While hernias certainly differ from patient to patient, the overall perioperative experience for most patients having routine, outpatient hernia surgery at the North Penn Hernia Institute is in general, as follows.
THE WEEK LEADING UP TO SURGERY
Patients may be, and in fact are encouraged to be normally active. While strenuous activity may make the hernia more symptomatic, aerobic ("cardio") activity is both permitted and encouraged.
PATIENTS on ASPIRIN or BLOOD-THINNER MEDICATIONS-Because of the potential for bleeding that they may cause during and after surgery, Aspirin and other blood thinning medications taken by mouth (e.g.,Coumadin, Plavix, etc.) should be withheld for 5-7 days before surgery. This should be specifically discussed with your surgeon. Patients who have had these medications specifically prescribed for other medical problems must discuss this circumstance fully with their personal prescribing Physician ( Primary Care Physician, Internist, Cardiologist , etc.) before discontinuing or withholding these medications. Collaboration between your personal Physician and the NPHI surgeon may, in some cases, be necessary prior to surgery. We will facilitate this discussion to assure safe and quality care if necessary.
Remember to call the hospital the day before surgery to identify the time at which you are expected to arrive. You must arrive at the hospital at the appointed time in order to avoid the small but real potential risk of having surgery delayed or even canceled.
THE NIGHT BEFORE SURGERY
To proceed with surgery, patients will be unable to eat or drink anything after midnight. If desired, patients may have a late meal. (Patients to take medications by mouth when routine basis will be allowed to take these medications on the morning of surgery with a small set of water.) Unless otherwise instructed, there is no need for patients to take laxatives or enemas prior to surgery. Do not shave the area of surgery yourself; this will be done for you in the operating room by your surgeon.
ON THE MORNING OF SURGERY
Remember, with the exception of routine medications (taken with a sip of water in the morning), patients will be unable to eat or drink anything after midnight. You will be expected to arrive at the hospital approximately 11/2- 2 hours prior to surgery. Bring with you the following:
A Robe and slippers if available
Comfortable clothes for you to wear upon discharge
Any routine medications that you normally take and may need
Your prescription pain medication if one was ordered (do not take this medication until recommended after surgery.
Reading material, laptop (WiFi available), cell phone, etc. if you desire
Go initially to the hospital registration area off the main lobby just inside the main entrance. Those patients who have pre-registered will be quickly directed to the ambulatory/outpatient surgery area. Your family may accompany you. Once in the ambulatory surgery area, you will be interviewed briefly by a nurse. You will be asked to change into a surgical gown at this time. We do aggressively respect and protect your privacy and dignity during this time. However, personal clothing cannot be worn in the clean/sterile OR environment. If you did not bring a robe and slippers with you, clean and fresh garments will be provided for you to wear.Your surgeon will also meet you in this area soon thereafter. At that time you'll be able to review your surgery with the surgeon and had any questions or concerns that you may have answered and fully addressed. With your participation, your surgeon will " mark" the surgical site. You will also be interviewed by a member of the department of anesthesiology, who will also be able to answer any questions you may have. A small IV will likely be started at this time, but may also be started in the operating room in some patients. Valuables that you may have brought with you (which should be limited) may be left with family/friends, or stored in personal lockers that are provided. Family and Friends may stay with you until the time of surgery.
FAMILY and FRIENDS
We are dedicated to making the perioperative experience both friendly and comfortable for family members. While they may spend time directly with the patient prior to and after surgery, they unfortunately are not permitted in the operating room directly. There are however several quiet and comfortable waiting areas available. An " Internet Café", made exclusively available for family members of patients undergoing surgery is just part of our expanded effort to provide a safe, quality, and comfortable environment for both patient and family. This area has free computer access for your use. Reading material, daily newspapers and contemporary magazines are also available in all of these areas. Coffee too! For those individuals wishing to leave the hospital area, either to walk a beautiful hospital grounds and Gardens, or to visit local merchants, easy-to-use "beepers" will be provided for us to keep in touch. Your cell phone if available, can also be used as a contact medium (please provide us with a number before you leave). Discount coupons are also available for local merchants and restaurants, both for patients and family. This includes access to our Top Rated hospital cafeteria where excellent (really !) hot, cold, and buffet style meals are available. Coffee and beverages are of course free.
Family and friends certainly will be constantly informed as to the progress the patient's care. In addition, the surgeon will speak you directly immediately after surgery. Additionally, the surgeon will provide specific instructions and details to both you and the patient prior to discharge. There will be ample opportunity throughout the day for you to ask questions, and get detail answers.
IN THE OPERATING ROOM
The operating room is but a short distance from the ambulatory, outpatient surgery area. He will be transported to the operating room by Anesthesia and your operating room nursing staff. Family unfortunately is not permitted in the operating room area. Your surgeon will be you upon your arrival in the OR.
Once in the operating room and IV will be started if one had not been started previously. You will again be asked to provide your name, birth date, and the type of surgery you're having. This period of " Time Out" is an added measure of our commitment to quality and safety in the care we deliver. The surgical area may be shaved by your surgeon (with a clipper) in some but not all cases. The surgical area will also be washed thoroughly with an antiseptic solution. Again your privacy and dignity are protected at this time, and fully respected by the professionals in the OR.
Most patients will receive a small sedative dose at this time to both calm and relax them. The overwhelming majority of our patients receive only a sedative, and full general anesthesia is unnecessary. Your surgeon will then paint the surgical area with a topical antiseptic. Surgical drapes will be placed, leaving only the small area of intended surgery exposed. Genitalia remain covered throughout surgery, again protecting and respecting your privacy and dignity.
When the sedative has become effective, local anesthesia will be infiltrated in the surgical area, numbing the area. Patients will be not only calm and relaxed but totally pain free throw out the procedure. This time the surgery will commence.
At the completion of surgery, dressings will be applied in the operating room by your surgeon. Most patients are fully awake, alert, and conversational at this point. The majority of patients will go directly back to the outpatient ambulatory surgery area where they made me dearly visit with their family. In m cases, snce general anesthesia is avoided, patient bypass the Recovery Room, and are immedtely reunited with famiy and friends. After a very brief period of rest and observation, the IV will be discontinued, a light snack provided, and the patient is encouraged to ambulate. Your surgeon will again visit with you to discuss your procedure in detail, address any additional questions or concerns that you might have, and provide you with full discharge instructions(e.g., diet, physicial activity, return to work, and follow-up plans). If notprously provided, a prescription for pain medication may be given to you. Arrangements for post-operative follow-up (either as an office visit, hotel visit, or personal telephone call) will be discussed at this time as well. Once you are fully ambulatory, these instructions will again be reviewed by your nurse, specific to your surgeons orders and insttion. You will then be safely discharged.
Patients may not drive themselves on the day of surgery. Recuperation and resumption of physical activity including driving will be discussed with you specifically buy your surgeon prior to discharge.
It is advisable for patients to be accompanied by a responsible adult (with driver's license). For those patients traveling to the North Penn Hernia Institute alone, please advise our office at least one week in advance of surgery. Arrangements for your transportation to local lodging will be made through our office. The use of public transportation after surgery without being accompanied by a responsible adult will not be permitted.
Any questions or concerns that our patients may have after discharge can be immediately addressed by calling our office at 215-368-1122 (or after usual business hours at 215-368-1139). One of our physician/surgeons is " On Call" and available to speak with you 24-7.