Kevin Masur

Most patients can be discharged home after the procedure. Most patients can return to “full function” within 7 days. Most patients will typically need <10 tablets of pain medication, and only take them for 1-2 days.

For a smaller laparoscopic procedure (i.e. appendectomy, cholecystectomy), being the “passive” partner during sex should be fine after about 2 weeks. Being a more “active” partner should probably wait until ~4 weeks.

It depends. If the hernia is found on exam alone (i.e. no visible bulge, no symptoms, normal activities without discomfort, etc.) - then surgery can be safely deferred until symptoms develop or the hernia becomes visible. If the hernia is visible and/or symptomatic - then repair options include open (more traditional) or laparoscopic (+/- assistance of the robotic surgical system) repairs with or without mesh (lap is with-mesh only).

Surgical site infections - which include infections in/around the surgical incision site in the skin - are fairly uncommon with “planned” (i.e. elective) surgeries. The risk increases with several patient factors - including morbid obesity, diabetes, immune-modulating drug use (i.e. steroids), and smoking.

Recovery following hernia surgery, including time off work and time before resumption of “normal” activities is variable depending on the size of the hernia, the location of the hernia, whether your surgery is outpatient or inpatient, and the method of repair. In general, most patients will have strong activity restrictions for at least 2 weeks following hernia repair - limited to walking, but no running/jumping/biking etc. and with a weight restriction of typically 15-20 lbs max. Most surgeons will lighten these restrictions for weeks 3-6, allowing for some light jogging, swimming, and riding a stationary bike. Weight limits usually rise to 30-35 lbs. Most surgeons allow “full” return to unrestricted activities anywhere between 4-8 weeks.

No, there is a growing trend towards non-surgical management of mild, early acute appendicitis. If he met the criteria, it is very possible that he will be successfully managed in the “acute” settings without surgery. The risk he runs is recurrent (or future) appendicitis, which is typically ~25%. It is still not “mainstream” to treat patients without surgery, but many surgeons and hospitals are employing this treatment strategy. If patients are managed non-operatively during the acute setting, there is not absolute indication that he should undergo an “elective” appendectomy in the future. Only for recurrent symptoms (or return of symptoms) after antibiotics completed.

The idea of “informed consent” is that the patient agrees to proceed with surgery after they have been given the risks, benefits, and alternatives to surgery. Many now include expected post-operative recovery to this list. I think any good discussion with your surgeon should include these - and how often the risks/complications can occur. For newer/novel surgeries (i.e. robotics, etc.) - it is generally an OK question to ask the surgeon about their volumes of doing that procedure. Generally, having done MORE is better. Although complications from surgery are generally rare, it is good to get a sense of whether the surgeon will “stick with you” if they arise, as opposed to one who will “push you away.” Not easy to determine at times, but helpful.

The work-up of abdominal pain can be challenging. If the primary care doctor has been unable to make a diagnosis after taking a good history and performing a good physical exam, they add labs and/or imaging to help make the diagnosis. For gallbladder, this includes labs (CBC, CMP) and an abdominal ultrasound. If the symptoms (history) fits and the ultrasound shows gallstones, then it is oftentimes the culprit. If unsure (or no gallstones), then an additional test (called HIDA scan) can be performed. If your doctor ends up deciding the gallbladder is the source of your discomfort/pain, then surgery is only known intervention. Modifying your diet and herbal remedies can temporarily relieve symptoms or make the symptoms less frequent/severe - but are not a good long-term strategy.