Luke Elms, M.D.

CT scans of the abdomen are one of the most accurate and sensitive tests we have to look inside the abdomen. As with all tests though, there are a certain amount of things that can be missed, and certain things are not able to be seen as well with CT scans, as with other scans. It is important to consult with your physician to determine which imaging study or test is best to diagnose the problem you are evaluating.

Many times we are able to perform lymph node biopsies with just a needle which greatly reduces the postoperative recovery and pain. If removal of the entire lymph node or a surgical approach is necessary, it is completely dependent on the location of the lymph node and the size of surgery needed to biopsy it.

This is a great question. It depends on the type of hernia and the type of repair used. In my patients, I usually restrict running for two weeks after a minimally invasive inguinal (groin) hernia repair. That limitation is six weeks for other types of hernias and for open groin hernia repairs. Ultimately this should be part of the discussion with your surgeon around the time of surgery to determine the expectation for recovery after your specific surgery.

Pain control after surgery is one of the focuses of my practice. I do recommend the use of all available options forpain management after a surgery. It is important to understand that not all pain medications are narcotics (opioids). It is also important to understand that many times medications work better in coordination with one another than they do individually. I also counsel my patients on the fact that there is a certain amount of pain or discomfort that is expected and is a normal part of recovery. Pain doesn’t necessarily mean that something is wrong. I utilize a pain regimen to reduce the amount of opioids needed if possible. The regimen usually involves acetaminophen, an anti-inflammatory, a muscle relaxant, a nerve block and an opioid if needed. Ultimately good pain control is the primary goal is to control pain and the use of an opioid should be considered if pain management cannot be achieved without them. But, there are some side effects of opioids that can slow recovery in certain individuals. Not every patient is a candidate for all of the medications and it is important to consult with your surgeon to determine the appropriate regimen for your specific case.

Many times stitch infections are actually just irritation from the sutures as many sutures cause an inflammatory reaction. If there is an actual infection, many times it may require removal of the suture or antibiotics. It is important if you feel like you have a stitch infection to consult with your surgeon and let them know so appropriate treatment can be started.

As a hernia surgeon, I recommend my patients to continue to be physically active with cardiovascular exercise to maintain their health and stamina prior to surgery if possible. I do recommend avoiding heavy, lifting or strenuous activities, depending on the type of hernia. I also recommend a healthy diet with high protein to ensure that you’re not malnourished part of surgery to help with healing. I also recommend stopping the use of nicotine products prior to surgery to also help with healing, reduce infections, and prevent recurrences. as with all hernias, I do recommend you consult with your individual surgeon to make sure that your hernia and situation are appropriate for these recommendations.

This is a great question and depends very much on what type of surgery you underwent whether it was minimally invasive or open. The reason you underwent the surgery is also very important as the different types of surgeries can have different recovery lengths.

The majority of patients are able to go back to eating a full normal diet. Occasionally, some patients may experience symptoms such as bloating or diarrhea after eating certain foods, especially foods that are high in fat content. If you experience these symptoms, they will resolve the majority of the time after a few weeks after surgery. But if they do not, there are medications that can be used to help with the symptoms.

It is very dependent on the type of hernia repaired. When I perform robotic inguinal hernia surgery, I usually ask patients to avoid strenuous exercise for two weeks. If the surgery needs to be open, or it is a different type of hernia, the time to avoid exercise can be extended to six weeks in many cases.

This can depend on how deep the lipoma extends and how large the incision needs to be. Usually the pain can be treated with a combination of non-opioids medications and occasionally may need an opioids.

There are many factors that play into this type of procedure and how long it takes. It can take on average 15 to 30 minutes from start of anesthesia to finish.

We usually recommend that most hernias be repaired once they are identified to prevent them from becoming an emergency or prevent them from getting larger or more complex to fix. Occasionally, when hernias are small, we are able to fix them without the use of mesh which has benefits.

It depends on the type of surgery performed, and the size of the incisions needed. The majority of patients have a period of two to six weeks that we ask them to avoid lifting more than 15 pounds or straining the abdominal wall. This does not mean bedrest and we still ask patients to walk and perform normal daily activities even the day of surgery.

After you have recovered fully from surgery and are not taking any pain medications there are usually no limitations to alcohol use. If there is a noted problem with your liver, we may ask that people stop using alcohol altogether. This is not because you no longer have a gallbladder, but because your liver does not work well and alcohol can worsen this. We do recommend that alcohol use be avoided or only consumed in small amounts just for your overall general health..

The only treatment for gallstones that can definitively remove the stones and prevent them from causing future problems is to remove the gallbladder. Some medications claim to dissolve stones or prevent them from forming, but these are not usually successful once stones have already formed. Gallstones cannot be blasted or removed like kidney stones. Unfortunately the only way to fully treat them is to remove the gallbladder. Sometimes if gallstones are causing only minimal symptoms or not causing any symptoms at all, they can just be watched or the patient can try eating a low-fat diet to control symptoms. However, this does not get rid of the stones.

When I have patients from out of town that require appendectomy I usually determine when they can fly using a few factors:
1. Was the surgery straightforward or complicated?
2. How long is the flight and are there places to divert?
3. What other factors specific to the individual patient could make it safe or unsafe to travel?

Ultimately it will depend on those and other factors and I recommend discussing it with your surgeon to determine the safest time to fly. Best of luck on your travel home!

Appendicitis is an emergency and I would recommend being seen in the nearest emergency department to get the right treatment.

You can expect to feel pain after surgery but in my patients I utilize all available pain treatment options in combination to keep the pain controlled and allow patients to continue their non-strenuous daily activities during their recovery. Every case and patient is unique so consultation with your surgeon can give you more specific answers to your individual recovery expectations.

It depends on the type of hernia and the type of repair performed. In my patients some inguinal hernias can return to full activity as soon as 2 weeks while other ventral hernias are 6 weeks before full activity. I recommend speaking your surgeon to determine the approach and their recommendations for the best recovery in your individual case.

It is completely dependent on the size and type of hernia and the type of repair needed to fix it. Some can be fairly quick while others take longer.