fever (over 101°F or 38.3°C), odor or increased drainage from your incision, or no bowel movements for three days. 

*We provide procedure education for prospective patients and those who educate them. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. The American College of Surgeons (ACS) makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard.

Before Surgery:

• You must perform pre-operative tests that include blood samples, urine samples, X-rays, and electrocardiogram depending on your age. Remember that the preoperative laboratories must not be more than 7 days old.
• If you smoke, you should stop smoking 2 weeks before surgery to avoid lung risks.
• If you use any recreational substances or drugs, you must leave them 1 week before the day of your surgery, otherwise, your surgery may be canceled.
• One day before your surgery, the last solid meal should be until noon. After noon to midnight, you should only drink liquids. After midnight you should not eat anything nor drink water.
• Patients taking medications for diabetes and high blood pressure should check with their doctor whether they should take the medication before surgery.
• The night before surgery, the patient must bathe with soap disinfecting all areas and surfaces of their body.
• Arrive early on the day of your surgery for your registration. Remember that the process will take a while.
• You must be accompanied by a family member or friend and we recommend that you keep this company at home, especially the first 24 hours after surgery.
• We recommend that you have fiber-based laxatives on hand and begin taking them a week before surgery to avoid constipation.
• It is important to keep the phone number for the surgeon’s office in case you need to call them for any reason.

 

After surgery:

• Patients who have medication for diabetes, high blood pressure or other medications, should consult with the doctor when they should resume taking their medication after surgery.
• After surgery, walk every two hours for 10 minutes during the day. At night rest.
• The first two days after surgery, the diet should be light and easily digestible, stay well hydrated (water, tea, juices, coffee)
• After surgery you should not smoke or use recreational drugs for at least 10 days.
• Do not carry heavy items greater than (10 lb.) ex. a 5-year-old child weighs approximately 50 lbs.
• You should not do intense or heavy exercises for 8 to 12 weeks depending on the type of surgery you had. Talk to the specialist to see when you can start.
• After 48 hours of your surgery you can take a shower, remove the bandages without worrying about getting the wound wet. When drying, remember that you should not use the same body towel to dry your wound, you must do it with a clean towel or an air dryer.
• After bathing, the wound may run out of bandages, meaning you do not need to put on gauze again. Keep your clothes clean.
• Remember to call the medical office the third day after your surgery and make your appointment with the specialist for an examination after 7 days of your surgery.
• Remember that it is not possible to be pain free, however what is sought with medications is to calm the pain to the point that you can walk.
• If you are breastfeeding, you should refrain from doing so if you are taking medications such as narcotics and/or antibiotics. Ask and follow the advice of your doctor.
• Refrain from intimate relationships for at least 7 to 10 days and depending on the type of surgery. Always ask and follow the advice of your doctor.

 

What is umbilical hernia repair surgery?

Umbilical hernia repair surgery is a procedure that fixes umbilical hernias. An umbilical hernia involves a bulge or pouch that forms in the abdomen. This type of bulge occurs when a section of the intestine or other abdominal cavity tissue pushes through a weak spot in the abdominal wall near the belly button. It can develop in young children and adults.

In rare cases, adults with umbilical hernias can develop a serious condition called strangulation. Strangulation occurs when the blood flow to the herniated tissue is suddenly cut off. This can occur in umbilical hernias that are non-reducible or can’t be pushed back into abdominal cavity. 

Symptoms of strangulation include nausea, vomiting, and severe pain. The area around the umbilical hernia might look blue, as if you have a bruise. The herniated contents could also become nonfunctional and die if they’re strangulated. 

Why is umbilical hernia repair surgery done?

Umbilical hernias don’t always require surgical repair. Surgery is needed when the hernia:

• causes pain
• is larger than half an inch 
• is strangulated

Umbilical hernias in adults are less likely to go away on their own. They usually grow larger over time and often require surgical repair.

How do I prepare for umbilical hernia repair surgery?

Umbilical hernia repair surgery is usually performed under general anesthesia. This means that you’ll be fully asleep and won’t experience any pain. 

You’ll likely need to stop taking nonsteroidal anti-inflammatory medications such as aspirin and ibuprofen several days before the surgery. This will reduce your risk of significant bleeding during the procedure. 

Fasting for at least six hours before surgery is generally a standard requirement. However, Dr. Enriquez may give you different instructions before the surgery.

Umbilical hernia repair surgery is performed in two different ways: open hernia repair or laparoscopic hernia repair.

What happens if a hernia is left untreated?

Potential complications of a hernia. If left untreated, your hernia may grow and become more painful. A portion of your intestine could become trapped in the abdominal wall. This can obstruct your bowel and cause severe pain, nausea, or constipation.

How long does it take to recover from umbilical hernia repair surgery?

You’ll be taken to a recovery room to fully wake up after the procedure. Hospital staff will monitor your vital signs, including your breathing, oxygenation, heart rate, temperature, and blood pressure. Most umbilical hernia repair surgeries are done on an outpatient basis. This means you’ll likely be able to go home the same day or the morning after an overnight stay.

Dr. Enriquez will give you pain relieving medications and instructions to keep your stitches clean and dry. They’ll schedule a follow-up appointment within a couple weeks to assess your healing. Most people can return to their full range of activities within a few weeks after surgery. It’s possible for another umbilical hernia to develop in the future, but this is fairly rare.

What is the recovery time for an umbilical hernia surgery?

After recovery, you can usually return to work within 2 to 3 days. You will not be able to lift anything over 10 pounds, climb, or do strenuous activity for 4 to 6 weeks following surgical repair of an umbilical hernia.

Is umbilical hernia surgery painful?

It’s normal to feel sore and uncomfortable immediately after surgery. Local anesthetic, which numbs the area, will be injected before the end of the operation to reduce the pain. Painkillers will also be provided.

Can I climb stairs after hernia surgery?

There are no medical or physical restrictions on activity after surgery. That means it is OK to walk, climb stairs, lift, have sexual intercourse, mow the lawn, or exercise as long as it doesn’t hurt. In fact, returning to normal activity as soon as possible will most likely enhance your recovery.

When to Call the Doctor

Call your doctor if:

• There is more redness, pain, swelling, or bleeding at the wound site.
• The wound is larger or deeper, or it looks dried out or dark.
• The drainage coming from or around the wound increases or becomes thick, tan, green, or yellow, or smells bad (which indicates pus).
• Your temperature is 100.5°F (38°C) or higher.

 

*We provide procedure education for prospective patients and those who educate them. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. The American College of Surgeons (ACS) makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard.