Open surgery for abdominal hernia

Prior to showing up for the surgery it is an indispensable requirement that you stop smoking and using nicotine substitutes (e.g. Nicorette, e-cigarettes). This also includes passive smoking.

By not smoking 6-8 weeks prior to your scheduled surgery the risk of wound complications are reduced from 30% to 5%. Similar observations are seen for lung and heart complications.

All patients will be tested approximately 14 days prior to surgery at a visit in the Surgical Outpatient Clinic, since 30% of selfreported non-smokers are actually smoking. The test will be repeated on the day of admission. If the test is positive for smoking, your surgery will be cancelled.

Do not take any alternative/herbal medicine during the last two weeks before the surgery.

Hair in the surgical area must be removed before your surgery. The hair on both thighs must be removed, both on the front and back because surgical equipment will be attached there. Keep in mind to remove the hair from 5 centimeters below your pubic hair.

The hair removal must be done 1 week before your scheduled surgery using a hair trimmer or the like.

• You must not use a razor when removing the hair, and we do not expect a clean-shaven surgical area.
• If you do not have a hair trimmer or there is less than 1 week until your surgery from your preliminary examination, the hair removal can be done in the ward when you show up to your scheduled surgery.

Diabetes has great significance in regards to risks and complications. Your long-term blood sugar must therefore be under control before your surgery.

There might be special circumstance in regards to your preparation before surgery when you have diabetes. You will be informed at your preliminary examination.

Obesity has great significance in relation to the apperance of hernia in the first place, but also the risk of the hernia reappearing after surgery. Some patients with hernia are therefore required to lose weight before the surgery. The agreed upon weight to lose is individual for each patient.

You must make sure to wash yourself thoroughly before your surgery to prevent infections. It is important to reduce the number of bacteria on your skin before your surgery.

Before your shower you must:

• Take off all your jewelry (including rings)
• Remove nail polish on hands and feet
• Clean your nails thoroughly
• Remove piercings

How to wash yourself:

• Rinse your entire body
• Wash your hair with soap
• Wash your face and neck with soap
• Wash your upper body
• Wash thoroughly under your arms
• Wash your navel thoroughly with water and soap - use a cotton bud to make sure all dirt is removed
• Wash thoroughly around your genital area
• Wash your legs and feet
• Rinse your entire body under running water
• Dry off and put on clean clothes

Do not apply cream after your shower. It will lessen the effects of the skin desinfectant which is applied before your surgery.

When you arrive at the ward the staff will make sure your personal hygiene is all right.

If you have bandages these will need to be changed before your surgery just like a potential catheter bag needs to be changed. This should be done in connection with your shower or immediately before your surgery.

You must bring your medication to the hospital in its original packaging when you are admitted. If your medication has been repacked by the pharmacy, you must also bring it in the original packaging.

The staff will ask to see your medication to ensure that your medication record is up to date, to determine which medication you should continue taking, and to assess whether you need other or new medication.

On the day of the surgery you must be fasting and thirsting as agreed upon with the Anaesthesiology Outpatient Clinic – see the materials provided from there.

When you arrive for your scheduled surgery you must scan your social security card at the stand and take a seat in the waiting area. The staff will get you organized and ready for the surgery.

As waiting time may occur from the reporting time to the surgery, it may be a good idea to bring reading material or the like.

Tell the staff if there is anything from your preparations that you may have had trouble doing.

The surgery is performed under general anaesthesia and through your old scar. Any adhesions that may occur up against the hernia will be detached and a “mesh” will be inserted to cover the weak area with some overlap. Often, 1-3 drainage tubes will be inserted. The surgical wound is closed up with clips that will need to be removed by your general practitioner after 14 days.

At any kind of surgery bleeding and infection can occur (<1-3%). After having a hernia surgery, regardless which type, there will always be a risk that the hernia can reoccur – but the risk is reduced by using net.

There is 8-10% risk of having chronic pain and discomfort in varying degrees.

The surgery will include a great deal of dissectional work in the subcutis. Afterwards, this may cause problems for the wound to heal properly – which in many cases can be fixed, but in worst case may include plastic surgery later on.

It is important that you get out of bed after the surgery, and that you are fully ambulant, in order to avoid complications such as thromboses in legs and lungs and pneumonia. This is done through cooperation between you and the staff. We recommend you stay active during your hospitalisation and when you come home.

After surgery you will be in The Post Anesthesia Care Unit or in The Intensive Care Unit. You should expect to stay the night in one of these units. The next morning you will be transferred to The Surgical Ward. If you are having any issues with pain you will stay at The Post Anesthesia Care Unit or in The Intensive Care Unit until the pain issues are solved.

Discomfort may occur such as pain and nausea. If you are feeling any of this please tell it to the staff so they can help you.

Pain after the surgery will often be treated with a pain catheter in the back and, additionally, with oral analgesics taken regularly for a period.

The analgesics will be gradually reduced. However, you should expect to need mild analgesics for a longer period after the surgery.

The drainage tubes inserted during the surgery will be removed when less than 30 ml of fluid is produced per day.

It is important that you start eating and drinking again immediately after the surgery, even though you are tired and nauseas the first couple of days.

Eat and drink as you usually do. Drink plenty and eat high-protein foods.

To prevent against thromboses you will be given an injection of anticoagulants (blood thinner) on a daily basis in a period of 6-28 days.

If you are already on blood thinning medicines, you must follow the medicine plan that you have received prior to your surgery.

All patients will be equipped with a hernia belt, which should be used day and night for 4 weeks and thereafter just during the day for another 4 weeks.

Most patients are hospitalised for 5-7 days.

Before you can be discharged the following must be fulfilled:

• You must eat and drink normally.
• You must be able to do your regular daily activities.
• You must be acceptably covered in regards to pain on tablet pain medicine.
• The drainage tubes must be removed.

We always schedule the discharge in cooperation with you and your relatives.

In the following period there will be no restrictions on lifting unless the surgeon has instructed you otherwise. But you should be careful if something hurts.

It will take approximately 4-6 weeks before the abdominal wall feels normal again.

You may remove your bandages and steri-strips 8-10 days after the surgery.

Sometimes a PICO-plaster is used instead of steri-strips. If that is the case for you, then you may remove the plaster 7 days after the surgery.

You should expect to be on a sick leave for at least 10-14 days after you are discharged, but you may go to work earlier if you feel well.

You will need to come in for a check up 1 month after the surgery.

You will receive an invitation in E-boks.

You are welcome to give The Surgical Ward a call if you have issues or questions during the first 24 hours after you are discharged. Afterward you have to contact your general practitioner.