Preoperative Video for Hernia Patients

So what is a hernia? A hernia is a bulge of tissue created by a tear or weakness in the muscles of the abdominal wall that may allow the intestines to push thru during movement, coughing or lifting.  The treatment is an operation to repair that weakness. 

Say ‘NO’ to mesh! It’s very likely that by now you have done your own research and have come to understand that there are many complications that accompany the use of mesh to repair your hernia, which is why you are at U First Health & Rejuvenation.  Dr. Tomas utilizes the Desarda ‘no MESH’ technique, which he has perfected over the last 17 years.  The Desarda technique is basically the use of a muscle graft to strengthen the floor of the inguinal canal. Dr. Robert Tomas has performed well over 4,000 ‘no mesh’ hernia surgeries.  The surgery typically takes about 40 minutes from start to finish, under local with intravenous sedation.

The following information will help you make the best of your  surgery experience and will also minimize any confusion or questions you may have.  It’s imperative to your recovery process that you familiarize yourself with the following information to help alleviate your risk of a recurrence.

U FIRST SURGERY PATIENT INSTRUCTIONS BELOW.  (Colonial Outpatient Surgery Patients, Scroll Down)

1) Recovery Pack “Insiders”

You have purchased our “Recovery Pack” which includes the following items…

• Arnica Pellets – Homeopathic dissolvable pellets for muscle pain, stiffness, swelling and bruising.
• Docusate (Colace – red/white capsule) – used to treat constipation, acting as a stool softener
• Gabapentin (yellow capsule) – can be used as an ‘analgesic’ non-narcotic pain management method
• Tramadol (small white pill) – can be used in place of Gabapentin. Mild narcotic for more severe pain.
• Motrin (white tablet) – non-steroidal anti-inflammatory pain reliever, fever reducer
• Cephalexin (Keflex – green capsule) – antibiotic that treats infections caused by bacteria
• Bactrim (if allergic to penicillin – white tablet) – antibiotic that treats infections caused by bacteria
• Mullers ice bag – besides the above, ice will be your best friends 🙂
• Lidocaine patches (prescription strength) – provides temporary loss of feeling in the area where the patch is applied

Medication instructions: Pack 1 contains your Keflex (green capsule) or Bactrim (for penicillin allergies) and Docusate (Colace – red/white capsule).  Start by taking one (Keflex – green capsule/Bactrim white tablet starting at #1) at breakfast, along with one Docusate (Colace – red/white capsule).  With lunch take one Keflex (green capsule), if this has been ordered for you.  With dinner take one Keflex/Bactrim and one Docusate.  Repeat this cycle for ten days, per doctors order.

Pack 2 contains a dose Motrin (white tablet) and Arnica Pellets (white dissolvable pellets) and Gabapentin (yellow capsules) or its replacement Tramadol (small white pill).  Start by taking one Motrin 800 mg #1 (white capsule) along with the five Arnica tablets to be dissolved under the tongue , then four hours later take Gabapentin (yellow capsule starting at #2) or Tramadol (small white pill in #2) then four hours later take one Motrin (white tablet starting at #3) and dissolve 5 Arnica pellets (white pellets  also in #3) under your tongue.  Repeat this alternating cycle every four hours for five days, per doctors orders. If you feel like you need to take two Gabapentin (yellow capsule), you may do so on your next alternating cycle. The bottle included includes the extra Gabapentin yellow tablets or Tramadol (small white tablets) for your convenience after completion of pack #2.

Lidocaine Patches: After surgery a lidocaine patches will be placed near your incision/s.  After 24 hours you will need to replace your lidocaine patches.  You will need to cut your new lidocaine patches into fourths. Place one fourth above and below the incision in the area that hurts the most. repeat this process every 24 hours.

Around the 24 hour mark of your surgery, it’s best to combine replacing your lidocaine patch/s with the application of the Arnica gel by simply peeling back the large bandage covering your incision, remove your old lidocaine patches, apply the Arnica Gel (wait for it to dry), then apply the new lidocaine patch 1”-2” above the incision, then place the large bandage back over your incision.

48 hours after your surgery, you may remove the large bandage covering your incision.  Again, it’s best to combine replacing your lidocaine patches with the application of your Arnica gel every 12-24 hours, as needed.

Mullers ice bag:  Ice will be your best friend during this time.  Please ice the area once every hour for 20 minutes.  Do not place the ice pack directly on your incision.

COLONIAL OUTPATIENT SURGERY CENTER PATIENTS, YOU WILL LEAVE OUR OFFICE WITH A PRESCRIPTION FOR YOUR MEDICATIONS OR THEY WILL BE SENT ELECTRONICALLY TO THE PHARMACY OF YOUR CHOICE. 

THE MEDICATION PACKS MENTIONED ABOVE DO NOT APPLY TO YOU.

The day before your surgery you may get your prescriptions for pain and your antibiotic and follow the instructions on the bottle.

Lidocaine Patches:  After 24 hours you will need to place your lidocaine patches.  You will need to cut your new lidocaine patches into fourths. Place one fourth above and below the incision in the area that hurts the most. repeat this process every 24 hours.

Around the 24 hour mark of your surgery, it’s best to combine replacing your lidocaine patch/s with the application of the Arnica gel by simply peeling back the large bandage covering your incision, remove your old lidocaine patches, apply the Arnica Gel (wait for it to dry), then apply the new lidocaine patch 1”-2” above the incision, then place the large bandage back over your incision.

48 hours after your surgery, you may remove the large bandage covering your incision.  Again, it’s best to combine replacing your lidocaine patches with the application of your Arnica gel every 12-24 hours, as needed.

Mullers ice bag:  Ice will be your best friend during this time.  Please ice the area once every hour for 20 minutes.  Do not place the ice pack directly on your incision.

2.) Hernia Specific Information:

 Important Information for Inguinal Hernia Surgery

• Must wear supportive underwear (tight fitting supportive underwear) for at least 2 weeks to support and lift your testicles to reduce inflammation.  
• Make sure to SHAVE the entire area prior to your consultation and/or surgery to limit bacteria.
• After your inguinal hernia surgery you may have a hard ridge over your incision that is called a healing ridge. This should resolve in 2-3 months.
• You may also have a lump above the incision toward the outside and this is probably a knot from the suture that will absorb. This is felt in patients who are very thin.
• Your penis or testicles or labia in women may become bruised and turn a shade of purple and this will resolve in weeks. This is the blood traveling from the inguinal canal into your scrotum or labia in women.

Important Information for Umbilical/Incisional Hernias

• You will need to buy an abdominal binder (CVS, Walgreens,etc) and wear for at least the next 8 weeks.  You will need to sleep with the abdominal binder the first four weeks.
• Make sure to shave the entire area prior to having your consultation and/or surgery to limit bacteria.
• If you cough, sneeze or laugh hard, you must hold your incision for the next 8 weeks.
• After your surgery you may have a hard ridge above your naval that is called a healing ridge. This should resolve in 2-3 months.
• For ventral and incisional hernia repair patients your entire incision will be hard and should soften in 2-3 months.

3.) Important Information about Incision Care

• You may take off the large bandage covering your incision 48 hours after surgery.
• For the first 48 hours, we recommend to take a ‘sponge bath’ with a warm wet washcloth and soap to maintain hygiene.  Do not remove the large bandage covering your incision during this time.
• After 48 hours, you may get your incision wet however do not rub your incision with soap, a washcloth, luffa, etc. and only pat dry. 
• No baths, hot tubs, beach or swimming until the incision is completely healed which is usually 3 weeks or until your incision is completely healed.
• DO NOT APPLY ANY TOPICAL CREAMS ON THE INCISION.   
• Steri-strips (butterfly Band-Aids) underneath the large dressing stay on for 10 days.  You may remove them on the 10^th day after surgery in order to avoid ulceration of the skin.
• If your surgery is at COLONIAL OUTPATIENT SURGERY CENTER, your incision will be closed with surgical glue. There will be no steri-strips.

4.) Diet-day before surgery AND after surgery

• NOTHING TO EAT OR DRINK AFTER MIDNIGHT-this includes gum, mints, candy, water, coffee, smokes.  If you normally take a blood pressure or pain pill in the am then you may take it with a small sip of water. 
• Also, drinking gatorade and protein shakes will help your body heal.
• After surgery on the 1st day, go easy-buy a milk shake or smoothie for the ride home to get your stomach working and prevent nausea and vomiting, drink it slowly!    
• 2 -3 hours later you can try soup, sandwich, eggs, salads, fruits, chicken breast, your goal is to eat healthy with lots of proteins and fiber. 
• Eating small frequent meals are best 48 hours. We do caution eating NUTS UNTIL YOU HAVE A BOWEL MOVEMENT.
• The day of the surgery for dinner you may resume your normal diet.

5.)  Additional Information

• Swelling and black and blue are normal.  Bruising along the incision is also normal.  This resolves over 3-4 weeks and the Arnica pellets will help to minimize post surgery bruising. 
• The more you walk with your ice bag the first week, the better. While watching TV lie flat with a pillow under your knees instead of sitting in a chair. we want you to walk, but not miles.
• Get up and walk around every 1-2 hours the 1^st and 2^nd day after surgery to prevent blood clots (take a 10 to 15 min walk).  Walking is encouraged-gradually and build up distance as this will be your only exercise. 
• Please limit yourself from excessive bending, twisting, or reaching over your head for the first weeks. 
• NO LIFTING more than 10 lbs for 4 weeks-after 4 weeks you can lift up to 20 lbs.  After 6 weeks GRADUALLY increase 10 pounds per week. 
• No driving for 7 days.
• Expect to pass gas a day or so after surgery. 
• If you do not have a bowel movement by the second day after your surgery, buy a 10oz. bottle of Magnesium Citrate.  Take 3/4 of the bottle all at once and a bowel movement should occur within 8 hours or so.  If you do not have a bowel movement after the Magnesium Citrate, please call our office.
• On a scale of 1 to 10, your pain goal is to be below a 6.
• You may discontinue the use of your Gabapentin (yellow capsule) four days after your surgery if your pain is tolerable.  However, do not discontinue the use of any medications from pack 1 and continue taking the Motrin (white tablet) from pack 2.  IF YOU HAD YOUR SURGERY AT COLONIAL OUTPATIENT SURGERY CENTER, YOU MUST FINISH ALL OF YOUR ANTIBIOTICS. 
• Climbing stairs: use your good leg first.  Remember to move slowly and carefully.
• Call the office 239 243-8222 and schedule your post operative appointment if have not already done so.  FL residents may have a post operative appointmentt within 10 days.  Non FL residents should have a post operative appointment within 3 days to get cleared to return home.

6.) After hours–

• If you have concerns that cannot wait until normal business hours please contact our office either via info@UFirstHealth.com or call our office 239.243.8222.  Please leave a message if no one answers. 
• Your anesthesia practitioner or staff member will call you within 24-48 hours after your surgery.
• For urgent matters, you may call the office and follow the emergency prompts.  The after hours service is to be used only by patients who had surgery within the last 3 days and should be emergent.
• Please call our office if you are experiencing lots of drainage from your incision or you have a temperature of more than 100.5 F. 
• Emergencies, Go to nearest Emergency room or Gulf Coast Medical Center, located at 13681 Doctors Way, Ft. Myers, FL. Phone 239.343.1000.  Dr. Tomas has privileges for patient care at Gulf Coast Medical Center.  If you are not local, please go to your nearest emergency room or call 911 FOR ANY CHEST PAIN OR SHORTNESS OF BREATH.
• For urgent questions that cannot wait till the next business day call Dr Robert Tomas 239-243-8222 and follow prompts for Dr. Robert Tomas and he will answer or return your call.

Please bring these instructions with you the day of surgery. 

We recommend No Mesh Hernia Repairs for all primary (first time) inguinal/umbilical hernias. We are the premier No Mesh Hernia Center in the United States. We perform exclusive no mesh hernia repairs and do not even mention mesh in your consultation. Dr. Robert Tomas has performed over 4,000 of these type of Desarda no mesh inguinal hernia repairs. This is the kind of surgeon you want repairing your inguinal/umbilical hernias. He is the only surgeon in the United States certified by Dr. Mohan Desarda to repair inguinal hernias using his technique. We get calls every day about people wanting their mesh removed because of pain. This is why you should travel to Florida for your hernia repair.

You cannot lift heavy objects (greater than 10 pounds) for 4 weeks if a single side hernia was repaired. If you have both sides repaired then you cannot lift heavy objects (greater than 10 pounds) for 6 weeks.

You can return to a desk job or any other job that requires no lifting after a week.

You can drive one week after surgery if you are off of narcotics and have minimal pain.

You will have your consultation on Monday, Tuesday, Wednesday or Thursday and then have blood work and EKG after your consultation. You will then have surgery the next day on Tuesday, Wednesday, Thursday or Friday. We recommend that you stay the night and have someone drive you home in the morning if you live in Florida. We have had patients driven home after the surgery if they live 2-3 hours from Fort Myers. They are instructed to walk around at a rest stop half way home to encourage circulation to the lower extremities. If you live out of state we recommend you stay for 2-3 days and leave after your postoperative appointment.

Majority of cases are done with local (inguinal block) and intravenous sedation (propofol). General anesthesia is used if the patient is obese, the hernia is extremely large or patient requests general anesthesia

All inguinal and umbilical skin incisions will be closed with absorbable sutures. No staples are used. No stainless steel wire is used as in the shouldice inguinal hernia repair. All inguinal hernia repairs utilize absorbable sutures. However, all umbilical and ventral hernia are repaired with non-absorbable sutures. The skin is closed with absorbable suture.

On average 15-20 hernia surgeries a week. Dr. Tomas has been personally trained by Dr. Desarda in the No Mesh hernia repair (Desarda Technique). He even recently visited the center to observe several patients having surgery. Dr. Tomas has performed over 4,000 Desarda hernia repairs.

These are the number of no mesh inguinal hernia surgeries Dr. Robert Tomas has performed over the last 6 years.

These calculations were discontinued after 2015. Our recurrence rate remains under one percent/.

2010 – 69

2011 – 134

2012 – 181

2013 – 403

2014 – 345

2015 – 392

Total – 1,524 no mesh inguinal hernia repairs.

To date we have approximately 11 (0.7%) documented recurrences and the majority of these were within the first few years.

Yes our surgery center is certified and has been inspected with the state. We have also been inspected and certified by the AAAASF which is an ambulatory surgery center inspecting board.

A nurse anesthetist will be providing anesthesia at U First Surgery Center. An anesthesiologist will be performing the anesthesia at Colonial Outpatient Surgical Center (COSC). The surgeries at COSC are on Tuesdays only and involve Medicare and higher risk patients (obese or with heart conditions, etc..)

We do not accept any insurances and all patients are treated as self pay. We are mainly a one price all inclusive concierge surgical practice. Why? The answer is that there is a tremendous amount of staff needed to handle insurance confirmation/billing/denials. This was not cost effective for our practice so we dropped all insurances. We do offer Medicare patient discounts so please call for the pricing.

However, many patients submit their paperwork and receive all or a portion of their surgical fee back from their insurance carrier. We will give you all the paperwork required to submit to your insurance carrier. The amount you receive will depend on your insurance carrier and your deductible.

Please see the Springhill Marriott logo on our home page. Homewood Suites has also entered into contract with our facility. We have arranged a discount of $89.00 per night for our patients. Prices between June and April may vary because of tourist season. Pick up to and from the airport and surgical center is complimentary for your convenience.

The Shouldice repair involves a multiple layered repair of the floor of the inguinal canal. One of the layers that the Canadian surgeons use is a running stitch that is a stainless steel suture. In the United States many surgeons use a non-absorbable suture instead of a stainless steel suture. In the Desarda repair we are laying a one inch strip of your muscle on the floor of the inguinal can to strengthen the floor. The muscle is sewn in with all absorbable sutures, so nothing will be left behind on the floor of the canal except you own muscle. I don’t know about you, but I would rather not have stainless steel suture in my groin.

The surgeons in the United States are trained using mesh techniques. This is what is taught in surgical residency programs.

You may find a surgeon performing a no mesh technique on the west coast and it will most likely be a Shouldice or McVay repair which are tension repairs. The Desarda is a tension free repair and all the sutures used to sew the muscle are all absorbable. Dr. Robert Tomas repairs inguinal hernias exclusively with The Desarda no mesh technique and this is another reason to travel to Fort Myers to have your hernia repaired. You don’t want a surgeon that repairs hernias with no mesh only as only a small percentage of their practice.

Dr. Tomas will only remove mesh from a previous inguinal hernia repair only if it was an open technique. We will need the operative report faxed to  239-236-1595 or emailed to info@ufirsthealth.com. Dr. Tomas does not remove mesh if the repair was done from a laparoscopic approach. If it was an umbilical hernia repair with mesh, then the operative report will need to be reviewed by the surgical team before your case is accepted.

Yes the Desarda repair is better than the laparoscopic repair because it does not involve mesh. Laparoscopic repairs use mesh for the repair on inguinal hernias.

The Desarda Technique is essentially a muscle graft that is laid across the floor of your inguinal canal. It will grow into the surrounding structures and remain with you for the rest of your life. You can resume normal lifting after 6 weeks from your surgery. There will be no deformities or weakness of the musculature associated with the repair. There is no foreign body like mesh and all the sutures are absorbable.

Yes. U First Surgical Center is credentialed by AAAASF credentialing board. We are inspected every two years and must and must pass a rigorous inspection process.

Our umbilical or ventral repairs require a three layered closure that closes the naval or ventral defect and repairs the tissue three inches above and below the defect to lower the recurrence. These three rows of sutures to reinforce the area above and below the defect or hole lower the recurrence dramatically. Recurrence rate for this technique is less than 5%. Again, no mesh is involved in the repair. Umbilical hernia repairs are $5,500.00 and ventral hernia repairs are $5,500 which are all inclusive rates if done in our center.

Complications rarely occur with our surgeries. However, if they do it will be within the first 2-3 days from surgery and that is why we require a visit within this period. These complications can me remedied usually with the office setting. The other small complications like a small wound infection or rash from a medication at a later date can be handled by your family physician.

I am sorry, there are no guarantees with any surgery. We will make exceptions at times if there is a recurrence within the first 3 months. This has only happened once and there was a reason for the recurrence because of the patient lifting prematurely.

We have repaired hernias on all types of athletes including basketball, soccer, tennis, football and even jujitsu fighters.

The Desarda Technique is essentially a muscle graft that is laid across the floor of your inguinal canal. It will grow into the surrounding structures and remain with you for the rest of your life. You can resume normal lifting after 6-8 weeks from your surgery. There will be no deformities or weakness of the musculature associated with the repair. There is no foreign body like mesh and all the sutures are absorbable.

There is a very rare chance (1%) of this occurring because Dr. Tomas  identifies the ilioinguinal nerve as well as the spermatic cord and isolates them  once he enters into the inguinal canal on all surgeries. Therefore, damage to the nerves or spermatic cord is extremely rare.

Dr. Tomas uses absorbable sutures on the skin and subcutaneous tissue and uses absorbable sutures for re-constructing the floor with a one inch strip of the external oblique aponeurosis which is the muscle that covers the inguinal canal..

In only rare cases the tissue is so damaged that mesh is the only alternative in order to prevent a high rate of recurrence. This is mainly with patients that have had multiple inguinal hernia recurrences. Dr. Tomas rarely uses mesh for primary (first) hernias.

Dr. Tomas has been performing the Desarda technique since 2009, He performs 10-15 hernia surgeries a week and has performed over 4000 cases using no mesh tension free repair (Desarda Technique). Recurrence rate is approximately 1% which is very low for hernia surgeries.

Yes, the Desarda technique is as effective for women as it is in men. There is still a 1% recurrence rate for women with inguinal hernias. As far as umbilical hernia repairs, women can have the the triple layered umbilical repair and still get pregnant later in life.

Yes the Desarda Technique is essentially a muscle graft that is laid across the floor of your inguinal canal. It will grow into the surrounding structures and remain with you for the rest of your life. You can resume normal lifting after 6-8 weeks from your surgery. There will be no deformities or weakness of the musculature associated with the repair.