Laparoscopic Incisional Hernia Repair

You have recently undergone keyhole surgery to repair your incisional hernia under the care of Professor Sheen.

To aid in your recovery some simple advice is laid out below with respect to wound care and importantly what you can and cannot do after your operation.

Wound care

You will have three or four small incisions covered with a dressing called Mepore® (Molnycke). Mepore is designed to be air-permeable, comfortable and with reduced risk of allergic reactions. This dressing is specially designed to not ‘stick’ to your wounds but adhere only to the surrounding skin so that it can be removed without causing too much discomfort. Please advise your surgeon or nurse if you have experienced any allergic reactions to such dressings in the past so that an alternative dressing can be used for your wounds. If no dressings are used then the wound is pasted/covered with skin glue.

All the wounds are closed using dissolvable stitches, therefore no sutures (stiches) are required to be removed unless specifically stated.

A dressing is required for your wounds for at least 7 days after surgery. If any dressing is removed, becomes wet
or falls off, you are advised to reapply another dressing which should remain for up to 7-10 days. You can shower after at least three days, but do not rub soap into your wounds and ensure that your wounds are kept dry and clean.

You can take a bath or go swimming at least two weeks after surgery.
The wounds may be red after a few days and swell. This is part of the normal healing process and you should continue to carefully monitor your wounds.

Your wounds must be kept dry.

Common problems with wounds

Pain

Some patients describe wound pain. Although you have undergone surgery and may experience some pain, it
is important to inspect the wounds and look for other factors, which may be the cause for the pain including bleeding or redness, indicating a possible infection and a yellow coloured discharge which could also indicate a possible infection.

Redness

This can generally represent a simple irritation but if the redness continues then you should consult the hospital ward, your GP surgery or make an appointment to see Mr Sheen in his next available clinic.

If either pain or redness should occur and you are not able to contact your GP surgery or the hospital where you had your operation for advise and you are sufficiently concerned, then you are advised to report to your local A&E department.

Stitch/Suture material

Sometimes suture material can be seen protruding, particularly at the ends of the wounds. This can usually occur after a few weeks when the wound is almost healed and will usually ‘fall’ away by itself. If the protruding suture material persists then your GP practice nurse

may be able, if possible, to remove it for you or it can be removed by Mr Sheen in his out-patient clinic.

Main post-surgery events to look out for

1) Shoulder tip pain – in order to inflate your abdomen to allow any keyhole surgery to take place, ‘gas’ called carbon dioxide is used. The diaphragm, which is a sheet of muscle we use to breathe can become stretched and consequently bruised as a result of the abdominal wall inflation. The pain from this is felt as shoulder tip discomfort or bruising and should subside after a few days.

2) Bruising – this is noticed commonly at the largest wound (10mm) used for the optical camera in surgery but it should settle with time.

3) Generally feeling tired – some patients describe tiredness after their incisional hernia surgery, but in time your energy levels will return with most patients being fully back to normal after about three weeks.

4) Abdominal pain - as small stacks are used in most cases to secure the mesh inside your abdomen, you may experience pain around your hernia. this can make your general mobility difficult and your are advised to hold a small pillow up against your abdomen when moving around the house, sitting up and when generally undertaking any tasks around the house. If the keyhole technique used (endoscopic) did not involve the use of tracks then you will have less pain, but the mobilisation precautions with a pillow remain the same.

5) Seroma – this is a fluid collection at the original site of the hernia, which may later ‘harden’ before it disappears and cause some discomfort. Patients sometimes think the hernia is still there after surgery. It will completely resolve after 4 weeks or in some cases up to 3 months. In some circumstances the fluid can be drained off by

a simple procedure, which is carried out in the out- patient clinic or in the X-ray department. If you have any concerns please contact the hospital where you had your surgery or Mr Sheen as soon as possible.

Post Surgery

Rehabilitation

Below is a suggested mobilisation programme to help you recover after your laparoscopic ‘keyhole’ incisional hernia surgery. It is also important to maintain a good healthy and high fibre diet so as to try and avoid becoming constipated.

Mobilisation

Days 1-5:

Gentle walking, start with 10 minutes then increasing every day, may need to continue taking pain killers (paracetamol).

Week 1

Increase in movements and walking, gentle stretching and very light exercises can also commence. Any untoward pain experienced while carrying out stretches, should then lead to a reduction in this activity until your body is better recovered.

Week 2

Increase in walking further, simple light exercises such as gentle swimming is suggested if the wound is healed at the end of the second week.

Week 3

You should now be able to walk fully without much pain.

Week 4

If an emergency stop is possible with relative little pain or discomfort then driving can commence – please make sure that you are not on any strong painkillers as these may make you feel drowsy. Most patients can drive after three weeks (25-30 days). A small pillow can be placed over your abdomen ‘belly-button’ for comfort. Long distance driving is not advised for at least six weeks.

Week 6

Heavy lifting can be commenced after the end of week 6. Pain in the abdominal area should be minimal.

After 6 weeks

Recovery should be complete.

This information is to be used only as advice. Your surgeon may inform you of any further specific advice that you may require.