Your goal is to minimize David’s risk of complications after a herniorrhaphy. You instruct the patient to:
A. Avoid the use of pain medication.
B. Cough and deep breath Q2H.
C. Splint the incision if he can’t avoid sneezing or coughing.
D. Apply heat to scrotal swelling.
Correct Answer: C. Splint the incision if he can’t avoid sneezing or coughing.
Teach the patient to avoid activities that increase intra-abdominal pressure such as coughing, sneezing, or straining with a bowel movement. Patients should be advised to avoid strenuous activities for a few weeks. Typically, light work can be resumed after 1 week, heavier jobs after 6 weeks.
Option A: Postoperative chronic pain is more frequent than was previously understood and has become one of the most important primary endpoints in hernia surgery. In published reports, the incidence of post herniorrhaphy pain has ranged from 0% to more than 30%. Chronic inguinodynia is defined as pain persisting more than 3 months post herniorrhaphy, after the process of wound healing is complete.
Option B: Recurrence in Lichtenstein hernioplasty may be due to inaccurate execution of the technique (inadequate size or improper fixation of the mesh) or to an overlooked hernia at the primary operation. To avoid the latter, the patient should be asked to cough, and the region should be carefully examined for an indirect hernia, a direct hernia, a femoral hernia, or a combined hernia.
Option D: After the procedure, the patient is asked to rest for a few hours. He or she may be discharged later the same day on a day-care basis. Early mobilization is the key to rapid convalescence. Patients can safely ambulate on the evening of the operation. If general or regional anesthesia is used, the patient may be hospitalized for a few days.
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