*** OFFICIAL INGUINAL HERNIA RECOVERY Thread ***

[SoccerAgain]

I had my surgery on 30th June 2018 and I’m getting home today from hospital. I’m not sure how I acquired hernia but I want to find out if anyone of you brothers here had problems due to lifting after the surgery. My doctor mentioned (here in India) to stay away from bending or any diet of lifting for one year. I can use this time 1-1.5 hr a day to do something else other than lifting to improve myself. But I want to get back to lifting after complete recovery. Please share your experience and precautions need to be taken in this 1 year and after starting lifting.

Without knowing the type of hernia, and its extent nobody can give you reasonable advice, especially from the internet. "Hernia" covers a very wide range of possibilities and the size of the hernia can vary dramatically. Plus your general physical condition, the type of repair the doctor used, and his or her history with that repair. The doctor's history with the repair is probably the most important since they would know what actions cause a recurrence or other problems.

If you can give details of your problem, and the repair method and materials, people here could tell you about their experiences if they've had similar. None of us out here are medical doctors though. I wouldn't take internet advice over the advice of the surgeon who did the work.

[drgephys]

My doctor told me that 80% healing is achieved after four weeks. Assuming a logarithmic healing, this is what you get:

Healing achieved Days passed after surgery

0% 0 days
5% 1 day
10% 2 days
15% 3 days
20% 4 days
25% 5 days
30% 6 days
35% 7 days
40% 9 days
45% 10 days
50% 12 days
55% 14 days
60% 16 days
65% 18 days
70% 21 days
75% 24 days
80% 28 days
85% 33 days
90% 40 days
95% 52 days
97% 61 days
99% 80 days
100% Infinite days (logarithmic approach to 100% healing)

t = -17.40 days * ln(1 - Healing achieved)

[SoccerAgain]

I think that you might be confusing mesh implant strength, the strength of the bond between mesh and tissue, with overall healing.

Regardless, the OP did not give enough detail about his situation for even a professional to make a recommendation.

[drgephys]

This is neither my doctor nor the place where I had my operation. However, he has some very good advice on when you can start your activities and lifting:

californiaherniaspecialists.com/hernia-recovery

He does both open with 3D mesh and laparoscopic surgeries. In summary he is saying that you can start heavy squats and dead lifts at the end of Day 21. However, as my doctor did, he is cautioning you to listen to your body and stop and don't do it if it hurts.

I am planning to start lifting at the end of Day 32 (on Monday). This is 11 days longer than this doctor's recommendation. I probably could have started this week. My doctor said that 80% healing is reached at the end of Day 28 and I wanted to wait until then plus the weekend.

[drgephys]

I have finally been able to find a scientific study on when to start activities and lifting after hernia-repair surgery! It was done at the University of British Colombia in 2012, where they went through extensive literature. Anyone who is going through hernia-repair surgery and wondering when to start lifting weights should read it:

bcmj.org/articles/timing-return-work-after-hernia-repair-recommendations-based-literature-review

These are the recommendations in the conclusions:

The adoption of new technologies and techniques has challenged the practice of recommending a prolonged period of convalescence after hernia repair. However, it is clear from the sports-medicine literature and biomechanical studies that recommendations must be patient-centered and take into consideration both regular work activities and individual pain experience. Tensile forces sufficient to cause an early repair failure can be generated by lifting more than 10 kg (22 lb), and this risk persists up until 6 weeks after surgery. All patients should avoid coughing and strenuous activities such as jumping in this period.

For patients needing to lift more than 10 kg or perform other activities that generate a prolonged intraabdominal pressure of 50 to 60 mm Hg or more, the evidence supports 6 to 8 weeks of convalescence.

Intraabdominal pressures and tensile forces generated by various activities:

bcmj.org/sites/default/files/public/BCMJ_54Vol7_hernia_table1.JPG

Recommendations for time after the surgery before returning to various activities:

bcmj.org/sites/default/files/public/BCMJ_54Vol7_hernia_table2.JPG

In conclusion, this scientific study recommends lifting above 10 kg (22 lb) only 6 to 8 weeks after the surgery and not before that, regardless of the type of the hernia or repair method (see the second JPG image above).

[ShoulderBrah]

To give everyone an 8 year status. My hernia repair is perfect. I had surgery August 2010 and 8 years later, I forgot that it even happened. I don't come on the forum that often anymore, but every once in a while I get a private message, and I realize that it isn't even on my mind anymore. The surgeon used a mesh and tied it to the bone. He allowed the mesh to be less than tight for what he normally does because he knew that I lift and he wanted the mesh to have the ability to flex or give just a little. I have not had any complications or anything. I am so glad that I had Dr. Brian Kurland in Fort Myers, FL. He knew exactly what he was doing. I asked him tons of questions before the surgery occurred. He recommended against the laparoscopic method because he wanted full access and view of open surgery method so that he can fine tune and get the mesh perfect, WHICH HE DID! If you have any more questions or anything you would want me to dive into deeper, let me know. I am glad to share any details with you since I had a 100% perfect experience. I even got stronger and hit PR's afterwards. I am very lucky to have found Dr. Brian Kurland in Fort Myers, FL.

[SoccerAgain]

Thanks for posting Shoulderbrah. It's good to hear that there are proven methods out there.

Denmark and Germany keep a hernia repair registry to keep track of issues with the various combinations of material and methods. I think that the States are too owned by the device makers to have something like that. It's caveat emptor over here, which, of course, doesn't work to predict long-term results, if nobody keeps track. But, eventually, the truth comes out.

Good luck.

[drgephys]

Thanks for posting Shoulderbrah. It's good to hear that there are proven methods out there.

Denmark and Germany keep a hernia repair registry to keep track of issues with the various combinations of material and methods. I think that the States are too owned by the device makers to have something like that. It's caveat emptor over here, which, of course, doesn't work to predict long-term results, if nobody keeps track. But, eventually, the truth comes out.

Good luck.

There is really not a huge variety of methods out there. The two most common methods are the open Lichtenstein anterior front mesh and the laparoscopic (TEP or TAPP) posterior mesh. There is also a less common open posterior mesh method. Plug-and-patch is even less common and probably inferior. 3D meshes are also considered problematic. Tissue repairs (Shouldice, Desarda, McVay, etc.) are all problematic for adult hernias.

US is a lot more strict on mesh approvals. I was asking my doctor about the new Dynamesh PVDF (as opposed to the common polypropylene) mesh, which is a very good material, and he said it was great but hasn't been approved in US. There were two hernia experts from Denmark with him and he said they've been using it and ask them. They said, it's no different -- there are so many meshes these days and they are all good.

He used the Ethicon Ultrapro Advanced mesh in my Lichtenstein repair, which is the most advanced half-absorbable mesh available in US. For laparoscopic repair, he uses the Progrip mesh that has absorbable self-gripping hooks.

Repeat: The most important criterion for success is the choice of the doctor. If he's a good doctor, he will know what mesh. He needs to have at least 500 repairs done by himself on the particular repair method. He needs to have good technique and have learned the latest modifications. For example, most doctors still do Lichtenstein according to the original description, stripping the cremaster away from the spermatic cord and skeletonizing it, manipulating the nerves, etc., which could create a disaster. None of these should be done. They need to keep up with the research and developments. Therefore, spend a lot of time to find a good doctor.

In the case of ShoulderBrah, his doctor wasn't an hernia specialist and his technique wasn't that great -- large incision, attaching the mesh to the bone, which is not done these days -- but his repair still worked well -- perhaps partly by luck or partly because of his good general surgery skills. You will increase your chances of success if you research the doctor. The two major risks of hernia repair are recurrence and chronic pain. My doctor claimed that the occurrence of chronic pain is only 0.5% in both his laparoscopic and open patients, which is remarkable given that the average doctor gets about 7% occurrence of chronic pain in open and 3% in laparoscopic.

If you are in the Southern California, private-message me and I will recommend my doctor, who is an international hernia expert for both open and laparoscopic repairs.

[SoccerAgain]

You're just parroting the standard meme drgephys. For what purpose? You're just one guy, very early in his hernia repair,who is no more an expert on the subject than I am.

Do your homework people. The data shows that somewhere between 10 - 16% of people who have hernia repair with mesh will suffer chronic pain. The lawsuits aren't being supported by thin air.

Come back in over a year drgephys and your words will have a little bit more weight. Although many problems don't manifest until multiple years after repair.

You really should not be promoting something that can cause so much pain, for the sake of an internet reputation. Your PhD is in physics, not medicine.

[drgephys]

You're just parroting the standard meme drgephys. For what purpose? You're just one guy, very early in his hernia repair,who is no more an expert on the subject than I am.

Do your homework people. The data shows that somewhere between 10 - 16% of people who have hernia repair with mesh will suffer chronic pain. The lawsuits aren't being supported by thin air.

Come back in over a year drgephys and your words will have a little bit more weight. Although many problems don't manifest until multiple years after repair.

You really should not be promoting something that can cause so much pain, for the sake of an internet reputation. Your PhD is in physics, not medicine.

There is really no good alternative to the mesh. If there was, no one would deal with a mesh.

Did you realize that Shouldice, Desarda, McVay, etc. tissue repairs involve a lot of anatomical modification? Plus, you have a lot of permanent suturing placed inside you.

Any good hernia specialist will offer you a tissue repair as an option. Mine did. However, he said, "Don't do it." A simple tissue repair would probably work in my case because my hernia was an indirect hernia, which is congenital; however, my colon going in an out of my spermatic cord had also weakened the direct inguinal floor over so many years. So, I wouldn't risk a recurrence. While I was on the operating table, he was talking that he did a tissue repair on a woman recently because she strongly objected to the mesh. She had a recurrence two weeks later.

[drgephys]

I wrote that last post more as a summary of my thoughts on the subject. Since I've been stuck right in the middle of it, I'll probably be thinking and talking about it until I die.

I'm actually doing really well since removal surgery. Dr. Peter S. Billing of Eviva in Shoreline WA removed both sides in two operations. It's tedious, difficult work, I think. Each side took 2-4 hours. He said that the right side was folded over and inflamed, and the left side had moved medially (toward the middle) and downward. And was very inflamed. The original small direct hernia on the right side was filled in by scar tissue. He has been removing mesh for eight years, in addition to his main practice focus.

So at this point I'm essentially back to where I was just before I got the hernia. But the last three years have been difficult, for more than just me. Which brings up something else I've realized - many surgeons will just see you as an abdomen with a defect when you go in to talk about your hernia. Like a tire that needs a patch. They'll install the patch and if it doesn't leak they consider their work to be done, and successful. They will listen to your words at the initial consultation but, probably, won't really hear anything about weight-lifting or running or biking or hiking or sports. Just an abdomen with a hole in it.

Some doctors will consider your activities and plans but it's surprising how many don't. Even the ones that acknowledge that there might be differences in mesh and materials will still be thinking about a large piece of mesh to cover that small hole. Because recurrence is what success is based on, not quality of life. It's in the training.

The field has changed a lot in just the three years since I got the hernia. When I was looking for a fix, I had to choose between open and laparoscopic. It was still a choice. Now, just three years later, it seems that everybody is recommending lap. Maybe because they get graded on short-term issues, like infections and suture tears. Not the 20+ years that the patient will live with the procedure.

Hi SoccerAgain,

I went through your posts and this is the only one that actually tells what went wrong.

First, I should say that you are probably the only other person on this thread who actually did good research on hernia and understood it well. I was impressed.

Second, I am glad that your problems are gone or going away.

Everything is indicating that your surgeon made technical errors during the surgery. When that happens, all bets are off. Mesh is not supposed to fold. However, it sometimes does, and the only reason it does is technical error by your surgeon. Therefore, so much with your surgeon being a good one. You mentioned about 300 repairs. This is not many at all. Usually 1000 means the surgeon is an expert. Also, expertise doesn't indicate knowledge. Chief of surgery doesn't mean anything either other than an administrative position.

I doubt the particular mesh had anything to do with it. However, the self-fixating ProGrip mesh could perhaps have made up for the technical error made.

However, the other problem could be an early return to activities. I posted a very good research article a few posts back that you shouldn't return to intense activities before 6 - 8 weeks. Unfortunately most doctors rush the patients just to prove that their method is superior. I even saw one video posted here with the doctor (Mark Reiner, Mount Sinai) basically saying that you should attempt your new personal weightlifting records 48 after laparoscopic surgery. With no offense to him, this is plain crazy! I liked him though because he is very patient-centered -- always open-door with indefinite free follow-ups. He actually tried his best to have a short- and long-term recovery database for all his patients.

So, I would say that your problems were caused by a combination of technical errors and a rush to intense activities before the mesh settled in through tissue ingrowth.

These are the recent "ten commandments of Dr. Edward Felix," the current state-of-the-art guidelines for screw-up-free laparoscopic hernia repair. Chances are that not all were followed in your case:

researchgate.net/publication/311704613_Critical_View_of_the_Myopectineal_Orific e
(Dr. Edward Felix, "Critical view of the myopectineal orifice")

Also, I thank you for discouraging me from laparoscopic repair. At the end it was my own decision to go with open, and chances are that laparoscopic would probably work as well, but I am really, really glad that I chose open in my case. My inguinal canal was opened and its floor and deep ring was meshed from the outside, yes, but my extraperitoneal space (inside of my abdominal wall), bladder, vas deferens, spermatic vessels, etc. were left virgin and without a mesh. Arguably, that's less invasive in my opinion.

[drgephys]

Almost 8 weeks after primary unilateral left-side open Lichtenstein repair with anterior flat mesh (Ethicon Ultrapro Advanced partially [50%] absorbable) of large indirect inguinal hernia. I had a tissue repair for a large indirect inguinal hernia on the right side when I was eleven-years-old.

Note: All indirect inguinal hernias are congenital and caused by a "patent processus vaginalis," which means a congenitally dilated or not closed deep ring (internal ring) of the inguinal canal. The hernia sac protrudes into the inguinal canal indirectly from the deep ring. On the contrary, a direct hernia is caused by a tear on the floor of the inguinal canal (part of your inner abdominal wall) and the hernia sac protrudes directly into the inguinal canal from the tear in the floor of the inguinal canal (part of your inner abdominal wall). An indirect hernia sac also passes through the inside of your enlarged spermatic cord and the sac needs to be peeled away from the cord, the latter of which is made from the cremaster muscle and is split open during open repair and then it folds back on its own. Peeling it away is more challenging in laparoscopic repair, as it is done from the inner side of the deep inguinal ring. A direct sac on the inguinal floor simply pushes back in. Note that the hernia sac is usually composed of the peritoneum and contains your bowels.

ncbi.nlm.nih.gov/pubmed/12820028

Long story short, my hernia was indirect, which is always congenital and never caused by activity. On the other hand, a direct hernia is always caused by activity, such as lifting, playing sports, or too much coughing.

The two-inch-long horizontal incision low in my grown was closed by a plastic surgeon and it looks like there will be no visible scar at all when it heals.

The ridge under the incision remains. In fact, there are two ridges very close, one in the skin and the other in the external oblique.

Slight swelling in my lower groin below the incision remains. Slight discomfort/pain remains, probably caused by the healing ridge and swelling.

I never had any hematoma (purple skin or parts) that is typical with laparoscopic surgery.

As I posted a few posts back, the recommended return to unrestricted activity is 6 - 8 weeks. I might take a bit longer just because of a variety of reasons but when I go back, I plan to start my regular quarterly workout ramp that takes about three months to reach my maximum weights. Currently I can move around and run with no pain.

I would say that I am very satisfied with my repair so far.

My recommendations:

(1) There is no one-size-fits-all technique.

(2) Nevertheless, if you know a good surgeon with hundreds of repairs for the open Lichtenstein technique, this is the method I recommend. However, recommendation only holds if the surgeon knows what he/she is doing, has a lot of experience, and knows the latest modifications to the procedure.

(3) I chose not to have the laparoscopic method in my case because I felt it was more invasive deep inside my abdomen, with also small but serious risks to internal organs. I just felt it was safer and less problematic to go with the Lichtenstein open method. My surgeon does and recommend both equally. I am guessing that would also work if I chose laparoscopic but I don't really know and I'm happy with my open-repair choice. My surgeon pretty much says that open and laparoscopic are both the same, both good procedures. So, open was my choice after a very long, long consideration. I chose what appeared to be the simpler method, which has a smaller mesh, not placed next to my vital organs and inners, probably less likely to alter my abdominal wall. With the open surgery, you avoid general anesthesia and I was fully awake (the oxygen mask makes you incredibly alert and hyper) and watched the whole operation on the monitor, constantly talking to my surgeon.

(4) Never do any 3D-mesh or 3D-mesh-system (such as the Prolene hernia system) repairs. They are always problematic. If your doctor suggests anything other than a flat mesh, run away.

(5) Shouldice repair avoids the mesh but it's very invasive on the tissue, modifying your groin substantially. Besides, there are permanent sutures. Desarda and McVay are even worse -- they leave your spermatic cord above your external oblique and right under your skin! How creepy that is! Avoid these repairs, including Shouldice. In fact, I feel that my right groin where I had a childhood tissue repair is more uncomfortable than my left side with the mesh.

(6) Do not return to any intense activity before 6 - 8 weeks, regardless of whether laparoscopic or open repair! It's not worth it. This is the same for any serious sports injury and hernia-repair surgery is considered a serious athletic injury. There is research backing it:

bcmj.org/articles/timing-return-work-after-hernia-repair-recommendations-based-literature-review

In my experience, taking creatine monohydrate during the recovery period seems to help maintain muscle mass while not lifting.

(7) Do not delay the surgery as soon as you do your research and find a doctor. Hernias don't heal on their own and their symptoms get worse over time. You're probably already missing a lot if you're living with a hernia, with obvious as well as disguised symptoms. Have it fixed as soon as possible and get to a normal life.

(8) Hernia repair, while a somewhat simple operation, is also subtle and tricky. If the doctor doesn't know what he/she is doing, there is a good chance that something will go wrong, regardless of the type of the procedure (open or lap) or technique, use of mesh or not. You get the idea. Find a good doctor -- a really, really good one, more than just reputation, hearsay, position held such as chief of surgery etc. but also with proven research record and international recognition.

(9) I will go ahead and recommend my doctor. He's very busy and usually takes months to make an appointment for consultation and then months to get surgery scheduled. He's one of the only two American members of the International Hernia Society (Hernia Surge) that discusses the current literature constantly. He runs the Lichtenstein Center and is also equally an expert in laparoscopic repair, following the recent "ten commandments of Dr. Edward Felix," also known as the critical view of the myopectineal orifice, the current state-of-the-art guidelines for screw-up-free laparoscopic hernia repair. Meshes currently used: Ethicon Ultrapro Advanced partially absorbable flat mesh for Lichtenstein open and Medtronic/Covidien ProGrip self-fixating flat mesh for laparoscopic. Dr. David Chen, UCLA, Santa Monica, California.

[Bell0c]

(Notes: I wrote these posts over a 3 day period, so comments on days won’t necessarily line up. Also, I entered my birthday, but for some reason the system is subtracting 5 years. I'm 53.)

First, a heartfelt thank you to ShoulderBrah and the many contributors to this thread. I started reading this very long thread a couple of weeks before my operation and just finished it, now 6 days post-op. There’s a ton of useful information here, especially in what to expect immediately post-op. Many of the contributions regarding choosing a type of surgery seem to have come later in the thread, after I’d made my choice. But I got a lot out of it, and I’ll try to do my part to add to the discussion and to the general information.

I had a bilateral inguinal direct hernia. I think the bumps must have been there for several years, but I can’t say when they appeared. I remember seeing them, one on either side of my groin, three or four years ago, but they were symmetrical and where you would expect to see the diagonals of your abs, so I didn’t think anything about it. I started doing dumbbell deadlifts around that time to make my back feel better (with good results), but never felt any pain in my groin. I’d lost a little weight a few years before that, and they may have been there then. I’ve lifted off and on over the years, most heavily in my twenties when I was in the Navy, but never experienced any problems.

The dumbbell deadlifts turned into a full routine for the past couple of years, and I’m in better shape than I have been in twenty years. Still no pain of any kind. I don’t lift too heavy - maybe 3x5x290 on deadlifts, 3x5x220 squats (I’m 5’9”, 175, 53yo), with the usual upper body stuff. I would have gone on indefinitely but for the fact that my mother, 78 years old, maybe 105 lbs., was diagnosed with bilateral inguinal hernia. She regularly carries around 50 lb. bags of mulch and other things for gardening and apparently (to my surprise) suffers regular constipation. I read the wikipedia article on inguinal hernias and saw that hernias run in families, and there was a picture that looked exactly like mine. When I looked in the mirror again, I realized that the bumps were no longer symmetrical, but that the right side was bigger. I’m not sure when that happened, but I clearly had at least one, and probably two, hernias.

My mom was told to do watchful waiting, but I knew that wouldn’t work for me, with one side already enlarging, so I started doing the same research everyone here seems to do. As with everyone, I found that it comes down to variations on open mesh, variations on lap mesh, variations on tension tissue repairs, and Desarda. Desarda has been around since 2001, I believe, and is a technique invented by an Indian doctor (Dr. Desarda).

Contrary to what several people on here have suggested, Desarda isn’t a tension repair, as evidenced by the fact that it uses all absorbable sutures. It’s the only modern repair I could find that doesn’t leave anything permanently behind inside you. It uses a roughly 1” wide “undetached strip of the external oblique aponeurosis” to cover the gap in the inguinal canal. There are lots of explanations and videos around that explain it better than I can. I apparently can’t provide links yet, but if you google “Lichtenstein vs Desarda,” several studies from the NIH and other organizations pop up, some following patients for as long as 3 years. The consensus is that results (as measured by post op recovery time, post op pain, chronic pain, recurrence, etc.) are as good or better with Desarda as with mesh, and several make a point of saying that it’s not a tension repair, that it’s cheaper, faster, and eliminates the possibility of mesh moving around causing problems with nerves, etc.

My take-away from that was that I’d probably be okay either way, mesh or Desarda, but that Desarda would probably sidestep the outlier incidents. Googling around for Desarda lawsuits or horror stories didn’t turn up anything, either. There aren’t many doctors in the States doing the procedure. I found a Dr. Peterson someplace in California that several people recommended and Dr. Desarda’s Indian website mentions a Dr. Guthrie, but at the top of the list on Dr. Desarda’s site is a Dr. Tomas in Fort Myers, Florida, who he says he trained personally.

Dr. Tomas’s website isn’t terribly up to date. They seem to have put it together in 2015, or at least updated it then, and haven’t touched it since. He started using the Desarda method in 2009, and as of 2015 he had performed over 2500 procedures, 10-15 a week. They’re completely set up for people to fly into town, get the surgery done, get a second consult a couple of days later, and fly out again. Three or 4 local hotels provide shuttle service to and from the airport and around town and at the one where I stayed (Garden Inn Hilton, 2 minutes from their office) everyone knew immediately that I was there for surgery with Dr. Tomas. It seems pretty fast, but I couldn’t find anyone online that had any problems with it.

Ok, that’s long enough for one post. In the next, I’ll detail my experience with the surgery and post op thus far and what recommendations I took from this thread that made the most difference.

[Bell0c]

I flew into Fort Myers on Thursday, 9/20/18. The Hilton where I was staying sent a shuttle to pick me up and take me directly to the UFirstHealth Clinic (even without checking in first), since my appointment was soon after my arrival. I did the usual check-in paperwork stuff, then saw the doctor, who confirmed that it was bilateral. They did an EKG to clear me for anesthesia, took blood to do blood tests, and I sat down with a lady to pay for the procedure. I should note here that they don’t take insurance, and I know this is a deal-breaker for many people. For me, my lousy insurance deductible is $5700 plus 20% of the rest, so their fee of $6200 for the bilateral procedure all-inclusive of testing, anesthesia, surgery, and all medications, even with a flight there and 4 days in the hotel (about another $1000, give or take), I figured I was coming out ahead, or that it was at least a wash. I’d already paid a $300 deposit, so I paid the balance. All these figures, btw, are listed on their website, so this isn’t secret info or anything - everything is completely upfront.

Anyway, the surgery was scheduled for the next day at 1:30. They called and moved it up an hour, and there was a small issue with my eating a small breakfast at 6am, but we eventually got underway close to the originally scheduled time. They used an IV sedative (they said it put me into REM sleep), and an inguinal block. I wore compression socks (someone mentioned that here) and warm socks (the clinic recommended that), so while the rest of me was freezing till I fell asleep, my feet were warm. The whole procedure took less than an hour. I woke up feeling like I do most mornings, which is to say groggy but pretty normal, and the grogginess passed in a couple of minutes. I sat for a few minutes, then got dressed and went out front.

Florida law requires that someone stay with you for at least 4 hours after surgery, and I had arranged for someone to be there through a service they recommended. It was an extra $100. A nice older lady drove me back to the hotel, went back to my room with me, and sat and watched TV with me for 4 hours. I told her she could leave before that, that I felt fine, but she said she had to stay by contract. I felt perfectly fine, clear-headed, and had no trouble moving around. Mainly I felt a tightness in the area above my groin, but the only pain was getting in and out of bed if I used my abs. I had done some shopping on Thursday (the hotel shuttle took me to and from the grocery), and based on recommendations here I had stocked up on canned soup, apple sauce, yogurt, instant steel-cut oatmeal, and milk, (and jelly beans and cookies, for morale) and I made some soup and coffee as soon as we got back.

I should pause and explain the medicine they give you: Dr. Tomas doesn’t like narcotics because of the constipation issue, so he proscribes Gabapentin, some kind of nerve blocking stuff used for a spectrum of things from restless legs to epilepsy. As I found on Day 6 when I stopped taking it for 10 hours, it works pretty well. Gabapentin every 8 hours alternates with Motrin and Arnica tablets every 8, so you’re taking something every 4 hours, plus antibiotics at every meal for about 10 days and stool softener a couple of times a day. All of these are in sheets of blister cells with the times written on them. Plus they give you several 5% Lidocaine patches that you can cut into whatever sizes you want to put above and below the incisions. They make a big difference, too. Oh, and a tube of Arnica gel that I keep forgetting.

Other than getting in and out of bed, Day 1 was a breeze, as many have reported. Activating the abs caused sharp burning, and standing from a sitting position felt like everything was being stretched out, but once standing I could walk without stooping. Based on recommendations here, I made a point (and continue, now at day 7, to make a point) of walking every hour or two. The first three days, I even got up when I took my 4am medicine and walked up and down the hall a couple of times. And, as someone here said, ice is your friend. I kept an ice pack going the whole time I was at the hotel, then rediscovered it a few days after I got home.

The second day wasn’t bad, but it was a little worse than the first day. I just generally felt more sore and more tired. Being in the hotel instead of at home turned out to be a good thing as I could get up, walk up and down the hotel hallway a couple of times, come back and recline on the bed, drift in and out of sleep, get something to eat, etc., with everything nearby and without distraction or anything else going on. Day 2 came and went without much change.

The morning of Day 3 was the worst. I’d missed my 4am meds by about an hour and a half (don’t remember what it was), and rolling out of bed caused burning in the incision area, nausea, cold sweats, all that good stuff. I ate some oatmeal, did my walking, drank some coffee, and the worst passed. By that afternoon, everything was back to Day 2 levels. At 48 hours after the surgery, I could take off the giant bandage covering my front side and take a shower, which felt great. The incisions looked good. There was a little swelling above the groin, and a bruise and a little swelling had begun to appear at the top of the scrotum and the base of the penis, but nothing dramatic.

Day 4, Monday, (really 72 hours after surgery) I went in for the second consult and check-up and to get cleared to fly home. The doctor poked around above the groin and under the scrotum and said it all looked good. He said the nerves in the front of my belly, and the nerves to the sides of the incisions where the inguinal block was done, would continue to be sore for several days, and that I could stop taking Gabapentin when the soreness passed (as I mentioned, I miscalculated that at Day 6). They had told me before to contact the airline and arrange for a wheelchair and early boarding, but I hadn’t done it, so I shuffled around with my carry-on duffel clutched against my chest or with my arms through the handles (which was tricky to get in place). I hadn’t brought a checked bag. I wore the sweatpants I’d brought, and the two flights of 90 minutes or so each weren’t really bad. I was pretty tired by the time I got home to Houston. My wife is a NICU nurse, and when I showed her the incisions, she said, “That’s beautiful! Those are beautiful!,” so the stitching got her seal of approval, and she was impressed that there was so little swelling and bruising.

In the days since, I can feel it hurting less and less as I engage my abs, to laugh, cough, sit up, etc., though it can still hurt, and I’m still super careful getting up or sitting or getting into bed. I can feel the hard ridges along the incisions that many people mention, but they don’t hurt. The main discomfort comes where the doctor said it would come - from the nerves above the groin. I mentioned stopping Gabapentin on the 6th day, and that was a mistake. I skipped my noon and 8pm doses and by 10pm I’d changed my mind and started it back up. It seemed to take a couple of doses to tamp the pain back down, which is what my wife had told me about pain - catch it early and keep it in check, otherwise you’ll have to work it back down. The Gabapentin does make me feel like I’ve lost a few IQ points - nothing like I imagine narcotics to be, but a little dulling.

Wow, this is getting long! I’ll make a few more points in a final post.

[Bell0c]

Things I learned from here and my own experience:

- Walk, walk, walk. I think even getting up to walk in the middle of the night the first few nights kept things from getting stiff. Frequency is more important than distance. The nurse said that your calves are considered a “second heart” because they are important to the circulation when they contract. I think they also play an important role in the lymphatic system. You don’t want blood to pool in the legs, and you want good circulation for healing. The compression socks were probably a good idea, too. The nurse saw them and told me to take them off at bedtime and put them back on in the morning, which I did for a couple of days.
- Beware constipation. I didn’t have general anesthesia, and didn’t take opioids, but I still didn’t see any movement for several days. My stomach was more distended than usual and seemed kind of hard, and the doctor said that something caused that (don’t remember what - antibiotics?), but I started thinking I should do something on day 5, I think. So I ate some prunes, some blackstrap molasses, some artificially sweetened gummy bears (I know that sounds weird, but go read the Amazon reviews - they’re crazy!), some kind of tea stuff my wife gave me, and of course the stool softeners I’d been taking all along, and by evening the floodgates opened. Didn’t really change anything, though, which made me remember what several people said here, that surgery just kind of stops things for a while. Come to think of it, I’m not sure what the lesson is here…
- Try to find a doctor with lots of experience with whatever procedure you decide on. No, I can’t say what kind of shape I’ll be in in 5 years, and what I say now is no guarantee of future success (as they say), but all else being equal, a doctor who has done a procedure 1000 times will be better at it than one who has done it 100 times, and someone who does it 5 times a week will be better than someone who does it twice a month. It’s worth going the extra mile for expertise when you can.
- Eat well before and after the procedure, and treat the recovery period like muscle-building recovery.
- Try to arrange it so that you can rest whenever you feel like it for the first few days. It’s nice to be able to just say, “screw it,” and just doze off whenever you feel tired.
- When the nerves in front are raw and feel like guitar strings being plucked, gentle pressure with an ice pack, or even your hand if you’re walking, can give some relief.
- Since this is outpatient, it may be hard to avoid being dropped right back into your crazy daily situation. If possible, make some space in there for a few days to rest.


Some other points:

To answer SoccerAgain’s frequent criticism, yes, I’m only a week post-op at this point, but I can’t help that, and really, all the immediate first hand info that so many people took the trouble to write out in detail made a huge amount of difference to me. I can’t imagine how different the whole experience would have been without all the first-hand accounts here, and I want to extend the same courtesy. And I disagree that people who never come back to the thread probably had bad outcomes - I think generally people tend to just move on after something like this unless they have a bad outcome, at which point they go looking for info, and to share their bad experience. I think you have to be especially conscientious to keep coming back when everything went well (another thank you to ShoulderBrah and several others for that!). I do want to thank you (SoccerAgain) for all the information you’ve shared, and for being the contrarian through all this - it’s good to have a dissenting voice to keep people thinking critically, and to keep sharing.

To Drgephys: though Desarda is a tissue repair, it’s not archaic and it’s not a tension repair, and lots of recent studies back up its efficacy. Done according to Dr. Desarda’s method, all sutures are absorbable and nothing is left inside - no mesh, no sutures, no tacks, no anything. You said the method left the spermatic cord outside the external oblique and right under the skin and that that was creepy. I haven’t seen that mentioned anywhere, in any study. I know you’ve been through a million studies and sites, but if you happen to remember where you learned that, I would appreciate it. If it is indeed true, I can’t feel it, and I’m not fat. In any case, you mentioned earlier that the alternative with mesh is that your spermatic cord will be rubbing against the mesh, or with a different placement, your intestines will be rubbing against the mesh, so I suppose it’s a matter of choosing which kind of creepiness you fancy. You also mention in connection with tissue repairs in general that they are creating anatomical modifications, as if inserting a foreign body into your abdomen to create a sheet of scar tissue where there wasn’t one before isn’t modifying anything. I think it’s important to look at what changes are being made. In any case, even at this late date, if you’ve seen any studies impugning Desarda, I’d very much like to read them, just to know what to look for in the future. I think you’re off on some of your Desarda info, but you’ve laid out a bunch of good stuff in general, so thank you for that. Also, I googled, “international hernia society hernia surge,” just because I wondered what international society for such a common procedure would have only 2 members from the U.S., and I didn’t come up with anything. Do they have a website?

And picking your poison is really what all this is. Each method has its own strengths and weaknesses: quicker recovery, fewer long-term problems, less chronic pain, more common, cheaper, less recurrence, locally available, covered by insurance, etc. Picking the most experienced doctor you can find is one way to improve your chances, just as it is when you have your car’s transmission rebuilt. I think avoiding having a foreign body inside me is a good idea, but people get all kinds of implants these days, so does that really matter? I didn’t like the idea of a tension repair, or of having stainless steel or other permanent sutures, but lots of people do fine with them. Desarda seemed to have the fewest objectionable features, so that’s where I put my money. But even if I come back in 5 years and say that I’ve been contesting the World’s Strongest Man and haven’t felt a twinge in years, it’s still one story among thousands. Even if 10 people chime in here with the same procedure from the same doctor, it’s still not much of a statistic. This thread can’t help but be anecdotal, but that’s not a bad thing, since it wasn’t created to be a comprehensive comparison of hernia repair types.

As a side note, I like the way Dr. Tomas’s office does business. There were zero surprises in the process - I’ve had more trouble getting my oil changed before. Practically everything is explained on the website, or in the very detailed emails they send, and it all went down just like they said it would. Everyone was polite, helpful, quick to respond, and professional in person. There were no tacked-on charges or anything weird. I can’t comment on follow-up or long-term results yet, of course, so time will tell. I can also recommend the Garden Inn Hilton. They shuttled me everyone I wanted to go, and I drank about 20 of their K-cups over the 4 days, which they supplied without complaint. Otherwise they left me alone, which was great.

So again, many thanks to the many fine contributors to this fantastic resource of a thread. I’m sure I’ve left out important details (even as long as this is), so please don’t hesitate to ask if you have questions, especially with as few here who have done Desarda. I’ll be sure to check in at regular intervals to document my progress. If I’ve made any mistakes, blame it on the Gabapentin…

[ezzy227]

Things I learned from here and my own experience:

- Walk, walk, walk. I think even getting up to walk in the middle of the night the first few nights kept things from getting stiff. Frequency is more important than distance. The nurse said that your calves are considered a “second heart” because they are important to the circulation when they contract. I think they also play an important role in the lymphatic system. You don’t want blood to pool in the legs, and you want good circulation for healing. The compression socks were probably a good idea, too. The nurse saw them and told me to take them off at bedtime and put them back on in the morning, which I did for a couple of days.
- Beware constipation. I didn’t have general anesthesia, and didn’t take opioids, but I still didn’t see any movement for several days. My stomach was more distended than usual and seemed kind of hard, and the doctor said that something caused that (don’t remember what - antibiotics?), but I started thinking I should do something on day 5, I think. So I ate some prunes, some blackstrap molasses, some artificially sweetened gummy bears (I know that sounds weird, but go read the Amazon reviews - they’re crazy!), some kind of tea stuff my wife gave me, and of course the stool softeners I’d been taking all along, and by evening the floodgates opened. Didn’t really change anything, though, which made me remember what several people said here, that surgery just kind of stops things for a while. Come to think of it, I’m not sure what the lesson is here…
- Try to find a doctor with lots of experience with whatever procedure you decide on. No, I can’t say what kind of shape I’ll be in in 5 years, and what I say now is no guarantee of future success (as they say), but all else being equal, a doctor who has done a procedure 1000 times will be better at it than one who has done it 100 times, and someone who does it 5 times a week will be better than someone who does it twice a month. It’s worth going the extra mile for expertise when you can.
- Eat well before and after the procedure, and treat the recovery period like muscle-building recovery.
- Try to arrange it so that you can rest whenever you feel like it for the first few days. It’s nice to be able to just say, “screw it,” and just doze off whenever you feel tired.
- When the nerves in front are raw and feel like guitar strings being plucked, gentle pressure with an ice pack, or even your hand if you’re walking, can give some relief.
- Since this is outpatient, it may be hard to avoid being dropped right back into your crazy daily situation. If possible, make some space in there for a few days to rest.


Some other points:

To answer SoccerAgain’s frequent criticism, yes, I’m only a week post-op at this point, but I can’t help that, and really, all the immediate first hand info that so many people took the trouble to write out in detail made a huge amount of difference to me. I can’t imagine how different the whole experience would have been without all the first-hand accounts here, and I want to extend the same courtesy. And I disagree that people who never come back to the thread probably had bad outcomes - I think generally people tend to just move on after something like this unless they have a bad outcome, at which point they go looking for info, and to share their bad experience. I think you have to be especially conscientious to keep coming back when everything went well (another thank you to ShoulderBrah and several others for that!). I do want to thank you (SoccerAgain) for all the information you’ve shared, and for being the contrarian through all this - it’s good to have a dissenting voice to keep people thinking critically, and to keep sharing.

To Drgephys: though Desarda is a tissue repair, it’s not archaic and it’s not a tension repair, and lots of recent studies back up its efficacy. Done according to Dr. Desarda’s method, all sutures are absorbable and nothing is left inside - no mesh, no sutures, no tacks, no anything. You said the method left the spermatic cord outside the external oblique and right under the skin and that that was creepy. I haven’t seen that mentioned anywhere, in any study. I know you’ve been through a million studies and sites, but if you happen to remember where you learned that, I would appreciate it. If it is indeed true, I can’t feel it, and I’m not fat. In any case, you mentioned earlier that the alternative with mesh is that your spermatic cord will be rubbing against the mesh, or with a different placement, your intestines will be rubbing against the mesh, so I suppose it’s a matter of choosing which kind of creepiness you fancy. You also mention in connection with tissue repairs in general that they are creating anatomical modifications, as if inserting a foreign body into your abdomen to create a sheet of scar tissue where there wasn’t one before isn’t modifying anything. I think it’s important to look at what changes are being made. In any case, even at this late date, if you’ve seen any studies impugning Desarda, I’d very much like to read them, just to know what to look for in the future. I think you’re off on some of your Desarda info, but you’ve laid out a bunch of good stuff in general, so thank you for that. Also, I googled, “international hernia society hernia surge,” just because I wondered what international society for such a common procedure would have only 2 members from the U.S., and I didn’t come up with anything. Do they have a website?

And picking your poison is really what all this is. Each method has its own strengths and weaknesses: quicker recovery, fewer long-term problems, less chronic pain, more common, cheaper, less recurrence, locally available, covered by insurance, etc. Picking the most experienced doctor you can find is one way to improve your chances, just as it is when you have your car’s transmission rebuilt. I think avoiding having a foreign body inside me is a good idea, but people get all kinds of implants these days, so does that really matter? I didn’t like the idea of a tension repair, or of having stainless steel or other permanent sutures, but lots of people do fine with them. Desarda seemed to have the fewest objectionable features, so that’s where I put my money. But even if I come back in 5 years and say that I’ve been contesting the World’s Strongest Man and haven’t felt a twinge in years, it’s still one story among thousands. Even if 10 people chime in here with the same procedure from the same doctor, it’s still not much of a statistic. This thread can’t help but be anecdotal, but that’s not a bad thing, since it wasn’t created to be a comprehensive comparison of hernia repair types.

As a side note, I like the way Dr. Tomas’s office does business. There were zero surprises in the process - I’ve had more trouble getting my oil changed before. Practically everything is explained on the website, or in the very detailed emails they send, and it all went down just like they said it would. Everyone was polite, helpful, quick to respond, and professional in person. There were no tacked-on charges or anything weird. I can’t comment on follow-up or long-term results yet, of course, so time will tell. I can also recommend the Garden Inn Hilton. They shuttled me everyone I wanted to go, and I drank about 20 of their K-cups over the 4 days, which they supplied without complaint. Otherwise they left me alone, which was great.

So again, many thanks to the many fine contributors to this fantastic resource of a thread. I’m sure I’ve left out important details (even as long as this is), so please don’t hesitate to ask if you have questions, especially with as few here who have done Desarda. I’ll be sure to check in at regular intervals to document my progress. If I’ve made any mistakes, blame it on the Gabapentin…

Thanks for documenting your experience! I have to make a decision about my hernia soon, and Dr. Tomas is an option I'm strongly considering.

[Bell0c]

Ezzy227, you're most welcome. I got so much from this thread, I figured I should add to it. I wish you the best in your choice, and in your ultimate results. My experience so far with Dr. Tomas has been excellent, but I should probably stop short of a personal recommendation till I've got a few months to see how things play out.

To give an update, Day 11, I'm still having some tenderness across the front of the groin, and also when I scrunch the area up by sitting, and unscrunch it by standing back up. I'll also get a sharp pain on the left occasionally when I shift around while lying down. I emailed and got a call-back from Rajim, Dr. Tomas's surgical assistant, who explained that it's probably not the inguinal nerves per se, but rather all the internal suturing of the muscle that's still tender and possibly a bit inflamed, that that isn't uncommon at this point, and that the discomfort should be dropping off quickly day by day starting soon. It has been dropping off, just not as quickly as I expected. It just doesn't match what most people on here report, so I wondered. I wonder if it's as simple as that the method is very different from the mesh methods, so causes a different kind of soreness. With mesh, the sutures closing the incision on an open procedure are the majority of the sutures you have (and less than that with lap). If you look at the pics of Desarda online, that swathe of muscle filling the gap is sutured all around on both sides of the canal. All the sutures are absorbed, but I'm not sure how long that takes.

I should mention that I'm still walking several times a day. I've found a point 4/10's of a mile from the house and I walk there and back (so 4/5's of a mile) at least 3 times a day, sometimes 4 or 5, depending on the weather. There's no trouble walking. If it's tight at first, it loosens up within a minute or two. Really, walking and reclining are the most comfortable positions/states.

I removed the steri-strips yesterday and the incisions look fantastic - clean, straight, no swelling or redness. Other than the ridge underneath, they seem almost completely healed.

All the meds that Dr. Tomas gave me ran out on the end of the 9th day: antibiotics, Gabapentin, arnica tablets, stool softener, and Motrin. With the tenderness, I was pretty worried that it would be like on Day 6, when I stopped Gabapentin for 10 hours, but I really didn't notice much difference from one day to the next.

Btw, in reference to a point made a couple of posts back, I confirmed with Rajim that the spermatic cord is in its usual position after the procedure, and not on the outside directly under the skin. He did indicate that that would be a very sucky place for your spermatic cord to be.

[Bell0c]

Day 18 Update: First, a clarification. When I said "groin" above, I really meant a bit higher, between the genitals and the waistline, all around the incisions. That area is still a little prickly (some of that may be exacerbated by hair growing back after being shaved), and I still get some of the scrunchy feeling sitting, especially for more than a few minutes, and when standing up, though all these sensations are diminishing. I get about halfway through the day at work before it starts to intrude too much on my awareness (sitting at a desk). I'm walking about 3 miles a day, in 4 walks usually, and it always feels good to stretch it out. It's still most comfortable reclining rather than lying flat, though it's ok on my side now. The points where the inguinal blocks were done are occasionally still sensitive, though not always. Overall, I get the impression that everything is moving forward, healing, getting better, just a little at a time. Maybe I'm a slow healer. There's no trouble getting in and out of bed or anything like that. I'm careful not to carry anything heavy, though I have grabbed a dumbbell a few times and slowly, carefully done a couple of light sets of arms in ways that didn't require cinching down my core. Anyway, at this point it's just incremental improvement, and I hope and expect for that to continue.

Incidentally, googling "Desarda method hernia repair" brings up some videos of Dr. Desarda demoing the procedure. I read lots of studies - not sure why I never thought to look for videos, but they're pretty instructive, though a little like looking at your baby in an ultrasound - hard for a layman to make out all the parts.

[drgephys]

Hi Bell0c,

Get well soon and best wishes.

It's too early for you to judge the pain. It should normally mostly go away after four weeks though.

Note that the scientific recommendation to start unrestricted activity and unrestricted heavy lifting is 6 - 8 weeks after surgery. I wouldn't do anything other than walking and normal activities before that. I posted a paper on that.

You will be the guinea pig for Desarda repair in this forum. Looking forward to hear about your outcome. (I was wrong about the sperm cord left above the external oblique. They slice the external oblique and use one strip to cover the hernia defect under the cord and another strip is folded over and creates a new envelope for the sperm cord. It's a weird repair technique but if it works, it works.)

In your case, I would have recommended Lichtenstein with mesh. It's far simpler than Desarda. All they do is to insert a mesh and you're set. Since you had direct hernias, you have a weak abdominal wall and you would have greatly benefited from the mesh. I don't understand why people reject the idea of the mesh. If you have a direct hernia, you need the mesh because your abdominal wall is torn away. If you're going to have surgery, why not use the mesh so that it's not torn away again in the future when you do rigorous physical activity such as heavy lifting or playing sports. Direct hernias are always a result of physical activity (heavy lifting, playing sports, jumping, or coughing). I posted a scientific paper on this. Indirect hernias on the other hand are always congenital and never a result of physical activity (they are caused by the internal ring of the inguinal canal being too wide at birth or before birth).

My open Lichtenstein hernia repair with an anterior flat mesh (Ethicon Ultrapro Advanced half-absorbable) exceeded my best expectations. I had an indirect hernia on the left side. I had tissue repair for an indirect hernia on the right side when I was 11. My groin is better than before I had surgery and even before I had the hernia symptoms. I don't feel the mesh at all. All my bodily functions have improved from before I had the surgery and before hernia symptoms. So, the result of the operation was me feeling "better than new." There is also virtually no scar mark. The two-inch incision below the "Speedo line" is fading away to nothing. My right groin, where I had the tissue repair at age 11 feels a lot more strange, as I can feel unnatural seams or scar tissue inside. So, no, tissue repair doesn't equal a better feel at all.

SoccerAgain has posted so much against the laparoscopic repair with mesh here, which seems to have scared some people away from the mesh. What he doesn't disclose is that the reason for the failure of his repair was caused by technical errors by his surgeon. His meshes weren't placed properly and they migrated away when tissue (probably peritoneum) got under them. Of course, that means a painful failure. Therefore, no matter what kind of repair technique, find a very experienced (500+ operations on the particular repair method) and skilled doctor. I prefer the open repair with mesh over laparoscopic repair with mesh, as the former is safer than the latter, but the laparoscopic repair also seems to work.

Regarding my current status, I'm at slightly over four months after surgery. Only a slight swelling remains in my groin and I occasionally feel a slight discomfort (probably when the hard healing ridge or slight swelling inside my groin rubs). The hard healing ridge under the incision is slowly going away. From what I've read, it takes up to a year for the swelling and ridge to completely disappear. Other than that, things are better than new as I said before. I can do any kind of activity without feeling any discomfort. Because of an overseas vacation I took, I just started lifting after four months. Oh boy, oh boy... I've got so weak! I still look fit and I didn't think I lost much strength but the weights didn't agree with me. The hernia is a thing of the past now, but I'll see how long getting my strength back will take. I'll post on that. Bench press later today. I was doing about four to six reps with 225 lb before surgery and if I could the same with 135 lb this evening after four months of no weights, I'll be happy. In hindsight, I would have lifted a little before my vacation but I should still be OK.

Update: I could do about eight reps with 135 lb on the bench press tonight. Triceps were especially weak. I couldn't do dips. Four months of not lifting was too long. Hopefully gaining strength back won't be too challenging. Compounding the problem, they closed my gym of 16 years just before my surgery and I'm getting used to new gyms.

[drgephys]

Doing more research on Desarda, it is becoming more evident that one downside is the recovery time. It seems some are taking up to a year to get back to near 'normal', with one or two reports of people who are still struggling after a year and a half (lots of groin tightness / pain, with regrets of having the surgery).

And to drgephys - you said "I don't understand why people reject the idea of the mesh". Oh come on, you know that's easy to understand. I'm finding reputable studies/journals stating that 10-20% (one report even said 50%!) of mesh patients experience moderate to severe pain 3-5 years after implant. Of course, what constitutes moderate pain is a massive gray area. My local surgeon is suggesting Lapro TEP with Covidien Progrip mesh. I'm certainly open to a mesh repair. I know a few MDs and they said they would definitely go with a mesh repair. I still have no idea what I'm going to do though. Thanks for all the excellent input!

You did good research on the Desarda repair. With the amount of manipulation of the external oblique in the Desarda repair (it's sliced in multiple places, attached to the internal oblique, and folded over), the pain and suffering in your groin is understandably expected.

Skip the tissue repair and go with mesh. Tissue repair is for kids, growing teens, and pediatric hernias, where a mesh is either not needed (all that is needed is to tie the hernia sac and push it in) or can't be used because of the subsequent growth of the patient. Adults need the mesh. There is nothing wrong with reinforcing a defective inner abdominal wall with a mesh. Consider it like reinforced concrete where the concrete is reinforced with steel rebars. Prosthetic is required if you have a weak or defective abdominal wall. If you were an elderly patient and your hip was so weak that could break any day, wouldn't you prefer if they had invented a prosthetic that could reinforce the bone and prevent it from breaking? Same here with the weak (inner) abdominal wall. You will be stronger with the mesh than you were ever before. Note that the inner abdominal wall is something you cannot make stronger by lifting weights. Your inner abdominal wall is either genetically strong or not. For example, women have stronger inner abdominal walls because genetically they are built that way to give child birth.

Avoid tissue repairs unless they are indicated for a good reason. You mentioned chronic pain but tissue repairs aren't immune to chronic pain either. I had tissue repair for my childhood hernia on the right side and I can feel weird ridges and shapes inside and sometimes my groin feels uncomfortable and even painful. With the tissue repair, they are attempting to repair your inner abdominal wall by modifying your groin anatomy (bringing together and overlapping tendons and muscles that are normally separate) and depending on the technique, they can use a lot of permanent sutures. Therefore, tissue repair can cause a lot of problems as well. The worse part of tissue repair is much higher rates of incidence of recurrence in comparison to mesh repair.

Back to the chronic pain: 99% of the incidents where chronic pain with mesh occurs happen because the surgeon doesn't know what he/she is doing. The risk of chronic pain with a skilled and experienced surgeon using the mesh is less than 1%. The chronic pain happens either because the mesh or sutures touch the nerves or they later migrate and touch the nerves. There could also be nerve damage during the surgery itself, which could happen with tissue repair as well. A skilled and experienced doctor knows what he/she is doing and will stay away from the nerves, let alone manipulate them as some surgeons do. The mesh will be placed properly with the sutures avoiding the nerves. There won't be chronic pain as a result.

I had horror stories on both the laparoscopic TEP with mesh (SoccerAgain) and open Lichtenstein with mesh. The latter guy was undergoing his second corrective surgery for dysejeculation (painful ejaculation) and chronic pain with my doctor right before me, after his first corrective surgery (neurectomy) failed and my doctor would do both open surgery and laparoscopic surgery simultaneously to attempt to correct the problem. I overheard them talking on whether they could save his testicle. Yes, that bad. The guy originally had his (failed) hernia surgery at Kaiser. My friend, whom later I told the story was saying, "Of course, Kaiser doctors are the C students." (Disclaimer: The last sentence is solely my friend's opinion.)

In case of SoccerAgain, his horrible experience was caused by a technical error by his surgeon in his laparoscopic TEP. Both his meshes (left and right sides) folded over and got displaced (migrated). The result was excruciating pain and he had to go through corrective surgery for removing the folded/displaced meshes. A good laparoscopic surgeon knows how to avoid this problem by placing the mesh in the right place after proper dissection of the preperitoneal space so that the peritoneum doesn't get under the mesh and lift and fold it away.

Regardless of which repair method you choose, find a doctor who has had 500+ mostly successful operations with that particular method. My doctor originally recommended the laparoscopic TEP with the Covidien Progrip mesh but he said open Lichtenstein with Ethicon Ultrapro Advanced (half-absorbable) mesh was also good. I chose the open Lichtenstein because it's safer and leaves the preperitoneal anatomy virgin (scarred preperitoneal space can prohibit other surgeries such as prostate operations in the future but I was more worried about bladder etc. damage and the fact that the laparoscopically placed mesh would make direct contact with the vas deference [sperm duct], as opposed to open surgery where the vas deference is protected by the spermatic cord, which is made of the cremaster muscle). It also avoids general anesthesia and I was fully awake and watched the operation on a display. Ask your doctor how many TEP operations he has had (the learning curve is very steep for laparoscopic and takes hundreds of operations to gain reasonable skill). If it's more than about 500 and he claims 99% success rate, go with it if you like. If you can find a doctor with 500+ operations on open Lichtenstein with 99% pain-free outcomes, that would be a great choice, too. If you don't mind traveling to Southern California and have the insurance and/or money, my internationally acclaimed doctor (associate professor) whom I recommended a couple of posts back is great with both open Lichtenstein and laparoscopic TEP.

[Bell0c]

I wrote out an answer to drgephys's reply while I was at work, but ezzy227's reply to that, and drgephys's reply to that, seem to have superseded it (though ezzy227's comment seems to have disappeared except in drgephys's reply, which is odd). It seems clear that we're entering the fabled internet debate ping pong game in a rabbit hole, so I'll be brief (well, brief for me) and let this particular thread inside the thread unravel on its own. (I'll keep leaving updates, of course.)

No, guys, "some are taking up to a year to get back to near 'normal', with one or two reports of people who are still struggling after a year and a half" doesn't constitute "good research." It may be true (and may not), but it's true about everything, and says nothing about anything. I might as well lob SoccerAgain's experience back over every time as the definite judgement on laparoscopy, or mesh, or surgery in general. Again, I can't apparently attach links, but I promise you that if you, right now, right here on the internet, google "Desarda vs Lichtenstein," "Desarda hernia recovery," "Desarda hernia repair results," or whatever - and go through the first few pages, you will find AT LEAST a dozen studies done by various doctors in various organizations in various countries, with sample sizes ranging from 100 to 4000, with follow up ranging from 5 days to 3 years, and several are double-blind, the most recent I saw being from July of this year. They explain their studies, and give results, with decimal points and everything. THIS is research. I've read the studies, from start to finish, and you can too. You can make a pot of coffee and read them, whenever you like. And all the ones I've read, without exception, have given the same results: same or better than mesh. Shoot, google "Desarda class action lawsuit" and the only thing that pops up is mesh lawsuits. While you're googling, read Dr. Desarda's explanation of the procedure, with photos and diagrams, and watch his videos. The aponeurosis is never "folded."

Anyway, I'm not getting residuals for promoting Desarda, and everybody will make their own choices for all kinds of reasons. As I've said, I don't think mesh is bad. But I haven't seen anything that makes me think Desarda is bad either, and comments about it being "weird" and "creepy" don't illuminate anything. Surgery is weird and creepy, come to that. Actual studies are actually out there, right now, actually accessible to everyone reading these words. If you find anything contrary, please tell me what to google to find it, or attach links if you're able.

As for me, since this is a hernia recovery forum, I think I'll return to our regularly scheduled program.

[drgephys]

I had horror stories on both the laparoscopic TEP with mesh (SoccerAgain) and open Lichtenstein with mesh. The latter guy was undergoing his second corrective surgery for dysejeculation (painful ejaculation) and chronic pain with my doctor right before me, after his first corrective surgery (neurectomy) failed and my doctor would do both open surgery and laparoscopic surgery simultaneously to attempt to correct the problem. I overheard them talking on whether they could save his testicle. Yes, that bad. The guy originally had his (failed) hernia surgery at Kaiser. My friend, whom later I told the story was saying, "Of course, Kaiser doctors are the C students." (Disclaimer: The last sentence is solely my friend's opinion.)

In case of SoccerAgain, his horrible experience was caused by a technical error by his surgeon in his laparoscopic TEP. Both his meshes (left and right sides) folded over and got displaced (migrated). The result was excruciating pain and he had to go through corrective surgery for removing the folded/displaced meshes. A good laparoscopic surgeon knows how to avoid this problem by placing the mesh in the right place after proper dissection of the preperitoneal space so that the peritoneum doesn't get under the mesh and lift and fold it away.

Regarding possible sexual side effects (pain, dysejeculation, damage to vas deference, testicular atrophy, etc.) by mesh, I just read this paper by Canadians:

ncbi.nlm.nih.gov/pubmed/28067674
A Pathology of Mesh and Time: Dysejaculation, Sexual Pain, and Orchialgia Resulting From Polypropylene Mesh Erosion Into the Spermatic Cord

Their conclusions: "The results have confirmed that mesh migration through the
investing layers of the spermatic cord and the vas deferens does take
place and plays a role in the development of dysejaculation, sexual
pain, and orchialgia. Attempts to preserve the vas in every situation
may not be justified, as the damage caused by the mesh and its
residual scarring are irreversible. It may be unexpected for many
readers to learn that the spermatic cord can in fact be entirely invaded
by mesh and replaced by scar tissue. It is a possibility that surgeons
will not be comfortable with, to discover that mesh can continue its
slow damage to the tissues for many years after implantation.
However, it is a reality that must be accepted until such time as
we discover a newer tissue replacement more compatible with
mammalian tissues. Most disheartening will be the disappointment
of many colleagues who have so generously referred to Theodor
Billroth and his oft quoted remark of 1878 that: ‘‘if an ideal tissue
replacement could be found, the problem of hernia would no longer
exist.’’ Polypropylene did not fulfill Billroth’s expectation of an ideal
‘‘tissue replacement’’ and so the search must urgently press on,
unrelentingly!"

So, they reported the cases of the mesh obliterating (eating away) the vas deference and/or spermatic cord in both open and laparoscopic surgeries. One of the reasons I chose the open Lichtenstein over the laparoscopic was that the vas deference is protected from the mesh by the cremaster muscle in the inguinal channel (open surgery), whereas it lies bare and flat against the mesh in the preperitoneal space (laparoscopic surgery). However, these guys claim that the mesh can even eat away the cremaster muscle in the inguinal canal and then get to the vas deference, destroying it. Interestingly they claim that this can happen slowly in the course of many years. Nevertheless, they fail to disclose that many surgeons skeletonize the spermatic cord (remove and get rid of the the cremaster muscle) during open surgery. My surgeon certainly leaves (and did so in my case) the cremaster muscle fully intact. So, we don't know how the patients in the study were operated on (skeletonized cord or cord left intact with the cremaster-muscle sleeve).

For example, these guys, in their opinion, recommend the open Lichtenstein over the laparoscopic (preperitoneal) approach for reducing the risk of damage to the vas deferense and other sexual problems for the reason I just mentioned here:

ncbi.nlm.nih.gov/pmc/articles/PMC1570612/
Vasal Obstruction After Hernioplasty
The Importance of Surgical Strategy in Preventing Azoospermia

"Unfortunately, the authors gave no details about the nature of the surgical techniques performed. We feel that the key to prevention lies in understanding anatomy. In fact, behind the transversalis fascia the vas is bare. In front, however, the vas is covered by the internal spermatic fascia and by the cremaster muscle. In our opinion the cremaster sparing and the integrity of the transversalis fascia, as barrier between an overfascial mesh and properitoneum, are the 2 fundamental keys to reducing the risk of vasal fibrosis. Thus, the procedures which expose the bare vas to a direct contact with mesh may be performed by an anterior approach (Rives, Kugel, Rutkow and PHS) or by a posterior approach (Nyhus, Stoppa's GPRVS, TAPP and TEP). Instead the Lichtenstein and PAD hernia repairs, performed by an anterior access, would afford the maximum of protection by maintaining a substantial protective wall about the vas at the level of internal inguinal ring, constituted by the integrity of transversalis fascia and the cremasteric fibers. It is true that, as reported by Uzzo in 1999, the use of mesh has become prevalent, perhaps without adequate study and consideration of the possibility of infertility. ... However, awaiting for providing some of these answers in the near future, we retain important, in our activity, to choose a surgical strategy in hernia repair that avoids the direct contact between mesh and bare vas."

So, they are saying that if you want to reduce the risk of sexual problems, go with the open Lichtenstein repair (first, making sure with the surgeon that he/she fully preserves the cremaster muscle and spermatic fascia) and avoid the laparoscopic (TEP or TAPP), open posterior (Nyhus), and open 3D mesh (PHS) repairs! (They are also recommending their own repair technique (PAD/Valenti), which is similar to Lichtenstein but uses two overlapping meshes.)

Heading to the gym for squats (after four months)!

Update: I did squats with 135 lb and some light dead lifts. There were no groin problems whatsoever. In fact, I feel more confident about the groin I had surgery (left side) than the side with the childhood hernia (right side). It also feels better than before the surgery and probably even before the hernia had become noticeable. I should mention that I occasionally feel slight dull pain -- expected since there is still some slight swelling.

[Bell0c]

Update: I did squats with 135 lb and some light dead lifts. There were no groin problems whatsoever. In fact, I feel more confident about the groin I had surgery (left side) than the side with the childhood hernia (right side). It also feels better than before the surgery and probably even before the hernia had become noticeable. I should mention that I occasionally feel slight dull pain -- expected since there is still some slight swelling.

Hey, that's excellent news, man, congrats! Did you try any pull-ups?

[drgephys]

Hey, that's excellent news, man, congrats! Did you try any pull-ups?

Thanks!

Yup, yesterday I did pull-ups, rows, back extensions, lying hamstring curls, calve raises, squats, dead lifts, and sit-ups, as well as various stretches. There was no problem with the groin whatsoever. I don't feel the mesh or anything unusual at all. The groin has full flexibility (the Ethicon Ultrapro Advanced half-absorbable mesh is designed to mimic the groin with 2:1 elasticity in the two perpendicular directions). My groin feels "better than new."

Interestingly, my sexual function and digestive function seem to have improved after the hernia repair. My guess is that repairing the hernia increased the blood supply to the testicle and lowered the pressured on the vas deference, since I had an indirect hernia (congenital hernia) and a large piece of intestine was coming through the spermatic cord, inflating it from the inside like a balloon (I coughed and observed on the screen the moving up and down of the large hernia sack inside the cord during my surgery, where I was fully awake). In my next physical, it will be interesting to see if the testesteron level has improved as a result. However, it could also be perception or placebo effect. Regarding the digestion, I was having frequent and painful gas before the surgery, which I thought could be because of the folded intestine in the hernia sack (like a folded garden hose). It has never happened after the surgery.

I've gained about 5 pounds, mostly in the lower belly, mostly during my vacation, where I ate a lot of sweets. I've lost a lot of strength, too. Now, there is no more focus on the hernia and the focus is on getting back to shape!

[Bell0c]

Thanks!

Yup, yesterday I did pull-ups, rows, back extensions, lying hamstring curls, calve raises, squats, dead lifts, and sit-ups, as well as various stretches. There was no problem with the groin whatsoever. I don't feel the mesh or anything unusual at all. The groin has full flexibility (the Ethicon Ultrapro Advanced half-absorbable mesh is designed to mimic the groin with 2:1 elasticity in the two perpendicular directions). My groin feels "better than new."

Interestingly, my sexual function and digestive function seem to have improved after the hernia repair. My guess is that repairing the hernia increased the blood supply to the testicle and lowered the pressured on the vas deference, since I had an indirect hernia (congenital hernia) and a large piece of intestine was coming through the spermatic cord, inflating it from the inside like a balloon (I coughed and observed on the screen the moving up and down of the large hernia sack inside the cord during my surgery, where I was fully awake). In my next physical, it will be interesting to see if the testesteron level has improved as a result. However, it could also be perception or placebo effect. Regarding the digestion, I was having frequent and painful gas before the surgery, which I thought could be because of the folded intestine in the hernia sack (like a folded garden hose). It has never happened after the surgery.

I've gained about 5 pounds, mostly in the lower belly, mostly during my vacation, where I ate a lot of sweets. I've lost a lot of strength, too. Now, there is no more focus on the hernia and the focus is on getting back to shape!

That sounds great. Lots of guys have reported difficulty with the stretching that pull-ups require, so that's good news, along with all the rest. I know it must be a huge relief to have those symptoms gone. I was fortunate with direct hernias not to have had any real pain going in. Anyway, keep up the good work!

[SoccerAgain]

In case of SoccerAgain, his horrible experience was caused by a technical error by his surgeon in his laparoscopic TEP. Both his meshes (left and right sides) folded over and got displaced (migrated). The result was excruciating pain and he had to go through corrective surgery for removing the folded/displaced meshes. A good laparoscopic surgeon knows how to avoid this problem by placing the mesh in the right place after proper dissection of the preperitoneal space so that the peritoneum doesn't get under the mesh and lift and fold it away.
.

Howdy all. Haven't checked the site for a while. Only responding to correct the false statement about my TEP procedure. I understand gephys's desire to paint things in a positive light, especially as he recovers from his own procedure. We all want to believe. I did the same, on this very forum, as I recovered from the surgery, but ultimately suffered from the mesh.

The surgeon who removed my mesh found that the left side was completely as intended,. No folding, no tacks in incorrect places. There were no tacks at all on the left side. The left side was perfectly as planned and should have worked perfectly. There was actually no significant hernia there. It was more prophylactic, than needed. Yet it caused chronic pain and discomfort, and I'm better off with it gone.

My surgeon made no mistakes and was at the top of his field. Chair of surgery for a very large clinic in a large metro area. He did his residency at the Mayo clinic, where many surgeons learn their mesh implantation techniques.

And, I did not suffer excruciating pain. It was constant pain and discomfort. Low enough that no medical help was needed, but high enough that it disrupted my life and made me less of a person. I was not strong and available anymore but more hermit-like, focused on my own problems. If you have other people that need you to be strong and available, consider that. You might not be there for them.

To anyone reading these posts for their own research, be aware that psychologically we all try to justify past decisions. It's still early in gephys's journey. Do lots of research, be skeptical and cynical. Especially, cynical in a larger perspective.

[drgephys]

Howdy all. Haven't checked the site for a while. Only responding to correct the false statement about my TEP procedure. I understand gephys's desire to paint things in a positive light, especially as he recovers from his own procedure. We all want to believe. I did the same, on this very forum, as I recovered from the surgery, but ultimately suffered from the mesh.

The surgeon who removed my mesh found that the left side was completely as intended,. No folding, no tacks in incorrect places. There were no tacks at all on the left side. The left side was perfectly as planned and should have worked perfectly. There was actually no significant hernia there. It was more prophylactic, than needed. Yet it caused chronic pain and discomfort, and I'm better off with it gone.

My surgeon made no mistakes and was at the top of his field. Chair of surgery for a very large clinic in a large metro area. He did his residency at the Mayo clinic, where many surgeons learn their mesh implantation techniques.

And, I did not suffer excruciating pain. It was constant pain and discomfort. Low enough that no medical help was needed, but high enough that it disrupted my life and made me less of a person. I was not strong and available anymore but more hermit-like, focused on my own problems. If you have other people that need you to be strong and available, consider that. You might not be there for them.

To anyone reading these posts for their own research, be aware that psychologically we all try to justify past decisions. It's still early in gephys's journey. Do lots of research, be skeptical and cynical. Especially, cynical in a larger perspective.

Hi SoccerAgain,

You're 100% contradicting your original post. Your doctor who removed your meshes told you that your mesh on the right side folded over and your mesh on the left side directly migrated away. Note that folding over or migrating both mean technical error by your surgeon, which in turn means that your surgeon doesn't have enough experience and/or skills. In laparoscopic surgery, the mesh folds over or migrates because the peritoneum gets under it due to technical error. Sufficient and proper dissection and proper placement of the mesh should prevent that from happening. Velcro-like self-sticking (Medtronic/Covidien Progrip) meshes are probably useful as well. You also returned to intense physical activity very early (the standard recommendation is 6 - 8 weeks after surgery) but I don't know if this had any effect on the failure of your meshes -- probably not in my opinion but I would follow the standard 6 - 8-week recommendation to return to intense physical activity in any case.

Your post from 01-01-2018, 07:23 PM:

I wrote that last post more as a summary of my thoughts on the subject. Since I've been stuck right in the middle of it, I'll probably be thinking and talking about it until I die.

I'm actually doing really well since removal surgery. Dr. Peter S. Billing of Eviva in Shoreline WA removed both sides in two operations. It's tedious, difficult work, I think. Each side took 2-4 hours. He said that the right side was folded over and inflamed, and the left side had moved medially (toward the middle) and downward. And was very inflamed. The original small direct hernia on the right side was filled in by scar tissue. He has been removing mesh for eight years, in addition to his main practice focus.

So at this point I'm essentially back to where I was just before I got the hernia. But the last three years have been difficult, for more than just me. Which brings up something else I've realized - many surgeons will just see you as an abdomen with a defect when you go in to talk about your hernia. Like a tire that needs a patch. They'll install the patch and if it doesn't leak they consider their work to be done, and successful. They will listen to your words at the initial consultation but, probably, won't really hear anything about weight-lifting or running or biking or hiking or sports. Just an abdomen with a hole in it.

Some doctors will consider your activities and plans but it's surprising how many don't. Even the ones that acknowledge that there might be differences in mesh and materials will still be thinking about a large piece of mesh to cover that small hole. Because recurrence is what success is based on, not quality of life. It's in the training.

The field has changed a lot in just the three years since I got the hernia. When I was looking for a fix, I had to choose between open and laparoscopic. It was still a choice. Now, just three years later, it seems that everybody is recommending lap. Maybe because they get graded on short-term issues, like infections and suture tears. Not the 20+ years that the patient will live with the procedure.

[drgephys]

That sounds great. Lots of guys have reported difficulty with the stretching that pull-ups require, so that's good news, along with all the rest. I know it must be a huge relief to have those symptoms gone. I was fortunate with direct hernias not to have had any real pain going in. Anyway, keep up the good work!

From what I've been reading here and from my own experience, I'm thinking that the open Lichtenstein with anterior flat light mesh is the way to go for weightlifting and playing sports. It looks like the people who had the laparoscopic repair with posterior mesh (inside the abdominal wall) are having issues with flexibility and stretching. It appears that a large mesh stuck to the abdominal wall from the inside (as done in a laparoscopic repair) is affecting natural movement and flexibility.

If you go with the open Lichtenstein, check with your surgeon that he/she doesn't manipulate the nerves and leaves the cremaster muscle (sleeve of the spermatic cord) fully intact (no skeletonizing of the cord). You can also check if he/she uses air knots on the medial (inner) side of the mesh. If he/she has no idea what you're talking about or says no, find another surgeon.

The first two - three days after the surgery are miserable -- intense pain accompanied by slight fever. I could squat and sit on a low stool to clean the litter boxes in Day Two, and around Day Five or Six, I was able to raise my feet enough to be able to put on my socks. It was impossible to put on my socks in the first several days though -- I just couldn't raise my feet because of the pain. After the first six or seven days, the pain was no big deal (I was able to go to work) and then it gradually decreased. By five or six weeks, it was mostly gone.

Again, keep in mind that 6 - 8 weeks is the research-based recommendation to return to intense activity (such as heavy lifting and playing sports) after hernia repair or similar soft-tissue sports-injury surgeries.

[Bell0c]

Day 24 Bilateral direct inguinal, repaired by Dr. Tomas using the Desarda method:

Today is Monday. I feel like I kind of turned a corner on Saturday (Day 22) when I went to the gym with my wife. Instructions said I could do elliptical at three weeks, so I did (I'd never done elliptical before). I walked on the treadmill at speeds up to 2.7 mph, I think, for a few minutes to warm up, then did the elliptical (not sure of the speed) for maybe 15-20 minutes, then, feeling very rubbery, walked at about 1 mph on the treadmill for another few minutes to ease off. I was pretty tired. I wandered around the machines for a few minutes and decided I might be able to do the chest press and the back pull machines without tensing my abs. So I tried them with no weight at all, then slowly added a few lbs. at a time, getting to 90 on the press and 55 on the pull (it was more awkward to position myself so that I didn't have to firm up my core on the pull, whereas the standard position on the press was fine). I even had my wife put her hand on my stomach to watch for any tensing. Anyway, no real workout, but it felt good just to work the muscles a bit. When we got home I reclined on the bed and crashed for about an hour (after having gotten like 9 hours of sleep on Friday night).

Sex is allowed at 2 weeks and we had taken advantage of that (forgot to report this before), but it was still a little uncomfortable at that point (in the area around the incisions, not in the genitals - I rubbed one out on the evening of Day 1 and again on Day 3 to make sure the plumbing was good - forgot to mention that too). We tried again later in the evening this Saturday and it was much better, discomfort diminishing as we continued. I was able to be a lot more active than I expected.

And between the elliptical and the sex, that corner seems to have been turned. Or maybe it was just coincidental. In any case, most days discomfort seems to diminish by like 3%, but when I got up Sunday it seemed to have dropped by like 10% - a noticeable change. Sitting is usually the least comfortable thing, but sitting having coffee on Sunday morning was noticeably less uncomfortable, riding in the car as well, riding the motorcycle, etc. Walking hasn't been a problem, but even that was easier. Etc.

Anyway, it had me thinking about physical activity. I mentioned before that walking was the thread running through all these recovery stories, and it seems to be. At a certain point, though, I think it may be helpful to increase the activity level, and the range of motion. Still not doing anything like real lifting, nothing that torques the torso hard or quickly or requires snappy flexing, but stuff that scrunches and stretches the area, which the elliptical does, (which is why it keeps getting mentioned), and, well, sex, which kind of does the same. I can see how putting off activity because of discomfort might allow everything to heal a lot tighter, prolonging the discomfort, perhaps even to the point where normal activities become a long term problem.

[drgephys]

Bell0c, this is good news. It sounds like you're on the way to a good recovery but don't start intense physical activity or heavy lifting before 6 - 8 weeks. The tissue doesn't heal that fast.