Inguinal Hernia(s)

Had bilateral inguinal hernias repaired 6 days ago - open surgery and no mesh. Left side was direct at about 4x2cm and right side was indirect at 7x3cm

Pain is variable but significant - purple junk is starting to subside!

How long before i can realistically start to feel better - sitting isnt good, standing is sometimes OK as is walking. Sleeping is a bit of a challenge die to a side sleeper and the incisions and hernias not liking that much - Much vitamin I for me -

So whats it gonna be like - sitting at a desk all day will suck for sure

Probably another week, maybe 2 before you can sit comfortably. Hard to predict--a lot of variability. I've had 2 done (separately) and they were very different. Having bilaterals done in one setting is only for the tough-I admire you. Hope you have something stronger than Vitamin I (by which I assume you mean ibuprofen) to take as long as you're not driving.

Thanks doc. I do mean vitamin I to mean that, have some tramadol too but it makes me feel wierd but I think I can tolerate codeine better if I need to.

It's odd in that each side feels different and will hurt in a new way compared to the other depending on the day.

Maybe I am dumb rather than tough....

oh and what do you mean by yours being different ??

Why no mesh?

Sent from my ADR6425LVW using TGR Forums

Because the tissue was good and could be repaired without and I didn't like the idea of mesh

I had one side done almost a year ago now. I used a wheelchair to get to the hospital door but walked from there. Sat around the house for a couple of days. Lots of cold compress.

Didn't use any pain meds because I was terrified to take a shit let alone have to deal with any constipation.

Within a week I took my dog for a short walk and was back to work in about 2 weeks. Hiking and riding my bike not long after that!

It was a mesh repair, but the mesh was placed on the inside of what I think is the the peritoneal lining, rather than on the outside of it, which is a fairly new procedure as it was explained to me...sooo yeah.

Not bad at all. Pain free and normal as ever!

Only now I experience anxiety of the other side blowing out...

Best of luck with your recovery!

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Originally Posted by neufox47

Why no mesh?

Sent from my ADR6425LVW using TGR Forums

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Not relevant to the OP's situation, but in general--these days surgeons are using mesh on nearly all hernia repairs, due to a lower recurrence rate and maybe less pain. But in the very unlikely event that mesh gets infected it can be a very difficult problem and the mesh will have to be removed. Also the scarring the mesh produces can contribute to chronic pain, and the recurrence rate with non-mesh repairs is still very low. (I started using a very light weight mesh that maybe causes less scarring--have to be careful with it though--if you put it down on blue drapes you can have trouble finding it again--it's quite transparent). In recent years I've used mesh on all repairs but my own repairs were both done without mesh--an esoteric repair called a Shouldice repair. Even though I'm a surgeon, I picked the surgeon I wanted, not the operation I wanted, and let him do what he wanted. (He later switched to mesh, too). Point is--while almost all repairs are done with mesh, nothing wrong with nonmesh repair, as long as the patient knows the trade-offs.

I too had a non mesh bilateral repair performed by the same team as the OP- but for sports hernias... thin/bulging fascia defect with no actual herniation or tear in the fascia-- and am now 9 weeks post surgery.

The docs in question are the best in the world at what they do. The walls are lined with photos of the pro athletes flown in from around the world for the repair.

Granted my defects were much smaller, but I went up 88 stairs the day after surgery. I've been on my road bike since day 11.

There were a few scares based on very odd feelings (all checked out)... but I feel incredible now.

Everything I've read- and I did a near formal review of the literature going back decades- indicates that Dr experience is more important even than technique. Our docs have only done hernia repairs for years and nothing else.

Indeed true regarding the doc - I picked the doc and they decide on the repair. Their preferred method of repair in younger patients is non mesh but if they go in and find the facia in tatters then they will use mesh as this is in the best interests of the patient.

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Originally Posted by chewymix

How long before i can realistically start to feel better

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quite a long time it seems when after not getting better - and actually getting worse MRI reveals CAM FAI on both hips with laberal tear in right hip and two tears in left, articular cartilage showing some signs of delamination in the left also. I fear that my hernias, although real and present, were not my pain generators and the hips were all along.

balls.

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Originally Posted by chewymix

quite a long time it seems when after not getting better - and actually getting worse MRI reveals CAM FAI on both hips with laberal tear in right hip and two tears in left, articular cartilage showing some signs of delamination in the left also. I fear that my hernias, although real and present, were not my pain generators and the hips were all along.

balls.

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If it's any consolation, you still needed the hernias fixed: even if they weren't the cause of the symptoms (and I don't know squat about hips) they would have become symptomatic in time, and the longer they've been there and the bigger they are the harder the repair and the higher the recurrence rate. Of course it would have been better to deal with the hips first, if in fact they were the source. OTOH with two different pathologies sometimes the only way to tell which is the source of symptoms is to fix one and see--and hernia surgery is certainly a smaller deal than hip surgery (if in fact you need hip surgery--I don't know.)
Good luck with the hips.

As far as balls--at least you still have yours. (Sorry, bad joke, couldn't help myself, I'm retired don't have to be professional any more.)

Old Goat Question-

So I managed to get an inguinal hernia, (right side), about three wks ago while stretching. Happened to have a physical a few days later and my doc, said I have a small bulge. Outside of about 10seconds of pain when it happened I wasn't having pain and would probably not have gone in to get it checked out. I got the Wait and See approach from my Doc.

Been a few wks and I think it has enlarged, (could be in my head). Anyway I have a decent size belly and was hoping to take the approach of losing weight and not getting sliced in the near future. I am only in slight discomfort and pain isn't bad. I really only have pain when I bend wrong etc.., and that goes away in a few seconds. As of now it doesn't appear that this stuff is going into my balls and unless I cough the bulge is barely noticeable. The most troublesome part is anxiety of having it fixed....I know the deal. It won't go away.

To appease my Wife, I made an apt with a urologist today, (he was recommended by a nurse anesthetist that we know). Should I be looking at a general surgeon? None of the three in my small hospital have the best reputations despite performing this on a routine basis.

A retired knee ortho, (who has had one of these repaired), friend of mine mentioned many of the open repairs are done with local anesthesia now. (I presume it's accompanied with an IV sedative or something of the sort). If I need to get this done what's your opinion on local vs general? I've never had either and general isn't on my list of things to experience if possible. Have had asthma since I was a kid and others in my family seem to struggle with ga recovery.

Thoughts? The!

With my hernias I had the first one fixed about a year after I discovered it--when it was convenient. The other right away because it was quite painful. If it isn't bothering you there's no rush. Around here I don't know any urologists who do hernias but if yours does that's fine; in general hernias are fixed by general surgeons but I'm guessing that your nurse anesthetist friend knows that your urologist does hernias. As far as the diagnosis--although it certainly sounds like a hernia, I would only take the word of a surgeon or urologist, not a family doc/internist, although sometimes they're right. As far as anesthetic--these days there's not a whole lot of difference between general and local with sedation. Even if you have it done under local you might think you were asleep the whole time even if you weren't. I've done a few hernias with local and no sedation at the patient's request and it went fine, but obviously the patients were motivated. Generally I would do young patients under general, especially if the hernias were large, and older, less healthy people under local with sedation. Either way is fine. Mine were local with sedation; I don't remember much. I preferred local a) because I was more afraid of nausea afterward than of pain during, although nausea isn't usually a problem and b) I wanted to be awake so that the nurses, all of whom I worked with on a daily basis wouldn't be making comments about my anatomy, or lack of it.

It's interesting that doing good sedation--so that the patient is relaxed and not having pain but is still cooperative, not overreacting or getting crazy--is a lot harder for an anesthetist than doing a general. Patients who get too much sedative and get uncontrollable often wind up with a general. Ask your friend who he or she recommends to do the anesthetic if you wind up having surgery, whether it's general or local.

Thx! It's nice to hear from a doc that has experience on both sides of the table! This thing has started to bug me, although much of it is in my head! As much as I want to avoid surgery I think I need to go down that path. The urologist was not helpful. He told me I have a hernia and said I could wait or get it done. Not a very personable fella! He recommended the laparoscopic approach and in turn referred me to a guy who has been known not to be the man to go to. Oh well... He also thought I was crazy for even asking about local with sedation. Our folks are behind the times I think.

Given that I have 5 friends, (4 males , 1 female ), that have had this done in our valley and 4 of the five have had bad experiences and complications ranging from life threatening to on going problems, I'm beginning to think I will leave the area for it.

So I need to choose which type, open or lap. I understand laparoscopic usually has a shorter healing time but it seems to me there is a larger margin for surgeon error while messing around in there. For reference, 3 or the 4 friends that had problems here had the laparoscopic surgery. I'm torn btwn the two. Either way I'm freaked.


Thanks again OG! Hope this thread helps others with their decisions!

As far as now or later--you are going to need it done sooner or later. If it's convenient you might as well do it now if you can get it done in time for ski season, otherwise in the spring. If you think it might be more convenient at some time in the future then ok to wait. Or maybe you better get it done while Obama is still president--you never know what may happen to your insurance in the next administration (unless Bernie wins and eliminates all copays and deductibles.)

I didn't do laparoscopic hernias but my partners who did use them for hernias on both sides or hernias that have came back after previous surgery. For single, new hernias I think an open approach is still best. Longer recovery perhaps but less risk of complication. One interesting approach that only one of my partners does is a preperitoneal repair with a Kugel patch. Pretty quick recovery, but I'm not sure if the long term success rate is good. If you find a surgeon who does that repair do some research. I generally predict 1-2 weeks off work for desk work, 2-4 for walking around/light physical labor, 4-6 weeks for heavy labor and sports, 1-2 days for self employed, up to 6 months for state workers. (Sorry, state workers, I don't really mean it, I know you work hard.) Most surgeons will have 1 or 2 operations they do; pick the surgeon, let the surgeon pick the operation. And keep in mind that the reason there are so many different ways to fix a hernia is that there are problems with every method.

And a story about returning to work--partner of mine did a hernia in a skinny 19 year old guy who worked in a warehouse. Skinny young men have the most pain (I had one guy faint dead away when I just examined him for his hernia.) This guy came back a week after the surgery because he wanted to go back to work sooner than planned and needed a note. My partner was in the OR so I saw him. Given the nature of his work I was concerned, so I told him to pick up the electrocautery in the clinic--about 100 pounds. He picked it up easily. He got his note. The restriction on activity isn't to prevent the hernia from coming back; it's simply because of the pain--you can do what you want when it doesn't hurt too much.

So I saw a general surgeon. He does almost all of these with local + propofol sedation. 'Was told that stuff was only for general but I figure this fella knows what he is doing. I questioned if folks felt tugging and pain and his answer was not really but being that they are in deep sedation they don't recall. Granted, I'd like to forget the experience but if a patient feels something during surgery that would lead me to think the patient would freak out a bit.

Anyway, I think I'll get it done in the open fashion in January. Not looking forward to it! Thanks OG!

More importantly, can you still row a drift boat? If you want to look at getting it done in the SLC you and the fam are more than welcome to the guest wing.

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Originally Posted by teleee

More importantly, can you still row a drift boat? If you want to look at getting it done in the SLC you and the fam are more than welcome to the guest wing.

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Good question! Currently not rowing cuz I have that work trip this wknd. Didn't want to make things worse for leaving town. Surgeon made the point to me yesterday....if you can't do somewhat normal activity that you love to do, it's time.

Thx! I'll probably do it here unless you know of someone really good down there. My Wife might ship me down there and stay here. She's played nurse enough this yr!

I had both hernias repaired under local. Don't remember anything about either one. With one the only thing I remember was screaming when my friend who was doing the surgery made the incision--I could tell he was doing it although I couldn't feel it. That was to get back at him for putting magnesium citrate (look it up) in my 7UP just before I went on a backpack trip. With the other one the only thing I remember is babbling nonsense before they made the incision and being unable to make myself stop--truth serum works. The thing I worried about the most was having an erection while I was being prepped. Turned out not to be a problem--with one operation the nurse that prepped me was a guy and for the other one the female nurse has probably never given anyone a hard on in her life.
Don't worry about it--you'll do fine.

After surgery stay ahead of the pain--it takes less meds that way, keep the constipation under control, and before and after stay away from rug rats, sick people, etc. You DO NOT want to be sneezing and coughing afterwards.

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Originally Posted by old goat

I had both hernias repaired under local. Don't remember anything about either one. With one the only thing I remember was screaming when my friend who was doing the surgery made the incision--I could tell he was doing it although I couldn't feel it. That was to get back at him for putting magnesium citrate (look it up) in my 7UP just before I went on a backpack trip. With the other one the only thing I remember is babbling nonsense before they made the incision and being unable to make myself stop--truth serum works. The thing I worried about the most was having an erection while I was being prepped. Turned out not to be a problem--with one operation the nurse that prepped me was a guy and for the other one the female nurse has probably never given anyone a hard on in her life.
Don't worry about it--you'll do fine.

After surgery stay ahead of the pain--it takes less meds that way, keep the constipation under control, and before and after stay away from rug rats, sick people, etc. You DO NOT want to be sneezing and coughing afterwards.

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That's a good one! My kids are on the second cold of the school year already. I might have to go to Teleee's house to keep out of harms reach!

Did you use propofol for sedation? My knee doc friend told me he thought they should be using something milder for sedation + local. Apparently this doc is using some kind of nerve block that helps deal with the pain into the second recover day. Hope he's right!

I don't think I will get locked up....doc told me that's a bonus of sedation over general. Hopefully that's the case! Thanks OG!

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Originally Posted by schwerty

That's a good one! My kids are on the second cold of the school year already. I might have to go to Teleee's house to keep out of harms reach!

Did you use propofol for sedation? My knee doc friend told me he thought they should be using something milder for sedation + local. Apparently this doc is using some kind of nerve block that helps deal with the pain into the second recover day. Hope he's right!

I don't think I will get locked up....doc told me that's a bonus of sedation over general. Hopefully that's the case! Thanks OG!

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You are always welcome! I don't actually know any general surgeons but have a pretty good group of doc buddies so if you want me to find the best SLC has to offer I can find out with a quick text. Obviously we need to get out and fish before you go in to evaluate your pain level.

I have no idea what they used on me; best guess is Versed and maybe fentanyl. Propofol is fine unless you really want to be awake the whole time. (Hey, it worked for Michael Jackson.) A lot of patients under sedation do go to sleep, they might wake up during the surgery and then go back to sleep again. Whatever your surgeon or his anesthetist uses is fine. These days the line between general and sedation is a lot blurrier than it used to be.

The constipation is from the narcotics not the anesthetic.

I usually try to avoid pain pills but I'll probably have to go down that road, eventually moving to a bottle of whiskey and Advil if my Wife will let me slide laying on the couch sipping brown water.

Teleee - I'd be curious to know the best person for the job down there. Thx! Doubtful I'd come down to do it being that is be away from home for a week or so but maybe?? Unless there is someone really known for these things I should probably save my hall pass from family time for a couple days at the cabin or in the Keys.

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Originally Posted by schwerty

So I need to choose which type, open or lap. I understand laparoscopic usually has a shorter healing time but it seems to me there is a larger margin for surgeon error while messing around in there. For reference, 3 or the 4 friends that had problems here had the laparoscopic surgery. I'm torn btwn the two. Either way I'm freaked.

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I had a open surgery with mesh done 3.5 weeks ago. First few days sucked but it's been an improvement each day. There is still some occasional pain but have been able to get out and do some hiking over the past couple days.

My recommendation for when to get it done is as soon as possible. I had been stubbornly dealing with the hernia (ended up being two) for close to two years. The timing is never convenient and will blow up some plans but I am stoked to have finally gotten it done and am hoping to not have to deal with the pain while running or climbing again.

I was all set on laparoscopic after doing my initial googling, but the doctor I went to convinced me on the open, with the only drawback being an extra day or two longer in dealing with the surgical pain.

Thx for the advice, TW.

Old Goat - I'm being stubborn about getting it done too. Go figure, when I spoke with the surgeon, he danced around the question and gave me the right answer...if you can't do what you want to then it's time. While I agree, I'm questioning timing. Is it a stupid idea for me to ski, (I live in JH), with a small-mid size, (I can feel it and have occasional slight pain), this season? Seems to me that skiing anything that is reasonably fun would be a lot of stress to the area. Point of asking is simply due to me not wanting to be forced into surgery because I did something stupid. I'm going fine with mild to moderate exercise. Gave up weights. I actually feel better from head to toe with more cardio now but that's another story.

Getting it done now would not work well for family and work reasons. Should I make turns in a "normal" fashion or hold back until I get it fixed?

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Originally Posted by schwerty

Thx for the advice, TW.

Old Goat - I'm being stubborn about getting it done too. Go figure, when I spoke with the surgeon, he danced around the question and gave me the right answer...if you can't do what you want to then it's time. While I agree, I'm questioning timing. Is it a stupid idea for me to ski, (I live in JH), with a small-mid size, (I can feel it and have occasional slight pain), this season? Seems to me that skiing anything that is reasonably fun would be a lot of stress to the area. Point of asking is simply due to me not wanting to be forced into surgery because I did something stupid. I'm going fine with mild to moderate exercise. Gave up weights. I actually feel better from head to toe with more cardio now but that's another story.

Getting it done now would not work well for family and work reasons. Should I make turns in a "normal" fashion or hold back until I get it fixed?

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I spent two years waiting for the surgery and dealing with the two hernias I had by using hip stretches and exercises to pop it back in so I could run. Totally stubborn even though I knew exactly what I had and looking back post-surgery I wish I had done it sooner.

This was the primary stretch:
http://smartartshosting.com.au/galax...ip-stretch.jpg

And mixed with this hip routine seemed to keep me together this whole past year with 30+ miles running per week.

https://www.youtube.com/watch?v=2GLrKr54yA0

As far as when to fix it--if it bugs you fix it. If it doesn't bug you fix it when it's convenient, whenever that is, just not during ski season. If it really hurts and you can't get the lump to go away when you lie down and push on it get it fixed today before your bowel dies.