*** OFFICIAL INGUINAL HERNIA RECOVERY Thread ***

[SoccerAgain]

May I ask you about the removal? My husband had the mesh done 10 years ago and he keeps having problems. We are thinking of going to Toronto or Germany and have the mesh removed. We live in NY. Thx for your time!

Sorry for the late reply, I don't get notifications. I need to fix that. I don't regret having the mesh removed. It's only been about 6 months and the area is still adjusting. But it's all forward progress.

There is another hernia related forum that has very good information. I would get on to that forumit and describe his problems. You'll get some good responses.

https://www.herniatalk.com/

[SoccerAgain]

May I ask you about the removal? My husband had the mesh done 10 years ago and he keeps having problems. We are thinking of going to Toronto or Germany and have the mesh removed. We live in NY. Thx for your time!

I sent you a message. Replying again to subscribe, I changed my settings. Good luck. Keep searching, there are not many doctors that know what to do about mesh problems.

[ryanp37]

Hello folks. As I am guessing is the case with many of you, I have been trolling this thread for the last month or so, which was the period of time where I was wrestling with the reality of a hernia. I sustained my injury in the process of doing quite a lot of weight on a smith machine flat bench press. I had about 400 pounds or so on there and felt something pop in the groin area on my last rep. This was around St Patricks Day. I think I knew immediately what had happened, but I was thinking that if I took a week off I would take stock after that. Long story short, that approach yielded no improvement and my PCP confirmed that I had a small direct hernia on the left side and suggested that I meet with a surgeon for a consultation. Bear in mind after one week of complete rest, I did return to lifting, but at 20 to 30% of my Max prior to the injury.

The surgeon confirmed that I had a direct hernia on left side but it was not poking through at all, nor did I run into an instance where it ever poked through. Although he confirm the diagnosis, at the time I had convinced myself that I might be able to trim down and get through the summer with the injury. This approach lasted about 2 weeks, as although I was getting through my extremely light workouts, I could clearly see myself shrinking. Once I came to that realization, I was able to get a laparoscopic procedure scheduled on a week's notice. My surgery took place earlier today.

I completely understand that everyone's response to surgery is different and that day 2 is generally far worse than day one, but I honestly have to tell you guys that my experience has not been all that bad. Basically, they tell you that they are giving you a sedative through the IV, but this is actually what knocks you out rather than the mask and obligatory count back routine. At my hospital, I never got to the point where I was exposed to the mask. Next thing I knew I woke up in the recovery room and I would estimate that my pain was a 4 out of 10. The nurse gave me an oxycodone while in the recovery room and I would say this reduced my pain to a 2. I am now home resting relatively comfortably and spitefully took another painkiller around 6pm (my surgery ended at around 1). I'm sitting on my couch with legs elevated, pretty comfortably watching the Red Sox and I would put my pain at a 3 out of 10. So in all these respects, so far so good. Thus far anyway, I would have to say that this is one of those things where the anticipation of the event was far worse than the event itself. I can generally get up and down from the couch without a ton of difficulty, although it is sore, and while it is certainly true that you tend to be a bit hunched over while you walk, it has not been my experience that it brings about any pain.

I will post an update tomorrow as I certainly know that I was starving for information when I was deliberating about getting this procedure. Feel free to send me a message if you have any questions.

[flanaganshane]

Ryanp37, good luck on your recovery my man! I’m at 5 weeks and two days, and I had an amazing workout today. I feel like I could push close to my max prior to the hernia but I’m afraid of a reoccurrence so much that I’m purposely holding myself back. I did do a pretty solid ab workout without any pain or issues at all.

Sounds like you’re already on a good path and very positive. You’ll be back before you know it!

[flanaganshane]

5 weeks and 2 days: I had my second and last post op appointment today. My surgeon gave me a clean bill of health and released me to normal activities without any restrictions. She did tell me that I’m still healing and to not go overboard and if I feel any pain to stop what I’m doing immediately. She’s a straight shooter and understands my lifestyle and mindset. She basically said to be smart and let my body dictate my actions and to not redline.

To this point I still feel fortunate that my surgery went so smooth without any complications and not much pain at all. I plan on continuing to update and I’m open to any questions. This site was literally a blessing for me in so many ways and I really appreciate everyone who’s contributed and continues to contribute!

[KonaKoffee]

Good luck Ryan! You mentioned that the hernia injury happened during a workout. When you read up on the subject “they” say that it’s an inherent weakness that isn’t caused by lifting, but I’m not so sure. I only have my feelings and circumstances to go by, but I was pushing deads pretty hard when mine showed up.

In a weird way I’m glad it happened because now that it’s fixed my inguinal canal should be stronger than before. Now that I’m getting older, I was seriously considering changing my entire approach to lifting... instead of always pushing for max and new PRs (which by definition puts me in the red zone for muscle tears, joint damage and I don’t know, maybe HERNIAS), I was going to downshift to a more moderate lifting regime. I’ve come to realize that you get the same benefits of fitness, bone and joint strength with moderate lifting as with the macho, ballztothewall version. This event sealed the deal: I’ll be dialing down the intensity and upping the volume. I’m ok with that.

question for Flanagan: I’m about two weeks behind you, so I’m tracking how you are progressing. We seem to have very similar experience. I’m feeling like a million bucks and forget that it’s only been a little over three weeks since I had surgery. Walking is great exercise at this point and I’m up to 10 mile hikes. However, I can definitely feel the consequences if I try to lift. I tried dead lifting an empty bar a few days ago because I felt so good. I feel it in the mesh area. Just a dull ache kind of feeling. Same goes for air squats or assisted pull-ups. Are you feeling anything straining down there when you lift? Oddly, ab work feels great, like crunches. Everyone else seems to say to avoid them for a long time. Stretching the area, as with back extensions, feels good too. Just seems that spiking my abdominal pressure with lifting weight is a bugaboo. (I can hear the responses now: “that’s why they tell you not to lift anything for a while, dumbass”). But I’m sure everybody tests the water along the way… Especially when you’re feeling good.

To Soccer: thanks for the Herniatalk site. Dang, there are some scary stories there. Makes me grateful that mine went well and that I had a good med team... and that I live in ‘Murica! The UK system sounds F’d up.

[flanaganshane]

Kona Koffee, glad to hear things are going good for you! I’ve yet to deadlift, squats of any sort or pull up’s. I did push and pull some pretty heavy weight while doing my arm workout yesterday and I never felt anything out of the ordinary. But to answer your question the only time I feel anything at all out of the ordinary is when I fart or take a dump. I’d describe it as a feeling of pressure in the mesh area itself, sounds similar to what you’re describing as well. I explained that to my Doc and she said it was normal and that I may continue to have random feelings for up to a year in that area. She said as long as I’m not overly swollen or red in the area then I shouldn’t get too concerned. She called it “growing pains” haha.

PS- I’ve been very disciplined with my breathing during reps. I say that because in the past prior to my hernia I was not always consistent with proper breathing and I’m certain that was a big reason I got the hernia in the first place.

[flanaganshane]

6 weeks: Over the past week I’ve pushed myself a lot in the gym and out of the gym. I’ve been on 2 mountain bike rides and I’ve been out rafting twice. I’ve also ran several times on the treadmill. Today at the gym I did flat, decline and incline barbell chest. 225 for 10x4 flat, 315 for 5x5 decline and I think I did 225 or so on incline but I can’t remember the reps and weight to be honest. I wasn’t planning on doing incline because I wasn’t sure how I was going to feel. So i added incline more for a pump.

I’m still feeling great! I have noticed some pressure feeling at the end of a long and tiring day but it tends to go away after I sit for a little while. I’m definitely still not a 100% and I can tell that so with that in mind I’m still taking it cautious and trying to not over do things.

A side note- I’ve noticed in the past 2 weeks that I’ll have a day where I feel like I did prior to the hernia, there’s no pressure or nagging feeling whatsoever. Then I’ll have a day where I’m reminded that I had surgery. Part of the healing I guess...

[ryanp37]

Hello folks. As I am guessing is the case with many of you, I have been trolling this thread for the last month or so, which was the period of time where I was wrestling with the reality of a hernia. I sustained my injury in the process of doing quite a lot of weight on a smith machine flat bench press. I had about 400 pounds or so on there and felt something pop in the groin area on my last rep. This was around St Patricks Day. I think I knew immediately what had happened, but I was thinking that if I took a week off I would take stock after that. Long story short, that approach yielded no improvement and my PCP confirmed that I had a small direct hernia on the left side and suggested that I meet with a surgeon for a consultation. Bear in mind after one week of complete rest, I did return to lifting, but at 20 to 30% of my Max prior to the injury.

The surgeon confirmed that I had a direct hernia on left side but it was not poking through at all, nor did I run into an instance where it ever poked through. Although he confirm the diagnosis, at the time I had convinced myself that I might be able to trim down and get through the summer with the injury. This approach lasted about 2 weeks, as although I was getting through my extremely light workouts, I could clearly see myself shrinking. Once I came to that realization, I was able to get a laparoscopic procedure scheduled on a week's notice. My surgery took place earlier today.

I completely understand that everyone's response to surgery is different and that day 2 is generally far worse than day one, but I honestly have to tell you guys that my experience has not been all that bad. Basically, they tell you that they are giving you a sedative through the IV, but this is actually what knocks you out rather than the mask and obligatory count back routine. At my hospital, I never got to the point where I was exposed to the mask. Next thing I knew I woke up in the recovery room and I would estimate that my pain was a 4 out of 10. The nurse gave me an oxycodone while in the recovery room and I would say this reduced my pain to a 2. I am now home resting relatively comfortably and spitefully took another painkiller around 6pm (my surgery ended at around 1). I'm sitting on my couch with legs elevated, pretty comfortably watching the Red Sox and I would put my pain at a 3 out of 10. So in all these respects, so far so good. Thus far anyway, I would have to say that this is one of those things where the anticipation of the event was far worse than the event itself. I can generally get up and down from the couch without a ton of difficulty, although it is sore, and while it is certainly true that you tend to be a bit hunched over while you walk, it has not been my experience that it brings about any pain.

I will post an update tomorrow as I certainly know that I was starving for information when I was deliberating about getting this procedure. Feel free to send me a message if you have any questions.

Hey guys,
Just a quick update and a question for you folks. For the first 7 days after the surgery I began to gradually increase the amount of walking I was doing daily. Throughout that time frame, I was rotating ibuprofen and acetaminophen at the surgeon's suggestion. During that week, I would say that any pain that I had was at the incision sites and not at the area of the repair. On day eight, I suspect that I might have introduced too much walking into the equation and took around 14000 steps with no resistance. At the end of that day, I began to encounter pain at the site of the repair and it has been sore for 3 days since with no noticeable Improvement ( today is day 11). Needless to say I've cut back significantly on the walking but it seems sort of odd that new pain would be introduced after not feeling any at all at the repair site in the first week. Did anyone encounter anything like this? Both my primary care doctor and surgeon on the phone seemed to think it was extremely unlikely that I would have blown out the repair but I was wondering if anyone had any insights on any of this?

[KonaKoffee]

Hey Ryan... what is 14,000 steps, about 8 miles? I’d say that’s pushing past what’s prudent for day eight. Would’ve been for me. I was up to a mile after a week, and I would feel it, but in a good way. No reason that I can see to do that much that soon.

I added one mile per week until week 4 and then I felt unlimited as far as walking. Tomorrow is week 5 post op for me and I’m starting light jogging and empty bar squats and deadlifts.

Hard to tell exactly what you did to yourself but if it’s only a matter of overdoing it and there’s no real screwup in the repair, rest it till you can test it and progress a little more modestly. If it’s a good repair, it really does heal quickly, but we still have to pace it smartly.

Other posters and even my doc said that you’re as healed as you’re going to be in 8-10 weeks, but I read elsewhere that the repair site is at 80% strength at six months. Based on those parameters, I plan on being active, lifting, running and progressing until I’m at 100% in about 8 months. Not sedentary, but nothing extreme either... who are we trying to impress, anyway? ha.

Hope you bounce back fast

[flanaganshane]

Ryanp37, I can’t remember where I was at day wise but at some point early on I for sure over did things on the treadmill, I wanna say I walked at a fast pace for 3 miles. Anyways, I do recall having some slight pain for a couple of days or so. Not enough pain to alarm me though, more like a feeling of over doing it. I hope all has worked itself out for you.

[flanaganshane]

Week 7: All has pretty much went well for me since I came out of surgery and my recovery has continued to improve daily. I honestly can’t complain about a single thing to this point. I’m still continuing to push my self in and out of the gym. I played a flag football game Sunday at 100% with zero pain or swelling. I’ve continued to push semi heavy weight at the gym without any issues at all this past week. The “pressure” feeling that I’ve had on occasions is completely gone. As a matter of fact I very seldom feel anything in the area of the hernia/mesh.

I hope my posts have helped in some way for you that have just had the surgery and for the ones that come along that are going to have to have surgery. I’ll update again next week at my 8 week post op and then I’ll continue to update as often as possible after.

[drgephys]

I'm a long-time heavy-weight lifter. I'm heading for surgery in a couple of weeks for primary inguinal hernia on the left side. Still trying to decide on laparoscopic with posterior mesh vs. open with anterior mesh (Lichtenstein tension-free). I also had a hernia when I was ten-years-old on the right side immediately after jumping off a five-foot-high window. I'll post more later.

Regarding intraabdominal pressures, they increase tremendously with the amount of weight used. So, squatting with three plates or more is not the same as squatting without weights. See this article. It looks like for heavy squats and deadlifts, pressures are far higher than those for coughing and jumping.

See Intra-abdominal Pressure Changes Associated with Lifting: Implications for Postoperative Activity Restrictions by Kimberly A. Gerten et al. (I can't post links).

I think it's also important how fast the pressures change. When coughing or jumping, they can change very fast. They can also change very fast when lifting if you're not careful with form. Shear forces, such as twisting can be problematic. I was also using an inversion table at the time the hernia happened, which is another suspect. I'll never know the cause but it could be a combination of genetics, age, heavy lifting, the inversion table, and even coughing. Regarding genetics some of my uncles, nephews, and cousins have also suffered from hernia.

Regarding mesh (tension-free) vs. tissue (meshless) repairs, the main reason for the mesh is that the recurrence rates are far, far lower. There is nothing worse than having your hernia repaired and then it comes back from the same weak spot that wasn't reinforced with a mesh. It's not only another surgery but also a more difficult one because of scar tissue. Yes, there are problems caused by mesh such as contact with nerves causing chronic pain or excess fibrosis requiring mesh removal, but they can be minimized at the hands of experienced, knowledgeable surgeons. They also say you should avoid 3D meshes because they don't stay in the same shape and cause problems. A good-brand, lightweight meshes are the best.

See the "Hernia Bible" -- aka SAGE Manual of Hernia Repair from the Society of American Gastrointestinal and Endoscopic Surgeons (I can't post links). It's complex and there is no clear best method. However, there are a lot findings for a successful repair.

[SoccerAgain]

You posted as drgephys, like maybe Dr. Gephys? Or just coincidence?

Regardless, it's not clear what message you're trying to convey. You seem to be educating but you haven't had the surgery yet. There are several things to consider today when having hernia repair, beyond just tension-free or suture repair. The industry is moving very heavily toward covering large areas of abdominal wall with mesh, in a prophylactic manner, even though they never say that. So, in today's world, if you get a laparoscopic repair you might end up with 60 square inches of mesh in your abdomen, to "fix" a small direct hernia. That is really the bigger concern, not recurrence.

Since you have a family history of hernia you also have a good source of information. Find out who in your extended family is happy with their surgery and have that same procedure done, by the same surgeon. Ask important questions and press for good answers. Don't accept "I'm doing okay" when you really need to know how close they are to where they were before the hernia. As you probably know, men tend to project tough images, but you need to know what's real. There are subtle problems that don't go away with time.

From what I've learned, if I was going to have a direct hernia repaired today, I'd find an old-timer that did open repair with mesh. Laparoscopic implantation of large pieces of mesh looks good from the outside, with small scars and less pain, and saves you a few days of recovery time but the long term effects of big pieces of mesh are much worse than a recurrence.

Here's another SAGE's article, showing the state of the industry, as of 2015. Things don't change fast in medicine so don't think that 2 1/2 years ago is ancient history. It's just an abstract but it shows that there is much room for improvement. Good luck.

https://link.springer.com/article/10...464-015-4309-4

[ryanp37]

Hey guys,
Just a quick update and a question for you folks. For the first 7 days after the surgery I began to gradually increase the amount of walking I was doing daily. Throughout that time frame, I was rotating ibuprofen and acetaminophen at the surgeon's suggestion. During that week, I would say that any pain that I had was at the incision sites and not at the area of the repair. On day eight, I suspect that I might have introduced too much walking into the equation and took around 14000 steps with no resistance. At the end of that day, I began to encounter pain at the site of the repair and it has been sore for 3 days since with no noticeable Improvement ( today is day 11). Needless to say I've cut back significantly on the walking but it seems sort of odd that new pain would be introduced after not feeling any at all at the repair site in the first week. Did anyone encounter anything like this? Both my primary care doctor and surgeon on the phone seemed to think it was extremely unlikely that I would have blown out the repair but I was wondering if anyone had any insights on any of this?

Hey guys,
I just wanted to share an update on this in the event that anyone is experiencing similar issues just shy of the 3-week point post-surgery. I met with my surgeon a few days back and basically he explained that it is expected to experience pain in the inguinal canal for a few weeks post-surgery with the worst point being at 2 weeks. It's actually a byproduct of inflammation and the discomfort extends from the waistline all the way to your member. He actually suggested that I stop light aerobic activity for a week and go on a regimen of 2400 mg of ibuprofen daily. I'm pleased to say that I followed the advice and as little as 3 days later have seen significant Improvement. The surgeon also confirmed that my repair is intact and rock solid given the time frame. Next week, when I hit the three week point, I am cleared to return to the gym using 10 to 15 pound weights with no core exercises. As you might imagine, at this point, that's like being told I hit the lottery. I hope this info is helpful for anyone scanning the board after their procedure. Keep the faith. It does get better. 3 weeks to go and back to the gym.

[drgephys]

Hi SoccerAgain,

Regarding my username, Physics PhD here.

Believe me I have read hundreds of scientific papers and watched dozens of videos on hernia. I know how the lap and open repairs are done. Neither is superior to the other in all respects. My doctor is both a protégé of Lichtenstein, the guy who invented the tension-free, and a protégé of Dr. Ed Felix, the guy who advanced the lap repair and came up with the ten commandments of lap repair recently, which ensures a good outcome. He is an active researcher and a member of the international hernia society (Hernia Surge). So, I'm in good hands. As he put it, both are good procedures and have some risks, some preventable others not. He literally told me not to overthink about it and pick one. He did recommend the lap though because he said I'm a young and active guy and that way I could return to the gym or any other activity as soon as possible. The biggest problem with anterior tension-free mesh method is possible nerve problems leading to chronic pain. The posterior lap method on the other hand causes a scarred abdominal wall and the cord elements are not protected by the cord's sleeve (cremasteric muscle), with vas deference and testicular veins making direct contact with the posterior mesh. This is probably why people have more swollen testicles immediately after lap repairs. However, a good doctor minimizes the dissection and minimizes the handling of the cord elements, nerves, etc., minimizing the risks. Of course, lap also requires general anesthesia. There is also a very small risk to internal organs. If I choose lap, it'll be the superior TEP procedure, in which they don't puncture the peritoneum (as opposed to TAPP, which is inferior but requires less skill). Still trying to decide on the method.

As for Shouldice and other meshless tissue repairs, the risk of recurrence is high and the pain is severe for about six months. I had Bassini or Shouldice on the right side when I was eleven and I know. My doctor also offered tissue repair, but I think it's too risky, more than the mesh.

Regarding family members, everyone had meshless open because mesh was invented in 1984 and lap was invented in the early 1990s. One of them had a recent tissue repair because he is a kid and they don't do mesh or lap for kids because they are still growing.

I have one more appointment with my doctor on Friday, six days before my operation, and I'll ask him more questions and pick the method.

[SoccerAgain]

My doctor is both a protégé of Lichtenstein, the guy who invented the tension-free, and a protégé of Dr. Ed Felix, the guy who advanced the lap repair and came up with the ten commandments of lap repair recently, which ensures a good outcome. He is an active researcher and a member of the international hernia society (Hernia Surge). So, I'm in good hands. As he put it, both are good procedures and have some risks, some preventable others not. He literally told me not to overthink about it and pick one. He did recommend the lap though because he said I'm a young and active guy and that way I could return to the gym or any other activity as soon as possible. The biggest problem with anterior tension-free mesh method is possible nerve problems leading to chronic pain. The posterior lap method on the other hand

If I choose lap, it'll be the superior TEP procedure, in which they don't puncture the peritoneum (as opposed to TAPP, which is inferior but requires less skill). Still trying to decide on the method.


I have one more appointment with my doctor on Friday, six days before my operation, and I'll ask him more questions and pick the method.

You're my doppelganger. And I had my mesh removed after three years. It ruined me. It is hard to believe how many very highly educated people will just repeat what the published results say, but won't acknowledge the reality of the lawsuits and the first hand accounts. It's very similar to today's politics, almost like some sort of social mental disease.

There's no valid reason to say that lap is better than open just because you're young and active. Even the published results say that lap causes less short-term pain, and gets people back on their feet faster, but after 2-3 weeks there is no difference. As a young and active person you want to be concerned about long-term results and a procedure that allows you to be active. There are many many stories from active people about how the large lap-implanted mesh pieces screwed up their insides. Do some research on athletes and hernia repair with mesh and you'll find that professional athletes, who are always young and active due to their profession, never get lap mesh. You can not find a success story out there anywhere about a doctor who repaired an athlete's hernia via lap mesh implantation. To the contrary, the doctors that are known as surgeons to the athletes all hate mesh. Dr. William Meyers, Dr. Ulrike Muschaweck, and Dr. William Brown, to name three.

I'm not trying to win an argument here. I just really hate to see people parrot the same exact things that I read four years ago, knowing that they might end up in the same hell.

Have faith in your doctor's concern, but not his knowledge of long-term effects. The studies are all relatively short-term and tend to define concerns as "pain", when what really happens is that people give up their active life to avoid discomfort. It's a fine distinction but it's the difference between enjoying an active life and becoming an unhealthy couch potato. A mesh reaction will change your life. That's why I suggested really talking to your relatives that have had surgery. You'll probably find that they've changed their lives to live with their hernia repairs, and wish that they had had better results.

And find an active young person like yourself, who has had hernia repair and is happy with it, after at least 2-3 years. The research shows that max strength is achieved well before then but max discomfort takes much longer to grow in. And you can't solve it with pain killers. Don't assume that because today's repairs are different and newer that they're also better.

Good luck. My degree is actually more closely related to the field than yours, and a good friend who was a surgeon recommended lap to me because he thought it was better than his open repair. It wasn't. My surgeon was top-notch, with many procedures under his belt. The problems were all caused by the mesh, not the way it was implanted.

In short, if you can't find somebody with a three year old or longer mesh repair of the type you're planning that is happy with it, that's a pretty good sign that they don't exist. The research papers don't capture that simple reality.

[SoccerAgain]

It has been about 10 months since my surgery

It was 10 months on 6 2011, so now it's about 7 years since surgery. Can you describe how you're doing today? Maybe with some details of the surgery and materials used?

I'm one that had bad results from hernia mesh and am trying to find people who have had good results so that they can avoid what happened to me.

Thanks.

[SoccerAgain]

Had my surgery yesterday... It went pretty well... I was walking around alil but until the hospital anesthesia wore off.. Then I was couched mostly unless bathroom time... Thanks for the info.. My hernia was a small one and hoping to return to work with out lifting of course... Plus I just had knee arthroscopy last weds also...

How is the hernia repair doing today?

[SoccerAgain]

Can a person send messages on this forum? I was going to go through the thread and see how people are doing. There's probably a lot of good long-term info in here but I can't figure out how to contact people.

[drgephys]

You're my doppelganger. And I had my mesh removed after three years. It ruined me. It is hard to believe how many very highly educated people will just repeat what the published results say, but won't acknowledge the reality of the lawsuits and the first hand accounts. It's very similar to today's politics, almost like some sort of social mental disease.

There's no valid reason to say that lap is better than open just because you're young and active. Even the published results say that lap causes less short-term pain, and gets people back on their feet faster, but after 2-3 weeks there is no difference. As a young and active person you want to be concerned about long-term results and a procedure that allows you to be active. There are many many stories from active people about how the large lap-implanted mesh pieces screwed up their insides. Do some research on athletes and hernia repair with mesh and you'll find that professional athletes, who are always young and active due to their profession, never get lap mesh. You can not find a success story out there anywhere about a doctor who repaired an athlete's hernia via lap mesh implantation. To the contrary, the doctors that are known as surgeons to the athletes all hate mesh. Dr. William Meyers, Dr. Ulrike Muschaweck, and Dr. William Brown, to name three.

I'm not trying to win an argument here. I just really hate to see people parrot the same exact things that I read four years ago, knowing that they might end up in the same hell.

Have faith in your doctor's concern, but not his knowledge of long-term effects. The studies are all relatively short-term and tend to define concerns as "pain", when what really happens is that people give up their active life to avoid discomfort. It's a fine distinction but it's the difference between enjoying an active life and becoming an unhealthy couch potato. A mesh reaction will change your life. That's why I suggested really talking to your relatives that have had surgery. You'll probably find that they've changed their lives to live with their hernia repairs, and wish that they had had better results.

And find an active young person like yourself, who has had hernia repair and is happy with it, after at least 2-3 years. The research shows that max strength is achieved well before then but max discomfort takes much longer to grow in. And you can't solve it with pain killers. Don't assume that because today's repairs are different and newer that they're also better.

Good luck. My degree is actually more closely related to the field than yours, and a good friend who was a surgeon recommended lap to me because he thought it was better than his open repair. It wasn't. My surgeon was top-notch, with many procedures under his belt. The problems were all caused by the mesh, not the way it was implanted.

In short, if you can't find somebody with a three year old or longer mesh repair of the type you're planning that is happy with it, that's a pretty good sign that they don't exist. The research papers don't capture that simple reality.

Hi SoccerAgain,

So, what are you recommending? Are you recommending open tension-free repair with anterior mesh (Lichtenstein) or open Shouldice meshless tissue repair? My doctor is offering Lichtenstein, lap (both TEP and TAPP), as well as Shouldice. He said he can even do robotic da Vinci if I want to but there is no advantage of it over lap and it has longer incisions. He has a lot of experience and knowledge on Lichtenstein and lap. The main risk of Lichtenstein is about 8% chance of chronic pain from mesh making contact with nerves and/or a possible need to pragmatic neurectomy in people with spider-web-shaped nerves during surgery.

Hernia Surge -- International Guidelines for Treatment of groin hernia -- which is composed of seven international hernia societies published their newest guidelines on 12 January 2018:

Hernia Surge website:

herniasurge.com

Hernia Surge newest international guidelines for groin-hernia repair (an absolute must-read for anyone with a groin hernia!):

link.springer.com/article/10.1007/s10029-017-1668-x

Note that guidelines are updated every year and free access will end soon for these year's guidelines. Check the Guidelines tab on the Hernia Surge website in the future for the current year's guidelines:

herniasurge.com/contact/

Here is an excerpt. I will read the full guidelines later today.

"Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered."

Again, please let me know what procedure you recommend and why.

[SoccerAgain]

I posted mainly to counteract your repetition of the common mesh repair meme. For any future readers.

My point was that things are not as clear as the hernia repair industry makes them out to be. I wanted to believe what I was reading also, in 2013, but even so I was close to going to Canada for a Shouldice repair to avoid mesh, based on what I was reading at that time. None of the mesh-based methods looked good. Until I talked to a surgeon friend who had had his own hernia repaired years earlier. I thought that I had found the perfect source of knowledge, and ended up going with TEP implantation of Bard "Soft" Mesh to fix a direct right hernia, based on his recommendation, as an expert who actually did the same types of activities as myself and was my age. How could it go wrong? The surgeon found a "defect" on the left so gave me the full coverage treatment. Two 6x6" pieces, that never settled in like I was told they would, just caused constant irritation and inflammation for three years. I found out afterward that my friend had had open repair with mesh, not TEP. Even he wasn't aware of the state of things and thought that TEP was the wave of the future.

As someone with a PhD you should know that there are always two or more sides to every situation. Use your research skills to understand the underlying truth of what you're about to do. Where are these lawsuits coming from? Why do professional athletes avoid mesh? Why are there few stories out here on the internet about how good the hernia repair was, years after hernia repair with mesh, not just months? Where are those "years later" success stories? If there are success stories, what procedure did they have done? You can find research papers to support any of the many arguments.

That's why I say to talk to your relatives and friends that have had hernia repair. Ask them what could be better about it. Then find out if the method you're considering addresses those issues, with fact-based long-term evidence. Or is the industry just selling the materials and procedure, and accepting the failures and ruined lives as part of the risk of being in the business?

And beware of how the results of different studies can vary, and how they define "chronic pain". You can spend hours reading publications and sill not be sure what is best. That's why I suggest finding real people who are happy after years and having that procedure done, exactly. One thing that is clear is that laparoscopic mesh implantation is meant to be permanent. If you have problems, there is no standardized "fix" for it like there is for the original hernia. So you're about to make a decision that will affect the rest of your life, not just the weeks or months of healing from surgery. It is a 30-40 year decision, easily. Put the time in and don't trust people in the industry to know what's happening. They are all overwhelmed with the bureaucracy of today's healthcare system. They don't keep up with their patients long-term results.

The first paper here is full of good references. The others are just recent samples, that show how you can find papers to support either side, or neither, or just confuse the issue entirely.

http://file.scirp.org/pdf/IJCM_2014072117033945.pdf

https://www.sages.org/meetings/annua...hernia-repair/

https://www.jwatch.org/jw20120510000...nguinal-hernia

[drgephys]

My point was that things are not as clear as the hernia repair industry makes them out to be.

This is the official statement of the international hernia "industry" (Hernia Surge), which I'm repeating from my previous post:

(Short excerpt from the 2018 international hernia guidelines linked below)
link.springer.com/article/10.1007/s10029-017-1668-x

"One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered."

So, they don't say one procedure is the best for everyone. In fact my surgeon offered me all possible options (open, lap, tissue, etc.).

The finding regarding recurrence with lap repair in the last paper you posted is absolutely false. Any recurrence after lap surgery is entirely due to technical errors and in the hands of an experienced surgeon, it should be practically zero. Same thing applies for Lichtenstein open tension-free repair with anterior mesh, albeit a slightly higher recurrence rate. Also, the paper by the Shouldice Clinic you posted is funny because they don't discuss the nerve problems in their repair while criticizing the Lichtenstein mesh repair. The other paper you posted doesn't apply to many people, as they discuss the open repair with posterior (as opposed to anterior) mesh, which is normally done only in recurrent hernias.

Regarding someone who had both open and lap, my primary-care physician had both on himself in the 1990s and both were successful. He personally recommended lap.

I don't know what went wrong in your case but I'm suspecting technical errors by your surgeon. At the time of your surgery, Dr. Edward Felix's ten commandments on lap hernia repair were not known. These ten commandments greatly reduce the risks in lap repair and my surgeon follows them:

(Dr. Edward Felix's ten commandments on lap hernia repair linked below)
researchgate.net/publication/311704613_Critical_View_of_the_Myopectineal_Orific e

So, yes, I'm well aware of the risks of lap repair. That's why I'm still debating. I'm not going to spend probably about $10,000 and go to Canada for a Shouldice repair. My surgeon offers that option for free here. Shouldice has long healing time as the normal tissue anatomy is greatly modified, with muscles and ligaments not supposed to be joined being joined together during the repair (Ouch!). Lichtenstein is probably the safest method among all hernia-repair methods but the risk of chronic pain is higher than in lap with posterior mesh.

The best resource on hernia repairs is probably that Hernia Surge guidelines paper I linked above. It's long but I'll read the whole thing before I meet with my surgeon this Friday. I also read parts of the SAGES hernia-repair manual but the information in it is more scattered and not summarized in a guidelines form.

I really feel sorry that you had gone through this experience that greatly reduced the quality of your life. Please wish me luck! I want to stay in the gym and not go through serious complications. My (highly experienced) surgeon stated, "Both open (Lichtenstein) and lap are good procedures. They have different risks, some preventable, others not. Don't overthink this and pick one. You'll be fine with either." That said, I'm still debating in less than two weeks to my surgery and will have another meeting with him next week.

[SoccerAgain]

Good luck. Don't overlook cognitive bias. It's powerful.

[SoccerAgain]

I've sent a bunch of messages out to people who reported getting a hernia repaired, way back at the start of this thread. Hopefully some replies will come through. There's quite a variety of materials and methods being used, from Shouldice to full coverage TEP. Should be interesting, and informative, I hope. I've only made it through page 4, November 2012. Should be some good many-years data there.


I'm doing pretty well since having my TEP implanted Bard Soft Mesh removed 6 months ago, after three years. All parts are back to functioning correctly, and I can actually go for a run and feel okay the next day.

[culican]

I'm a long-time heavy-weight lifter. I'm heading for surgery in a couple of weeks for primary inguinal hernia on the left side. Still trying to decide on laparoscopic with posterior mesh vs. open with anterior mesh (Lichtenstein tension-free). I also had a hernia when I was ten-years-old on the right side immediately after jumping off a five-foot-high window. I'll post more later.

Regarding intraabdominal pressures, they increase tremendously with the amount of weight used. So, squatting with three plates or more is not the same as squatting without weights. See this article. It looks like for heavy squats and deadlifts, pressures are far higher than those for coughing and jumping.

See Intra-abdominal Pressure Changes Associated with Lifting: Implications for Postoperative Activity Restrictions by Kimberly A. Gerten et al. (I can't post links).

Intra-abdominal Pressure Changes Associated with Lifting: Implications for Postoperative Activity Restrictions
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329922/



Seriously? Your extrapolating a 315 pound squat from a study that used 15kg as the maximum weight? Do you have any reason to believe that the relationship between IAP and weight lifted is linear as one goes into the hundreds of pounds?

[drgephys]

From the Hernia Surge Guidelines I linked above:

Evidence in literature
A medical literature search for primary IH risk factors
identified 989 studies. Included are a discussion of one
systematic review, two randomized controlled trials
(RCTs), 24 cohort or registry studies, five case–control
studies and five diagnostic studies in the material below.
A medical literature search for RIH risk factors identified
1191 studies. A discussion follows of two systematic
reviews, two RCTs, 31 cohort or registry studies, one case–
control study and four diagnostic studies.
Primary inguinal hernia
The lifelong cumulative incidence of IH repair in adults is
27–42.5% for men and 3–5.8% for women.14–17
Risk factors associated with IH formation (evidence
level—high):
• Inheritance (first degree relatives diagnosed with IH
elevates IH incidence, especially in females).18, 19
• Gender (IH repair is approximately 8–10 times more
common in males).
• Age (peak prevalence at 5 years, primarily indirect and
70–80 years, primarily direct).16, 20–22
• Collagen metabolism (a diminished collagen type I/III
ratio).
• Prostatectomy history (especially open radical).23–35
• Obesity (inversely correlated with IH
incidence).19, 21, 36–38
Risk factors associated with IH formation (evidence
level—moderate):
• Primary hernia type (both indirect and direct subtypes
are bilaterally associated).39
• Increased systemic levels of matrix metalloproteinase-
2.40–43
• Rare connective tissue disorders (e.g. Ehlers–Danlos
syndrome).44
Risk factors associated with IH formation (evidence
level—low):
• Race (IHs are significantly less common in black
adults).21
• Chronic constipation.19, 45
• Tobacco use (inversely correlated with IH incidence).37
• Socio-occupational factors.
There is contradictory evidence that social class, occupational
factors and work load affect the risk of IH
repair.46, 47 Heavy lifting may predispose to IH
formation.48
Risk factors associated with IH formation (evidence
level—very low):
• Pulmonary disease (COPD and chronic cough possibly
increasing the risk of IH formation).48, 49
Liver disease, renal disease and alcohol consumption
have not been properly investigated to determine if they are
risk factors for IH formation.
Recurrent inguinal hernia
Risk factors for RIH with a high level of evidence include
female gender,49–59 direct versus indirect IH,58, 59 annual IH
repair volume of less than five cases60 and limited surgical
experience.56, 61–68 However, this last risk factor may be
modifiable by surgical coaching.69–72
Risk factors for RIH with a moderate level of evidence
include: presence of a sliding hernia,73 a diminished collagen
type I/III ratio,40, 74, 75 increased systemic matrix
metalloproteinase levels,42, 59, 74, 75 obesity37, 59 (although
questioned in two very small studies57, 76) and open hernia
repair under local anesthesia by general surgeons.53, 77 A
recent meta-analysis examining features of
100,000–200,000 repairs demonstrated that size (\3 versus
C 3 cm) and bilaterality did not affect the risk of
recurrence.59
Incorrect surgical technique is likely the most important
reason for recurrence after primary IH repair. Within this
broad category of poor surgical technique are included:
lack of mesh overlap, improper mesh choice, lack of proper
mesh fixation, amongst others.
Several other potential risk factors have not been well
studied or have low or very low levels of evidence supporting
an association. Early postoperative hematoma formation
78 and emergent surgery50, 52, 58, 59 may be risk
factors for hernia recurrence but the association is not
conclusive. Low (1–7 drinks/week) versus no ethanol
consumption may protect against hernia recurrence. The
effect of high ethanol consumption is unclear.53 Increased
age,57, 59, 79, 80 COPD,57, 59, 76–82 prostatectomy,76 surgical
site infection,78, 83 cirrhosis,84 chronic constipation,76 a
positive family history.80, 85 and smoking.53, 57, 80, 85 have
not been consistently shown to be risk factors for RIH.
Incompletely studied factors which may impact the risk of
IH recurrence are chronic kidney disease, social class,
occupation, work load, pregnancy, labor, race and postoperative
seroma occurrence.
Conclusion: several demographic (anatomy, female gender,
abnormal collagen metabolism), acquired (obesity), and
perioperative risk factors (insufficient surgical technique,
low surgical volume, surgical inexperience and local
anesthesia) for RIH were identified. Risk factors for IH and
RIH are not comparable. In daily surgical practice, attention
should be paid to perioperative surgical factors as they
are modifiable. Allocation arms in future outcome studies
should be balanced according to these demographic and
acquired risk factors.

[drgephys]

Also, not in that excerpt I posted, but elsewhere in the Hernia Surge Guidelines I linked above, low BMI is also mentioned as a risk. I got my hernia when my body fat dropped to around 8% and I'm suspecting that could have been a factor. They repeatedly emphasize that overweight but not obese people are much less likely to get hernias. So, perhaps, preperitoneal fat protects against hernia formation.

From Page 122:

Certain individuals are at increased risk for the development
of a groin hernia. The list below contains certain
features that may make groin hernia development more
likely.

• Male gender
• Those with family members who have groin hernias
• So-called ‘‘impaired collagen metabolism’’ (collagen is
a protein in many body tissues like muscle)
• Those with a previous hernia
• The elderly
• Those who’ve undergone removal of the prostate gland
• The obese
• Those who are extremely thin (so-called ‘‘low body
mass index’’).

link.springer.com/article/10.1007/s10029-017-1668-x

[drgephys]

These are the official recommendations on activity restriction from Hernia Surge Guidelines, Page 57:

* Physical activity restrictions are unnecessary after uncomplicated inguinal hernia repair and do not affect recurrence rates. Patients should be encouraged to resume normal activities as soon as possible.

* Patients are recommended to resume normal activities without restrictions within three to five days or as soon as they feel comfortable.

link.springer.com/article/10.1007/s10029-017-1668-x

This is encouraging but are heavy squats and deadlifts considered normal activities?

[SoccerAgain]

Here's an interesting comment, in the linked video, from the Surgeon-in-Chief at one of the big clinics on the east coast, Carolinas Healthcare. Well-known for abdominal wall repair. It's at close to 12:10. "Pain is the #1 risk factor for inguinal hernia repair". I wish it wasn't so and that I was just one of a million. I could accept that and just go away. But it doesn't seem to be the case. I see real flaws in how things are done, and real avoidance of the chronic pain issue. I've been around and I know how big institutions work. It's just the reality of the situation.

The healthcare industry is getting very bureaucratic and cost-oriented, at the expense of patients' quality of life. They're putting more responsibility on the patient for the choices made. You can't trust the surgeon to have your specific best interests in mind, they are thinking more generally. About the greater good. They are locked in by the system. They probably hate it, but they don't have a choice.

There is much that's interesting in the video if you listen closely to the message he delivers and read the Q&A in the sidebar. It's a good summary, I think, of the state-of-the-art.

https://www.youtube.com/watch?v=aSOfH96kLnw

Considering all, there's nothing wrong with asking your surgeon to prove that his or her methods work. They should know, as responsible doctors. If they don't know, then they're just avoiding the answer to a well-known problem, or they are being prevented from finding out.