Parastomal Hernia Repair Surgery Postoperative Instructions

Plan to stay in the hospital as an inpatient for 5 – 7 days after your procedure. Some patients, based on the size of their hernia, will spend the first night in the intensive care unit (ICU) for monitoring.

The length of time that you spend in the hospital depends on how quickly GI function returns (passing gas), food tolerance, adequate pain control on oral medications and your ability to move around safely. Additionally, we want to make sure that there are no concerns about your wound or any other problems prior to discharge.

Repair of your parastomal hernia does not require any dietary restrictions after surgery. However, many patients find that their appetite is poor for a week or two after surgery. This is a normal result of the stress of surgery and manipulation inside the belly and your appetite should return in time. Some patients find that it is easier to eat smaller, more frequent meals early in recovery. Protein shakes such as Boost, Ensure or similar products can be helpful in providing both protein nutrition for healing as well as hydration. If you find you are persistently nauseated or unable to take in liquids after discharge, please contact our office and let us know.

When you get out of surgery you may have one or more drains inserted near your incision. The drains provide suction to drain excess fluid from around the surgical area, promote healing and reduce the risk of infection. The drain or drains may be removed before you leave the hospital or you may be discharged with it/them in place. In most cases, your drain(s) will remain in place until you have approximately 30 milliliters or less of fluid extracted per day for two days in a row.

If you are sent home with one or more drain(s), follow the instructions provided for caring for and emptying your drains and keep a record of how much fluid is extracted each day. After the drains are removed by your doctor, some fluid leakage may continue around where the drain was located. This is okay - just cover the area with dry sterile gauze.

Depending on your procedure you may have staples and/or nylon sutures to close your incision. These will remain in place for the first 2 – 3 weeks after surgery and be removed at a post-op office visit. You can shower with them in, but no baths, hot tubs or pools for the first two weeks after surgery.

We try to close your incisions to leave the smallest possible scar. Do not put any ointment or other medication on your incisions – it will not make them “heal better.”

We ask you to wear your abdominal binder for the first two weeks as much as possible, including while sleeping. Most patients find this provides added comfort and reduces pain.

At times back pain can develop from overuse due to painful abdomen muscles. The binder will help support your abdomen and relieve pressure on your back. It is also important to reduce the fluid that accumulates above the mesh after the repair. After two weeks, you can reduce how often you wear the binder and do not need to wear it during sleep. We do recommend that you continue to wear it during lifting or more vigorous activities.

There are some restrictions on your activity after your parastomal hernia repair. While every person recovers differently, most people require at least six full weeks for recovery. It commonly takes this amount of time to feel 80 percent back to normal and up to three months until you feel close to 100 percent.

You should plan on taking it easy, especially in the first few weeks after surgery. In general, all strenuous and exerting activity should be avoided until you are told you may do so. Make sure to ask for help with basic activities such as grocery shopping, cooking, and yard work. This is mainly to protect the incision while it heals.

You may also feel easily fatigued and "washed out" for a week or two following the surgery, which may further limit your activity level.

Everyone returns to work at different times. As a rough guide, most people take at least 4-6 weeks off prior to returning to work, depending on the physical requirements of their job. If you need particular documentation for your job, please call the office.

You may be given clearance to drive once you have not needed the narcotic (prescription) pain medications for two consecutive days. You should be able get in and out of the car without discomfort and brake without difficulty or pain. Plan for help driving to and from your appointments.

For patients with colostomies or ileostomies, the first stoma output (bowel movement) may occur anywhere from 1-5 days after surgery. Provided you are not nauseated or having abdominal pain, this is an acceptable time range. Some patients will have diarrhea for a week or two after their hernia repair. The bowels usually become more regular with time.

Constipation can become a problem for some patients, particularly those taking narcotic pain medications. You will be prescribed medications like Milk of Magnesia to help alleviate the problem and avoid straining which can increase abdominal pain. This can be continued until you are off narcotics and your bowels have returned to normal. Call the office if this persists for more than five days.

For patients with ileal conduits and other ostomies related to the urologic tract, urine output should resume almost immediately. If you are not making urine, please contact the office or proceed to the nearest hospital for medical attention.

You should be able to pouch your stoma without difficulty after a parastomal hernia repair. Stoma nursing will be consulted for most patients while you are in the hospital in case your pouching needs change after surgery. If you are having difficulty, please contact the office so that we can help arrange for you to be seen by a stoma nurse.

Some patients find that their hernia “returns” right after surgery. Don’t worry – this is a normal feeling and/or appearance. It is very unlikely that the hernia repair failed so soon after surgery. Much more commonly, the place where the hernia contents were can sometimes fill up with post-operative fluid, a condition called a seroma. This fluid collection is a normal result of surgery and will usually be absorbed by the body over time. This can take up to around 3 months. Wearing a binder regularly can help the fluid to reabsorb.

Call your surgeon’s office if any of the following occur:

• Fever of 100.4 degrees Fahrenheit or greater
• Shaking with chills
• Pain that increases over time
• Redness, warmth or pus draining from incision sites
• Persistent nausea or inability to take in liquids
• Separation between the edge of your stoma and the adjacent skin edge
• Change in appearance of your stoma