Patient Preparation for Hernia Repair Surgery
There are some measures patients can take before surgery in order to enhance their chances of obtaining optimal results.
- Smoking cessation 4 weeks prior to surgery: Smoking has been shown to significantly decrease the blood flow to surgical incisions and can impair one’s ability to heal. Smoking has also been linked to the development of cardiac and pulmonary complications following surgery. Cessation of smoking 4 weeks prior to surgery has been shown to reduce the risk of wound, cardiac,and pulmonary complications by half. Therefore, it is imperative to quit smoking prior to hernia repair surgery. We have programs that can assist in smoking cessation.
- Control of diabetes mellitus: Elevated blood glucose levels have been shown to reduce the ability of the body to fight off infection. For diabetics, the blood glucose levels should be in good control with blood glucose levels at < 180 or HbA1C levels < 8%.
- Preoperative exercise program: Repair of large hernia defects can be debilitating to certain patients. Some may require prolonged hospitalization or rehabilitation therapy to recover from their surgery. Those patients who exercise for 4-6 weeks prior to undergoing surgery have been shown to have a faster recovery and spend half the amount of time in the hospital recovering compared to those who did not exercise. An exercise program can simply involve walking around the block of your neighborhood, in a park or on a treadmill 3-4 times per week for at least 4 weeks prior to surgery. This will help condition you for surgery and significantly aid in your recovery.
- Malnutrition: Patients who are malnourished have a diminished ability to heal from surgery and are at a higher risk of developing a postoperative wound infection and a prolonged and complicated hospital stay. There are immune system enhancing nutrient supplements that can be taken 5-7 days preoperatively that can significantly reverse the detrimental effects of malnutrition. Impact Advanced Recovery is one of these supplements. It is enriched with L-arginine and Omega 3 fatty acids that can be taken as 1 can three times a day for 5-7 days prior to surgery and can easily be purchased online.
- Obesity: Morbidly obese patients have been shown to have a higher ventral or incisional hernia recurrence rate than those who are not morbidly obese. In this patient population a need for substantial weight loss via a weight loss program or bariatric operation should be considered prior to repairing the abdominal wall hernia. Unfortunately, some patients cannot lose the weight, refuse a bariatric operation or are too symptomatic from their hernia and cannot wait the 6 to 12 months often needed to lose the excess weight and therefore must proceed with the surgery in the overweight state and accept a higher risk of recurrence.
- Staphylococcus aureus carrier state screening and treatment: Up to 33 percent of the population are carriers of a skin bacteria called staphylococcus aureus. Up to 2 percent of the population is carriers of an antibiotic resistant strain of this bacteria called methicillin resistant staphylococcus aureus (MRSA). These bacteria are the most common cause of postoperative wound infections and can infect the incision site and possibly even infect the synthetic mesh. Therefore we screen all of our patients who are scheduled for incisional hernia repair with mesh for the carrier state of staphylococcus aureus. Those who test positive are treated 5 days before surgery with Bactroban ointment to the nostrils twice a day and a daily hibiclens soap shower to eliminate this bacteria.
- Maximize cardiac and pulmonary status