Michael C. Lilly, MD, FACS
Gulf Surgery
2061 Englewood Road, Suite 2A
Englewood, FL 34223
(941)474-5759
Laparoscopic fundoplication and hiatal hernia repair post-op instructions
You have had surgery to treat your GastroEsophageal Reflux (GERD) and/or your hiatal hernia.
Incisions:
This was done through 5 small incisions that have been closed with absorbable sutures under the skin which you cannot see, and do not have to be removed. There is glue like dressing called Dermabond covering the wounds. You may shower the day after surgery, but do not submerge (in a bath, pool or ocean) for 10 days.
Diet:
The expectation is that you will stay overnight after surgery and be discharged home the following day after demonstrating the ability to swallow liquids. After this surgery there is swelling around the lower esophagus and it is normal for swallowing to be slow, and that is why you will be on a modified diet over the course of the 2 months following surgery. This consists of liquids for the first 2 weeks. By liquids I mean anything that can be poured through a strainer. And yes that includes foods that if they were melted, would pour. After 2 weeks the diet is slowly advanced, adding soft foods (scrambled eggs etc) back first and then slowly the diet is liberalized week by week. You will have been given a food guide to assist with this. The goal of this modified diet is to avoid having food stick, which can be very uncomfortable, but more importantly, avoiding the retching that can result from food sticking, as that could damage the repair in this early post-operative period. Also if you are prone to nausea, please let us know, and we can provide you with a prescription for medication to alleviate nausea. It is very important that you avoid vomiting in this early post-operative period.
Pain:
Pain after this surgery is variable, depending on multiple factors, but probably most related to the size of the hiatal hernia that was repaired. Pain is generally felt in the back, chest and shoulders. The shoulder pain is referred pain from irritation of the diaphragm. There is nothing wrong with your shoulders. The pain improves quickly over the first few days after surgery. You will be given a prescription for pain medication to use as needed.
Activity:
You should be up and around soon after surgery. Hopefully out of bed the same day. When you go home (usually the day after surgery) it is important to walk often. You can climb stairs and be active, just avoid any significant lifting (for 6 weeks), especially if you had a hiatal hernia repair as part of the procedure.
Issues you may have:
Difficulty swallowing is common in the immediate post-operative period, hence the diet described above. Sometimes even liquids can be difficult, and if so it is important to just sip liquids throughout the day and do not try to sit down and have a large amount at one time. Also, in the first few days after surgery be sure your feet are on the floor when drinking your liquids, whether that be while sitting or standing, as it is easier to swallow if you are upright. Sometimes swallowing can get worse a day or two after you go home, this is due to the progression of the swelling/inflammation, and it will improve. Reasons to contact the office about this is if you are unable to take enough fluids to stay hydrated, or if you are retching due to something being stuck.
Pain that is worsening and or associated with a fever (temperature equal or greater than 101). It is normal to have some pain, and even a low grade fever can be common. Take the pain medication, or tylenol. Be careful not to combine prescribed pain medication that contains tylenol, and OTC tylenol, or at least be sure not to take more than 4000mg in a day.