*** OFFICIAL INGUINAL HERNIA RECOVERY Thread ***

[culican]

The no-mesh techniques are making a comeback. Take your time.

My hernia on the right side was recurrent, originally repaired by a non mesh method back in 1992.

I speak from experience when I say that the non mesh repair hurt for a couple of years before the pain finally went away. That only makes sense because, in the absence of mesh to block the hernia opening, the tissues must be pulled and sutured under tension to close the opening. The sutures they use are permanent, so you are still left with foreign material in your body.

So now, I have ProGrip mesh on both sides plus old sutures still in my right side.

Interestingly, the old repair did not fail. I asked the surgeon, it was still intact. What happens is that, due to the tension, you are more likely to have a hernia in the adjacent area.

During my research, I found out that any hernia in the groin area on the same side is classified as a "recurrence." It doesn't mean that the original repair failed. Surgeons usually use mesh large enough to cover all of the hernia sites in the groin so a mesh recurrence is caused by mesh shifting or mesh shrinkage whereas a recurrence for a tissue (non-mesh) repair is in many cases from the adjacent area herniating and not a failure of the original repair.

[SoccerAgain]

That's why they like the mesh. They can cover all of the future problems in one shot. It's also fairly common to get a hernia on the opposite side within a few years. Probably because the other side gets stretched when the fixed side tightens up. So if they see even a small sign of a hernia they put mesh on both sides. It sounds like a great idea. But if your body doesn't like the mesh it's a really bad idea.

My biggest issue with what's going on, since I'm involved now, is that there's no formal followup process, and no formal sharing of information. There is a lot of plausible deniability, which is great from a business perspective but deplorable from a "do no harm" perspective. The focus on recurrence is too narrow. One pain is traded for another.

[Magnacromion]

What type of surgery, open or laparoscopic?

Laparoscopic mesh repair. On both sides.

[Magnacromion]

You have lots of time to do research. Don't jump in. Every surgeon uses their own techniques and ideas. If you know what kind of life you want to lead afterward, keep looking until you find a surgeon who works on those types of people. I am serious, they all have their own methods.

The no-mesh techniques are making a comeback. Take your time.

Thanks, guys. I appreciate the warning, but I don't think I'm jumping in—I've been planning this surgery off and on for nearly five years.

I've seen a lot of conflicting literature on chronic post-herniorraphy pain syndrome. The surgeon stated that the risk in my case was extremely low. As far as the mesh/non-mesh debate, from what I've read, the most important thing is to elect whatever procedure your surgeon has the most experience performing. The studies I've read suggest that any difference in outcomes attributable to mesh/non-mesh procedures is dwarfed by the difference caused by the surgeon's relative level of experience. One thing that makes me lean toward mesh (especially when installed laparoscopically) is the markedly shorter recovery time. As I've stated, waiting more than 4-5 weeks to go heavy again would be an absolute dealbreaker for me. If I were looking at a layoff that long, I might forego the surgery entirely. I believe the Shouldice clinic (which I believe is one of the better non-mesh repair facilities) prescribes a significantly longer layoff than 4-5 weeks.

In my case, the surgeon I picked has a great reputation (including among the nurses who work for him), and he's the head of surgery at the biggest teaching hospital in my metro area. He specializes in colorectal/abdominal surgery, and he's been practicing for 30+ years. I feel pretty comfortable with my choice.

What do you mean by "find a surgeon who works on those types of people"? Find a herniorraphy specialist who works exclusively on athletes? I doubt such a doc even exists in my metro (total metro population is around 1 million, most of whom aren't athletic at all). Are you saying I should consider travelling for my surgery? I made clear to the doc that I lift heavy, I bike, and I ski, and I intend to continue doing all of those things until I'm six feet deep. He seemed totally on board with that, and said that after the recovery period, I wouldn't be able to fail the repair even if I tried.

I'm most interested in the immediate, short-term recovery period. Am I crazy for thinking I can go back to 90% of my normal working weights 4 weeks post-op? That's what the surgeon said…is he just overly optimistic? I just get concerned because I see stories in this thread of people who can barely walk down the street a full month post-op.

[Magnacromion]

One pain is traded for another.

Forgot to respond to this. I have virtually zero pain from my hernias. I may get a dull ache at the end of a long day once a month or so. Are you suggesting I should just leave them be? I'm concerned about incarceration. Even though the risk is low, I like to hike in remote places, far from roads and far from help. I thought I should get them repaired as a sort of prophylactic.

[culican]

T

I'm most interested in the immediate, short-term recovery period. Am I crazy for thinking I can go back to 90% of my normal working weights 4 weeks post-op? That's what the surgeon said…is he just overly optimistic? I just get concerned because I see stories in this thread of people who can barely walk down the street a full month post-op.

Last Thursday, 15 days post-op:


Deadlifts: 135x5, 225x5, 255x1, 275x3, 295x1, 275x5
SGDL [straps]: 225x5

My recent deadlift 1RM was 365. 295 two weeks after the operation is not bad.

When I had my open non-mesh repair 25 years ago, the surgeon didn't clear me to lift anything until 6 weeks out. And I felt pain at the surgery site when I finally started so I had to go slow. Last Thursday I felt no pain.

The reason so many guys talk of prolonged recoveries is because they baby themselves too much out of fear at the beginning. If you don't work the tissues while they are healing the scar tissue forms differently and may lead to more pain.

I quote again from one New York surgeon, "On the third post-operative day, unless told differently by me, you have FULL UNRESTRICTED physical activity. There is no limitation, and the more you do, the quicker the pain and discomfort will disappear. Some discomfort and pain is normal. Your body will set your limits, though it is ok to be aggressive."

The above quote is for laparoscopic repairs, not for open repairs, which have a longer recovery.

I think he is on to something there. He has done this repair on over 1000 patients.

[culican]

Forgot to respond to this. I have virtually zero pain from my hernias. I may get a dull ache at the end of a long day once a month or so. Are you suggesting I should just leave them be? I'm concerned about incarceration. Even though the risk is low, I like to hike in remote places, far from roads and far from help. I thought I should get them repaired as a sort of prophylactic.

One year ago I got a severe pain in my right groin with a hard bulge. I felt constipated. I lay down and fell asleep and when I woke up it was gone. At the time I was in denial that my hernia had returned. But I now know it had and it had become incarcerated. Fortunately it did not strangulate, which as you know, is a medical emergency. So it can happen out of the blue.

When I finally could no longer deny to myself that the hernia had returned I got it repaired right away.

[temerity76]

I have an appointment with one of the leading hernia surgeons in my country. Should I ask anything specific to him apart from the usual questions? Which is the best mesh nowadays and also size recommended for small hernias?

[SoccerAgain]

I've seen a lot of conflicting literature on chronic post-herniorraphy pain syndrome. The surgeon stated that the risk in my case was extremely low. As far as the mesh/non-mesh debate, from what I've read, the most important thing is to elect whatever procedure your surgeon has the most experience performing.

One thing that makes me lean toward mesh (especially when installed laparoscopically) is the markedly shorter recovery time. As I've stated, waiting more than 4-5 weeks to go heavy again would be an absolute dealbreaker for me. If I were looking at a layoff that long, I might forego the surgery entirely.

In my case, the surgeon I picked has a great reputation (including among the nurses who work for him), and he's the head of surgery at the biggest teaching hospital in my metro area. He specializes in colorectal/abdominal surgery, and he's been practicing for 30+ years. I feel pretty comfortable with my choice.

What do you mean by "find a surgeon who works on those types of people"? Find a herniorraphy specialist who works exclusively on athletes? I doubt such a doc even exists in my metro (total metro population is around 1 million, most of whom aren't athletic at all).

I'm most interested in the immediate, short-term recovery period. Am I crazy for thinking I can go back to 90% of my normal working weights 4 weeks post-op?

You're thinking almost exactly like I did. Now it's three years later and I would have taken a year long recovery for better results.

Not "exclusively" just defined as what you do. They should be able to talk about another weightlifter, or runner, or biker. Sitting at a desk and walking a mile each day is not the same as running 10 miles per week, or weight-training. . The surgery today is one-size-fits-all. My surgeon was top-notch, great reputation, etc. The surgeon's success numbers are going to be dominated by the desk-sitters, and the odd unhappy patient is going to be an outlier, and ignored. Don't be an outlier. That's why you have to be specific and get him or her to say it.

If the hernias aren't getting larger then there's no risk of incarceration. The bowel has to actually get through the hole and kinked, blocking it. You're planning to take a big dangerous step for a problem that does not exist.

You said that you're pain free and they've been stable for many years. You're probably a perfect candidate for mesh-free technique, like Shouldice, because, obviously, what you've been doing isn't stressing the area. Mesh is overkill.

Beside the mesh, one thing that's not talked about much is the fact that laparoscopy dissects, or cuts open, a very large area of tissue that was in perfect virgin form. Then the surgeon puts mesh where there is no hernia, as an anchor and as a reservoir of mesh, for the shrinkage that will occur. All of the new damaged area is where much of the post-pain comes from. They create a new broad problem, to fix a small specific one.

What I'm really saying is be very careful. There is a large bureaucracy behind the mesh hernia repair industry. And the health care industry is getting depersonalized. Patients are becoming more like numbers, or "human resources". The best meaning surgeons still have to work within that system, and still consider recurrence as their major problem.

[temerity76]

You're thinking almost exactly like I did. Now it's three years later and I would have taken a year long recovery for better results.

Not "exclusively" just defined as what you do. They should be able to talk about another weightlifter, or runner, or biker. Sitting at a desk and walking a mile each day is not the same as running 10 miles per week, or weight-training. . The surgery today is one-size-fits-all. My surgeon was top-notch, great reputation, etc. The surgeon's success numbers are going to be dominated by the desk-sitters, and the odd unhappy patient is going to be an outlier, and ignored. Don't be an outlier. That's why you have to be specific and get him or her to say it.

If the hernias aren't getting larger then there's no risk of incarceration. The bowel has to actually get through the hole and kinked, blocking it. You're planning to take a big dangerous step for a problem that does not exist.

You said that you're pain free and they've been stable for many years. You're probably a perfect candidate for mesh-free technique, like Shouldice, because, obviously, what you've been doing isn't stressing the area. Mesh is overkill.

Beside the mesh, one thing that's not talked about much is the fact that laparoscopy dissects, or cuts open, a very large area of tissue that was in perfect virgin form. Then the surgeon puts mesh where there is no hernia, as an anchor and as a reservoir of mesh, for the shrinkage that will occur. All of the new damaged area is where much of the post-pain comes from. They create a new broad problem, to fix a small specific one.

What I'm really saying is be very careful. There is a large bureaucracy behind the mesh hernia repair industry. And the health care industry is getting depersonalized. Patients are becoming more like numbers, or "human resources". The best meaning surgeons still have to work within that system, and still consider recurrence as their major problem.

So you mean to say if the hernia isn't getting larger we should not mesh fix it? Won't they have to cut and operate for a non mesh surgery as well?

Confused

[Magnacromion]

I have an appointment with one of the leading hernia surgeons in my country. Should I ask anything specific to him apart from the usual questions? Which is the best mesh nowadays and also size recommended for small hernias?

I think there are others here who may be better equipped to respond, but I would say to ask "the usual" questions and do your homework. Open vs. laparoscopic, mesh vs. tension, recovery period, general vs. local anesthesia, pain management plan, etc. Make sure you work it out with your insurance company and the hospital beforehand so you don't get balance billed. Just because your surgeon is in-network and the hospital is in-network doesn't mean the anesthesiologist is. Ask the surgeon how often he does herniorraphies. Ideally you want someone who does a minimum of 100 per year, with many years of experience. It's a very easy surgery to do adequately, but a very hard surgery to do perfectly. Someone who specializes in colorectal/abdominal surgery is good. Your run-of-the-mill general surgeon may or may not do that many hernia repairs.

[Magnacromion]

You're thinking almost exactly like I did. Now it's three years later and I would have taken a year long recovery for better results.

Not "exclusively" just defined as what you do. They should be able to talk about another weightlifter, or runner, or biker. Sitting at a desk and walking a mile each day is not the same as running 10 miles per week, or weight-training. . The surgery today is one-size-fits-all. My surgeon was top-notch, great reputation, etc. The surgeon's success numbers are going to be dominated by the desk-sitters, and the odd unhappy patient is going to be an outlier, and ignored. Don't be an outlier. That's why you have to be specific and get him or her to say it.

If the hernias aren't getting larger then there's no risk of incarceration. The bowel has to actually get through the hole and kinked, blocking it. You're planning to take a big dangerous step for a problem that does not exist.

You said that you're pain free and they've been stable for many years. You're probably a perfect candidate for mesh-free technique, like Shouldice, because, obviously, what you've been doing isn't stressing the area. Mesh is overkill.

Beside the mesh, one thing that's not talked about much is the fact that laparoscopy dissects, or cuts open, a very large area of tissue that was in perfect virgin form. Then the surgeon puts mesh where there is no hernia, as an anchor and as a reservoir of mesh, for the shrinkage that will occur. All of the new damaged area is where much of the post-pain comes from. They create a new broad problem, to fix a small specific one.

What I'm really saying is be very careful. There is a large bureaucracy behind the mesh hernia repair industry. And the health care industry is getting depersonalized. Patients are becoming more like numbers, or "human resources". The best meaning surgeons still have to work within that system, and still consider recurrence as their major problem.

Yeah, I know it's a big moneymaker for them. They are getting larger, very slowly. Or at least, they're larger than they were 5-10 years ago when I was first diagnosed. I'm not experiencing much pain/discomfort from them, however.

I appreciate hearing culican's success story, but I also appreciate hearing your more cautionary tale. Would you be willing to share anything of your circumstances? I'm guessing that you've experienced chronic low-grade pain…not debilitating, but enough to bother you? Are you less able to lift and do other physical activity than you were before your surgery?

[Magnacromion]

Last Thursday, 15 days post-op:


Deadlifts: 135x5, 225x5, 255x1, 275x3, 295x1, 275x5
SGDL [straps]: 225x5

My recent deadlift 1RM was 365. 295 two weeks after the operation is not bad.

When I had my open non-mesh repair 25 years ago, the surgeon didn't clear me to lift anything until 6 weeks out. And I felt pain at the surgery site when I finally started so I had to go slow. Last Thursday I felt no pain.

The reason so many guys talk of prolonged recoveries is because they baby themselves too much out of fear at the beginning. If you don't work the tissues while they are healing the scar tissue forms differently and may lead to more pain.

I quote again from one New York surgeon, "On the third post-operative day, unless told differently by me, you have FULL UNRESTRICTED physical activity. There is no limitation, and the more you do, the quicker the pain and discomfort will disappear. Some discomfort and pain is normal. Your body will set your limits, though it is ok to be aggressive."

The above quote is for laparoscopic repairs, not for open repairs, which have a longer recovery.

I think he is on to something there. He has done this repair on over 1000 patients.

That's a really impressive recovery. I had wondered if some of the posters had babied themselves a bit. Particularly the younger ones who've never experienced significant pain. Sounds like your layoff won't be long enough for you to experience any meaningful strength decline/muscle atrophy. Best of luck to you for a speedy return to your PRs!

[Magnacromion]

You said that you're pain free and they've been stable for many years. You're probably a perfect candidate for mesh-free technique, like Shouldice, because, obviously, what you've been doing isn't stressing the area. Mesh is overkill.

P.S. I thought I would probably be a poor candidate for tension repair. The hernias, while 99% painless, are large. The one on the right is the size of a golf ball. The one on the left is almost as large. They're big enough that I have to warn women about them before I undress. I thought that a tension repair was a poor choice for larger hernias.

[SoccerAgain]

Yeah, I know it's a big moneymaker for them.

I appreciate hearing culican's success story, but I also appreciate hearing your more cautionary tale. Would you be willing to share anything of your circumstances? I'm guessing that you've experienced chronic low-grade pain…not debilitating, but enough to bother you? Are you less able to lift and do other physical activity than you were before your surgery?

It's not really a money-maker, it's the whole healthcare system that's changing. Everything has a code and a standard procedure associated with it. Hernia's are the second highest volume surgery in the world, I think. Assembly line like.

I've written quite a bit in past posts. It's not function that's the problem. It's quality of life. If I was a farm animal, the surgery would be perfect. Put the yoke on, get the work done, keep me well-fed, no hernia, I can keep doing work. Notice the emphasis in info you'll find about getting back to work in a few days. I can do everything I used to be able to do, but I feel like crap afterward, for days and weeks. If you tell your surgeon that you feel like crap he tells you to take some pain medication. Because he's a surgeon, not a pain specialist.

I'm suggesting the questions I proposed because they are outside the system. The answers will be very educational. You only have to want to know. If a person wants to trust that the big institution is there solely for them, that's the individual's prerogative. If your surgeon says that post-surgery pain levels are low, ask him about his/her results, as opposed to industry results. Much of what you read is generated by a few research papers from ten years ago.

I've seen some good writing about how a good surgeon should know several techniques and should choose the one that's most appropriate for the patient. But if you ask my questions I think that you'll find that most surgeons do things one way. The surgeons that I talked to during consultation actually showed me a piece of mesh and said "here's what I do". It was one method, one material. Not "here's what I suggest for you, based on your activities".

All I'm saying is don't be afraid to make your surgeon uncomfortable. If he's done 100 surgeries per year, he should be able to talk about a few verifications of his methods.

I'm not criticizing the surgical profession. I'm saying that they are stuck with the same institutional inertia that the patients are. If nobody asks, and nobody tells them when things aren't working, then they don't have any any leverage to drive change. The patients show up, get the standard procedure, and disappear.

[culican]

Here is a fairly new technique (Desarda) that is supposed to give good results without mesh.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321139/

https://www.ncbi.nlm.nih.gov/pubmed/11355734/

[Magnacromion]

So you mean to say if the hernia isn't getting larger we should not mesh fix it? Won't they have to cut and operate for a non mesh surgery as well?

Confused

Not exactly. They have to cut and operate for the non-mesh (i.e., tension) surgery, as well. (Shouldice and Desarda are the most common tension repairs these days, I think.) What SoccerAgain is suggesting is "watchful waiting". Standard of care used to be "hernia → operate", no exceptions. Surgeons were afraid of the risk of incarceration/strangulation. Newer literature suggests that the risk of incarceration per hernia-year is quite low, and especially for older, more sedentary patients, some surgeons will advise their patients to leave the hernias be.

[SoccerAgain]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321139/

That paper has a good summary of the potential problems with mesh.

The paper was published just a little over 5 years ago. Not really that long.

What I'm really saying is be sure that you know what you're getting in to. If your surgeon can address all of your questions, you'll be better off. If they can't then your odds of being one of the unlucky ones goes up.

"The synthetic prostheses most often used in the inguinal area can create new clinical problems, such as foreign body sensation in the groin, discomfort, and abdominal wall stiffness, which may affect the everyday functioning of the patient [4]. Surgical-site infections, often with clinical symptoms delayed for many years, are more frequent after hernia treatment using mesh [5, 6]. Migration of the mesh from the primary site of implantation in the abdominal cavity is one of the most dangerous complications [7–9]. Intense chronic inflammatory process typically associated with foreign body reactions around the mesh prosthesis may produce meshoma or plugoma tumors, the treatment of which becomes a new surgical challenge [10–12]. Additionally, procreation and sexual function are reportly seriously affected after surgical hernia treatment with mesh [8, 13]. Thus, we are still far from accomplishing everything in the hernia surgical field, and complications remain the major clinical problem."

[culican]

That paper has a good summary of the potential problems with mesh.

I take issue with that. The conclusions they draw from some of the referenced studies are a real stretch.

"The synthetic prostheses most often used in the inguinal area can create new clinical problems, such as foreign body sensation in the groin, discomfort, and abdominal wall stiffness, which may affect the everyday functioning of the patient [4]. Surgical-site infections, often with clinical symptoms delayed for many years, are more frequent after hernia treatment using mesh [5, 6]. Migration of the mesh from the primary site of implantation in the abdominal cavity is one of the most dangerous complications [7–9]. Intense chronic inflammatory process typically associated with foreign body reactions around the mesh prosthesis may produce meshoma or plugoma tumors, the treatment of which becomes a new surgical challenge [10–12]. Additionally, procreation and sexual function are reportly seriously affected after surgical hernia treatment with mesh [8, 13]. Thus, we are still far from accomplishing everything in the hernia surgical field, and complications remain the major clinical problem."

I have to say something here: Many of the references this paper quotes for its assertions of problems don't really say what they imply (look up the papers themselves). Some, like the "Surgical-site infections..." address ONE incident ("We herein report a new case of postherniorrhaphy infection with a very late onset."). Some don't apply to inguinal hernias or humans (The scary #8 about sexual function is after the repair of an incisional hernia and is also about a single case where #13, also about sexual function, is about dogs.) My training is in biology and I have learned ALL papers have to be taken with several grains of salt. Just as the mesh industry is promoting their product and produces papers, those promoting alternative methods of repair also write papers.

Let's go the otherway. This paper says sexual function is better after mesh repair,

"Conclusions Inguinal hernia surgery positively affects sexual functions compared to the preoperative period. The improvement in sexual parameters in addition to the benefits of hernia removal and presence of no significant postoperative complications indicates that this surgery is useful and safe.
Keywords: inguinal hernia, sexual functions, Lichtenstein technique"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986302/

Or how about this one:

"Abstract Aim:  Several factors having an influence on the quality of life after an inguinal hernia repair have been studied, yet little has been reported on sexual function before and after this operation.

Methods:  In a prospective follow-up study from January 1999 to July 2002, 210 men and 14 women were asked to answer an anonymous questionnaire of 40 questions before elective inguinal hernia repair to assess pre- and postoperative sexual function (preoperatively, 3 months postoperatively and every 6 months afterwards). Inguinal hernia repair was performed using a standardized Plug and Patch mesh technique.

Results:  Fifty-two (23.2%) patients mentioned preoperative sexual dysfunction related to the groin hernia. Postoperatively, the surgical repair had a positive influence on the sexual function in these patients. Thirty-six (16%) patients complained of postoperative sexual dysfunctions, which improved or disappeared over the next few months. All patients suffered surgical complications, which were surgically treated in six cases. Symptoms specifically associated with inguinal hernias can cause certain limitations in the sexual life.

Conclusions:  In most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life in patients with preoperative sexual dysfunction, while, in most cases, it does not affect patients with a preoperative normal sexual life."

http://onlinelibrary.wiley.com/doi/1...35E8F51.f04t01

The truth, as in most cases, is probably somewhere in between "Wrecks your life" and "Turns you into a sexual superstar."

Also, don't limit yourself to just this site for anecdotal reports. I visited several sites that I am not a member of but which involve communities of active people. (Crossfit, rockclimbing, running, triatholoning, bicycling, etc.) There are unhappy people but also many who are completely satisfied with their repairs, both mesh and non-mesh.

100 years from now people will be aghast that we implanted mesh or that we sewed the person up with a needle and thread to repair the hernia. Just as people now are aghast to learn that hernia repair used to involve castration and then cautery with a hot iron to block the hernia via scarification.



Technology is what it is at this point in time. Not everyone gets a perfect result. For me, the alternative of feeling that my intestines were migrating down my groin after each set of exercise and then pushing them back in was not perfect either. Everyone has to come to their own conclusion, which unfortunately will be without 100% perfect knowledge.

[culican]

Today's recovery log (as I mention below, I consider this the last recovery day):

Sunday 9/17/17, 1:45pm, M 62yo, 5'9.5", BW=186.4lb, Waist=33.0in, Kcal/day (7 day average)=2923

18 days post laparoscopic bilateral inguinal hernia repair -- I consider myself recovered now so I won't be posting days post-op anymore. Now it's just like coming back from any layoff.

Squat: 275x3, 255x5, 255x5
Leg Press: 270x12, 360x10
Ab Wheel [kneeling]: 20repsx2sets

[SoccerAgain]

18 days post laparoscopic bilateral inguinal hernia repair -- I consider myself recovered now

It took 1.5 years before my repair stopped changing, enough to where I knew it wasn't going to end up where I wanted it to be. Look back over this thread and you'll find that everyone is excited to have survived the surgery, with many posts in the days and weeks after. And many gauge recovery on coming back from the low of the surgery itself, not before the hernia or even before the surgery. From the very bottom they experienced, with the swollen purple parts and surgery pain.

You do some good research, and it's fair to find papers supporting the other side. But I don't think that they really help avoid the potential problems. I'm posting to help people avoid long-term problems, not to encourage them to have the surgery. It's not a club to be joined, although it does feel like one.

A 27 year old probably has 50 active years ahead at least. Pay some days now, to make sure those 50 years are good ones.

[culican]

It took 1.5 years before my repair stopped changing, enough to where I knew it wasn't going to end up where I wanted it to be. Look back over this thread and you'll find that everyone is excited to have survived the surgery, with many posts in the days and weeks after. And many gauge recovery on coming back from the low of the surgery itself, not before the hernia or even before the surgery. From the very bottom they experienced, with the swollen purple parts and surgery pain.

You do some good research, and it's fair to find papers supporting the other side. But I don't think that they really help avoid the potential problems. I'm posting to help people avoid long-term problems, not to encourage them to have the surgery. It's not a club to be joined, although it does feel like one.

A 27 year old probably has 50 active years ahead at least. Pay some days now, to make sure those 50 years are good ones.

I should clarify, that was an exact copy of today's entry to a log I keep on another site. By "recovered" I mean I am resuming my regular strength training programming, albeit at a lighter level due to the layoff. I understand that the internal healing from the surgery is not done and will continue for a long time.

I have tried to be balanced in what I say in this thread. Having had a hernia repair back in 1992, I can assure you that I was not chomping at the bit to "join the club" again. I also know that I could feel the sutures from that repair (no mesh) inside of me for the better part of 10 years. I know I couldn't do ab exercises for over two years after (you will note that after my latest surgery I did some today) because it felt like everything was pulling apart inside.

I have over 60 links bookmarked from my research; I have visited each one and read each one.

I can only hope that the fact I had an experienced surgeon and he used the ProGrip mesh so I didn't have any staples, tacks, or sutures placed internally, where they could hit a nerve, will ensure a good long term result. I am also hoping that my aggressive return to activity will eliminate the tight scar tissue that sometimes develops. You are not going to find papers on this as most doctors think that you are straining to lift over 50lb.

Another site I frequent has many who have gone the aggressive route in the return to activity. I don't think it is coincidence that none of them complain of ongoing pain issues. The one guy I did encounter on the site who had issues admitted he stopped all activity for three months after the surgery. Not because he had to but "because of work." Of course this type of evidence is totally anecdotal so make of it what you wish.

I definitely agree with you that everyone should not rush into it and needs to make their own decision because they have to live with it. It is important to note however, that hernias tend to increase in size, especially if you are active. Repairs on large hernias may present more problems and less options for repair than ones repaired early. So there is a balance between rushing into it and holding back that has to be considered too.

[culican]

Rather than edit my previous post, I will put this in a new one.

I will also agree that there is horrible follow up. For example my surgeon (if he is still practicing) and Kaiser Permanente in California have no idea that I could feel the sutures for 10 years from my 1992 repair nor do they know that the repair ultimately failed.

I also agree that the medical community has been slow to admit that they have a problem with the current methods, as this paper shows:

If the incidence of chronic pain after mesh repair approximates 16.5%, then a very significant number of patients will have debilitating pain resulting from the procedure when most patients likely had little or no preopertive pain.

This possibility presents a potential time bomb for the surgical community and medical device suppliers. Hernia recurrence has been largely reduced by the use of synthetic mesh for repair, but a new problem, chronic postoperative pain, has arisen to rival recurrence as a serious consequence of surgical intervention. The surgical community, as well as the industry that garners huge profits from the use of synthetic materials must address this troubling issue. The evidence is mounting that mesh, which was generally thought—and promoted—to be inert, now appears not to be so.

Chronic Pain Following Inguinal Hernioplasty
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000866/

In my case the laparoscopic approach with mesh was appropriate because it was a repair of a recurrent hernia repaired previously in an open repair. That means that the surgeon would encounter lots of scar tissue going in the same way as was done in 1992 and things might not be where they are in a person who had never undergone a repair before. The big danger in that is that the blood supply to the testicle will be compromised, which would result in its ultimate loss.

If a person is not having a recurrence repaired, they do have more options for repair types.

[lockhrt999]

Pressures created by various activities (don't cough or jump):

Here I'm sure the video didn't mean weighted squats. I think weighted squat would rate much higher on pressure. I also think any bent over row exercise will have higher abdominal pressure than squat.

[culican]

Here I'm sure the video didn't mean weighted squats. I think weighted squat would rate much higher on pressure. I also think any bent over row exercise will have higher abdominal pressure than squat.

I am sure you are correct. I looked up the original paper and there were several more measurements but the max weight they used was 20lb. The main point was the coughs and the jumps, which are very high. I also read another study that gave the pressure while straining on the toilet at ~100mmHg.

[SoccerAgain]

Logged in mainly to say I appreciate the reasoned response. A good discussion.

It would be fantastic, I think, if a wave of questions started being directed at hernia repair surgeons by prospective patients, getting them all to wonder about the answers at the same time. Causing extended discussions and comparisons, and realizations that they know little about how effective their methods are. Followed by effort to find out.

I've read a few more papers about materials and methods and can see that individual surgeons are expected to choose from those results, as to which method they like best. That's why the papers are produced. But they have little guidance beyond that, as far as I can tell. If the prospective patients start asking for proof that their methods are good, they might start doing a little more followup.

It's an interesting profession, that of the surgeon. They have incredible leeway in what they do once they get in there.

[SoccerAgain]

Chronic Pain Following Inguinal Hernioplasty
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000866/

Thanks for this reference. I thought I was going far in my research but you've gone farther.

Of course, I've excerpted a part of the paper that supports what I've been saying. But it's good to see that others think that same way. The "one size fits all" approach just doesn't work. People need to make sure that their surgeon sees them as unique and is not planning to do just "what they do" on them.

In the long run, there may be a one-size-fits system, but it doesn't seem to be here yet.

" Therefore, any intervention must be tailored to the individual, with full preoperative disclosure of all potential complications and consideration given to the skills and resources available to the individual surgeon."

[TurkBrah]

Wow. How did I never think to look bb.com for this! Mine was more of a sports hernia and adductor/groin problems.

I knew my problems did not just relate to soccer(I play 3-4 times a week). I stopped lifting(heavy) 2-3 years ago and focused on playing soccer.


Here is my story(brief copy paste):

I am a life long soccer player. I compete at least 3 times a week, full 90 mins. The pain with kicking and running was so bad back in August I decided to take action. I went to couple of doctors, did PT, did blood injections with ZERO progress. I've searched and searched what was wrong with my groin area on both sides. I had an MRI, it showed a partial tear on left side and some irritations around pubic bone..but i KNEW i had more than that. Then I started looking online, NOTHING. Then in October, I met a guy who had surgery few years back, his pain description was exactly like mine, he had surgery done by a doctor in Philly, gave me his name etc. I looked him up online an it opened a whole new window to my own diagnosis! I finally knew what EXACTLY was wrong with me and there was a solution!! That doctor didn't take insurance so I needed to find someone just as good, if not better that takes insurance somewhere in the world!!

Then I came accross Dr. Brown on one of runner forums. His reviews were amazing and he was very responsive to my inquires. He knew what was wrong with me without seeing me.

Within a week, I scheduled my surgery and traveled DC to California. He examined me the same day I landed. He located my tears with his hands! and commented he had no idea how I was able to still play soccer in this shape..He suggested surgery for bilateral adductor longus tenotomy and repair of obliques on both sides. I agreed to it and within 4 months, I am back to playing the game I love.

[SoccerAgain]

Was it Dr. Bill Brown at SpotrsHernia.com? http://www.sportshernia.com/sports-hernia-specialist/

How long ago did you have the surgery? You said stopped lifting 2-3 years ago, then back in August, but then recovery within 4 months. No offense, can't figure out the dates, with the cut/paste. Was the surgery 2-3 years ago? I had gotten the impression that Dr. Brown was not as active now as he has been in the past.

I think that he also will do hernia mesh removal. He seems like a good guy, best to get good information out there about him, if he's still "in the game".

Thanks for the post.

[dogandbroom]

Hey guys so I finally got my surgery this morning. Open right side with mesh. I woke up from surgery with a weak burn pain and they gave me a pain killer (lopra something?) and it went from a 3/10 pain to a 1 or 2. I know it will hurt more when this anesthesia wears off. They prescribed me Hydrocodon. Haven't taken any yet. I'm just glad that the surgery is over and I'm now progressing towards getting back to being normal.