What advice is recommended for post-operative care following robotic laparoscopic repair of bilateral inguinal and umbilical hernia?

Post-Operative Care for Robotic Laparoscopic Repair of Bilateral Inguinal and Umbilical Hernias

Early mobilization and multimodal pain management are the cornerstones of post-operative care following robotic laparoscopic hernia repair, with patients encouraged to mobilize within hours of surgery and resume normal activities as soon as they feel comfortable.

Pain Management

Multimodal Opioid-Sparing Approach

• Implement a multimodal pain management strategy using non-opioid medications as first-line therapy 1:
  • Oral acetaminophen (1000 mg every 6 hours)
  • NSAIDs such as ibuprofen (400-600 mg every 6 hours) or ketorolac if prescribed
  • Reserve opioids for breakthrough pain only, typically requiring no more than 3 hydrocodone pills total 2

Special Considerations

• Ketorolac has been shown to be particularly effective in reducing both postoperative pain and opioid requirements 1
• Avoid routine use of codeine and tramadol in patients under 18 years, per FDA guidelines 1
• Ice packs applied to the surgical sites for 20 minutes every 2-3 hours can help reduce swelling and pain

Mobilization and Activity

Early Mobilization Protocol

• Begin mobilization within hours of surgery, aiming for at least 30 minutes on the day of surgery 1
• Increase to 6 hours per day of out-of-bed activity starting postoperative day 1 1
• Resume normal activities without restrictions as soon as you feel comfortable 3

Activity Guidelines

• Avoid heavy lifting (>10 pounds) for 2-3 weeks
• Light walking is encouraged immediately
• Return to work: 1-2 weeks for desk jobs, 3-4 weeks for more physically demanding work
• Resume driving when you can perform emergency braking without pain (typically 1 week)

Wound Care

Incision Management

• Keep incision sites clean and dry for 48 hours
• Showering is permitted after 48 hours, gently pat the incision sites dry
• No tub baths, swimming pools, or hot tubs until incisions are fully healed (approximately 2 weeks)
• Monitor for signs of infection: increasing redness, warmth, drainage, or fever

Nutrition and Hydration

Diet Progression

• Resume oral fluids as soon as you are fully awake after surgery 1
• Advance to solid foods within 4 hours post-surgery as tolerated 1
• Focus on high-fiber foods and adequate hydration to prevent constipation

Prevention of Complications

Preventing Ileus

• A multifaceted approach to minimize postoperative ileus includes 1:
  • Early mobilization
  • Early oral intake
  • Optimized fluid management
  • Opioid-sparing analgesia
  • Consider laxatives if needed

Preventing Urinary Retention

• Urinary retention is the most common postoperative complication in robotic inguinal hernia repair 2, 4
• Void immediately before surgery
• Monitor for inability to urinate or bladder discomfort
• Contact your surgeon if unable to urinate within 8 hours of surgery

Follow-up Care

Scheduled Appointments

• First follow-up: 1-2 weeks after surgery for wound check 5
• Second follow-up: 4-6 weeks after surgery to assess recovery 5
• Final follow-up: Consider a 1-year visit to evaluate for recurrence 5

Warning Signs Requiring Medical Attention

• Fever >101°F (38.3°C)
• Increasing pain not relieved by prescribed medications
• Excessive swelling, redness, or drainage from incision sites
• Inability to urinate within 8 hours of surgery
• Persistent nausea or vomiting
• Shortness of breath or chest pain

Expected Recovery Timeline

• First 24-48 hours: Expect some discomfort, managed with prescribed medications
• 1 week: Significant reduction in pain, resumption of most daily activities
• 2-3 weeks: Return to work for most patients
• 4-6 weeks: Return to full activities including exercise

Robotic laparoscopic repair offers advantages of less postoperative pain and faster recovery compared to open techniques 2, 4. Following these guidelines will help ensure optimal recovery while minimizing complications.