Hiatal Hernia Surgery

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1 2009 Hiatal Hernia Surgery

2

3 Hiatal Hernia Surgery Your doctor has arranged for you to have hiatal hernia surgery. A hiatal hernia occurs when part of the stomach moves up into the lower chest through an opening in the diaphragm. You may have an incision in the middle of your abdomen or an incision between the ribs on the appropriate side of your chest. This is called a thoracotomy. It will take a few hours to do your surgery. 1

4 After Surgery You will be in the Recovery Room (Post Anesthetic Care Room) for about 4-6 hours. You will then be moved to a step down unit called the Intermediate Care Unit on 6A. This 4-bed unit is set up so the nurses do not have to leave the room when they are caring for you. You will be in this room until you are well enough to return to the general floor. Visitors are not allowed to visit in the Recovery Room but may visit you on 6A. Chest Tube If you have a thoracotomy you will have 1 or 2 tubes coming out from below your incision. These tubes will remove air and fluid which collect in the area during surgery. The chest tubes will be connected to a drainage unit and remain in for a few days. Your doctor will decide when the tubes are ready to come out. Lying on the side of your surgery will not harm the tubes. 2

5 Intravenous You will have an IV (intravenous) in one of your arms. This is to give you medicine and fluids. Face Mask You will start with a mask on your face to give you moist air and oxygen. Later, this will be changed to nasal prongs to give you oxygen. Nasogastric tube A tube will be passed through your nose into your stomach to remove any fluid and air. This is to prevent you from getting sick and vomiting. The tube will remain in for a few days. You will not be able to drink or eat until the tube is removed. Once the tube is removed, you will be started on sips of water. Your diet will be increased gradually over the next 3-4 days until you are able to eat solid foods. Pain Medicine It is usual to have some pain around the incision and chest tubes. The pain can be relieved by medicine. The doctor who does your surgery will put a small tube near the area where the surgery was done. This small tube is called a paravertebral. This tube is attached to a pump with a bag of medicine. The pump sends the drug to you on an around the clock basis. The drug freezes 3

6 or numbs the area where you had the surgery. The paravertebral can stay in for up to 5 days. The pain team will visit you while you have the paravertebral. If your pain is getting worse, please let your nurse know. A way to think about it is.does the pain stop me from deep breathing, coughing and walking around? If you answer yes then you should let your nurse know. Pain Control You will be asked to describe your pain using a scale from If 0 was no pain and 10 is the worst pain ever, what number would you give your pain? No Pain Worst Pain Ever Breathing and Coughing You will be encouraged to do breathing and coughing exercises. This is to fully expand the lungs and prevent mucus from pooling in them. Practise this exercise before surgery: 1. Blow out 4 times quickly 2. Take a deep breath in and hold it 3. Blow the breath all the way out 4

7 4. Take another deep breath in and hold a pillow firmly against your incision while you cough out. 5. Repeat this exercise twice each hour while you are awake. Your physiotherapist/nurse will check your breathing and work with you to clear the mucus from your lungs. Activity Moving prevents blood clots from forming. It is important to move your legs and feet and turn every 2 hours while in bed. Your activity will be increased gradually as follows: After surgery About 4-6 hours after returning to your unit, you will be helped to a sitting position on the side of your bed. The day after surgery you will be helped up to a chair at the bedside by your nurse/physiotherapist and be encouraged to walk with help. When lying, sitting or walking, try to maintain a good posture. Based on your progress your activity will be increased daily. Bring a pair of good shoes or slippers to the hospital for walking after your surgery. 5

8 At Home Continue with your breathing and coughing exercises. You can expect to have some soreness around the incision for up to 6 weeks after surgery. Your doctor will give you a prescription for pain medicine. Steri-Strips may be covering your incision for up to 14 days after the surgery. They can be removed easily by taking a warm shower. Let your doctor know if the incision becomes reddened or painful. Do not lift, push, or pull anything heavier than 5 lbs. for 4-6 weeks. Examples of things NOT to do are: Carrying suitcase/heavy handbag Lifting a heavy or full saucepan/dishes Lifting a baby or small child Moving furniture Carrying grocery bags Using the vacuum cleaner/lawn mower Changing bed linen Carrying wet/dry laundry. Walking helps to increase your strength and keeps your lungs clear. Start with a 5 minute walk on a level. Gradually increase the time until you have reached 20 minutes. You are then ready to increase the speed at which you walk. You should not be short of breath or exhausted. If this happens, you should stop and rest. 6

9 Next time, walk slower. You should be able to walk and talk at the same time without getting out of breath. Before you start to walk remember to: Wear comfortable, loose clothing and supportive walking shoes. Wait at least 1 hour after a meal. Walk in the cool part of the day in summer. Walk in the warm part of the day in winter. Walk indoors (a shopping mall/recreational facility) on very hot or cold days. Avoid saunas, hot tubs, whirlpools, hot springs and very hot or cold showers for 4-6 weeks. All of these can effect the healing of your incision. Going up and down stairs should not be a problem. We will practice this with you before you go home. You can resume sexual activity whenever you feel ready to do so. Do not drive your car for 4-6 weeks after surgery. Sudden movements may injure your incision. At your follow-up appointment, discuss with the doctor what activities you may now do. 7

10 Notes 8

11 Write down any questions you would like to ask. Please bring this booklet to the hospital with you.

12 Looking for more information on this topic? Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia Prepared by: Physiotherapy Department and 6A, QEII, Halifax Illustrations by: Matthew Pelletier Designed and Printed by: QEII Audio Visual and Printing Departments WI Revised Aug The information in this pamphlet is to be updated every 3 years.

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