Patient & Family Guide Laparoscopic Hiatal Hernia Repair 2018 Please bring this booklet to the hospital with you. www.nshealth.ca
Laparoscopic Hiatal Hernia Repair A hiatal hernia happens when part of your stomach moves up into your lower chest through an opening in the diaphragm. This can cause trouble swallowing, as well as heartburn, regurgitation (swallowed food comes back up into your mouth) and burping. Large hernias have a risk of blocking the stomach. Your doctor has arranged for you to have your hiatal hernia repaired. You will have 5 or 6 small 1 to 1 1/2-inch incisions (cuts) in the middle of your abdomen (stomach area) between your nipples and belly button. Your surgery can take about 2-3 hours. Please see page 4 for breathing exercises to practice before your surgery. After surgery You will be in the Recovery Room (Post Anesthetic Care Unit or PACU) for about 1-3 hours. You will then go to the inpatient nursing unit. Visitors are not allowed in the recovery area but may visit you on the inpatient unit. 1
Intravenous You will have an intravenous (IV) in one arm. This will give you medications and fluids. You will be started on fluids by mouth and get guidelines on when to start eating solid food again. Face mask/nasal prongs You may have a mask or nasal prongs on your face to give you moist air and oxygen. Pain medication There will be some discomfort around the incisions, as well as possible chest and shoulder pain. The pain can be helped with medication. Pain medication can be given every 3-4 hours during the day and night. Please ask for pain medication, if needed. Pain after surgery is normal. We want to keep you as comfortable as possible, while avoiding the unwanted side effects of pain medications (such as nausea and vomiting, dizziness, and constipation). These side effects can slow your recovery. 2
You may have a tube in your nose to drain your stomach. If you have nausea (feel sick to your stomach), please ask your nurse for medication to help prevent vomiting. It is important to be as pain-free as possible. We will ask you to describe your pain using a scale from 0-10. No pain or discomfort Worst pain imaginable 0 1 2 3 4 5 6 7 8 9 10 Deep breathing and coughing We will encourage you to breathe deeply and cough. This is to fully expand (make bigger) your lungs and prevent mucus from pooling in them. You may be given a device called an incentive spirometer to help you with this. An incentive spirometer helps you take deep breaths. Use it 10 times every hour when you are awake. 3
Practice this exercise before your 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. Take another deep breath in and cough out. 5. After surgery, repeat this exercise 2 times each hour while you are awake. After your surgery, your physiotherapist or nurse will check your breathing and work with you to clear the mucus from your lungs. While coughing, hold a pillow firmly against your incisions. This will support your incisions and make coughing less painful. Activity Moving your body prevents blood clots from forming and getting upright improves your lung function. It is important to move your legs and feet and turn every 2 hours while in bed. Try and get up and move around, or at least sit in a chair, as soon as possible after surgery. Then start walking. Ask for help when you first start getting up. 4
Your activity will be increased bit by bit as follows: Evening of surgery About 6 hours after returning to the unit, we will help you to a sitting position on the side of your bed and to the bathroom. Day after surgery Your nurse or physiotherapist will help you up to the chair at your bedside. If you are feeling comfortable, they may take you for a walk. When lying, sitting or walking, try to keep good posture. Based on your progress, your activity will be increased each day. At home Keep doing your deep breathing and coughing exercises. You may take the incentive spirometer home. You can expect to have soreness around the incisions for up to 2 weeks after surgery. Your doctor may give you a prescription for pain medication. You may have Steri-Strips covering your incisions for up to 14 days. They can be removed by taking a warm tub bath or shower. 5
Tell your doctor if your incisions get red or painful. DO NOT lift, push, or pull anything heavier than 20 pounds for 4-6 weeks. For example: carrying a suitcase or heavy handbag lifting a heavy or full saucepan or dishes lifting a baby or small child moving furniture carrying a grocery bag using the vacuum cleaner or lawn mower changing bed sheets carrying wet or dry laundry Walking helps to increase your strength and keep your lungs clear. Walk regularly, and slowly at first. You should not get short of breath or feel exhausted. If this happens, stop and rest. Next time, walk slower. Avoid saunas, soaking in water, hot tubs, whirlpools and swimming pools for 2 weeks. These activities can slow the healing of your incisions. Going up and down stairs should not be a problem. We will practice this with you before you go home. You can go back to sexual activity (sex) whenever you feel ready. 6
Avoid driving. You should not drive until you feel you are ready. At your followup appointment, talk with your doctor about what activities you can do. Nutrition You will get a booklet explaining the Esophageal Soft Diet before discharge. It will explain how to reintroduce solid foods over 4-6 weeks after surgery. It is important that you eat only soft, moist foods and fluids that are easy to swallow for 6 weeks after surgery. Eat and drink slowly. Chew solid foods very well. Eat 6 small meals per day. Some foods can be hard to swallow. DO NOT eat the foods below and on the next page for 6 weeks: Grain products Fresh doughy or crusty breads, rolls, bagels, muffins, or biscuits Granola, Shredded Wheat and any other cereals that do not get soft in milk Baked goods with seeds, nuts, coconut or dried fruit 7
Vegetables and fruits Raw vegetables, salads, coleslaw Tough or stringy cooked vegetables such as spinach, celery, asparagus, corn Raw fruit (except for bananas) Dried fruit Milk products Stringy melted cheese Yogurt with nuts or granola Meat and alternatives Dry, tough or stringy meats and poultry Nuts and seeds Hard-boiled or fried eggs Other Gelatin-type candies (gumdrops, jelly beans, etc.) Popcorn, chips, tacos Pickles and olives Cakes, pies, pastry For more information, please ask for a copy of the NSHA patient pamphlet Esophageal Soft Diet. 8
Please write down any questions you would like to ask.
Looking for more health information? Find this pamphlet and all our patient resources here: http://library.nshealth.ca/patientguides Contact your local public library for books, videos, magazines, and other resources. For more information, go to http://library.novascotia.ca Connect with a registered nurse in Nova Scotia any time: call 811 or visit https://811.novascotia.ca Learn about other programs and services in your community: call 211 or visit http://ns.211.ca Nova Scotia Health Authority promotes a smoke-free, vape-free, and scent-free environment. Please do not use perfumed products. Thank you! Nova Scotia Health Authority www.nshealth.ca Prepared by: Physiotherapy & 6A, QEII, Halifax Designed by: NSHA Library Services The information in this brochure is for informational and educational purposes only. The information is not intended to be and does not constitute health care or medical advice. If you have any questions, please ask your health care provider. WI85-0702 Updated March 2018 The information in this pamphlet is to be updated every 3 years or as needed.