Dr. Kang – 1 Year update – Direct Hernia repair

[pinto]

@Mike M says, “The reason I am pointing at the ‘coughing’ is I had never experienced even a hint of a hernia at any point in my life. It was the furthest thing I thought possible.”

Exactly my experience–and to boot I was the fittest I could be. I had always heard growing up “be careful picking things up.” I had never heard that it could be from sneezing or coughing. Shocking to me. But what about simply reaching for something in your car with a heavy backpack on? I don’t think any surgeon can pinpoint the cause in our cases. And further they all seem to have their own pet causes. Another dilemma is that surgeons differ about physical exercise. Despite the hundreds of years of history, hernia surgery appears still full of mysteries.

Sliding hernia–yeah, sure there’s no secret about that. But there’s research to show that with proper surgical technique, outcomes match standard ones. “A little tricker to detect”? I don’t know but one surgeon looked at my prior CT scan and could identify it as sliding. I don’t know if he was blowing smoke but he seemed well-informed and experienced about hernias, one of the most impressive ones I met.

[Mike M]

@Ajm Also most patients were damn near doing barrel rolls immediately after the surgery from what I witnessed. My buddy helping me on the trip was making fun of me as I was walking out of the hospital from surgery. He was telling me I was giving Americans a bad name. lol meh I knew I was coming into it a little bigger and my hernia was probably larger than most.

[Mike M]

@Pinto The reason I am pointing at the “coughing” is I had never experienced even a hint of a hernia at any point in my life. It was the furthest thing I thought possible. However I was forcing myself to cough in a pretty extreme manner over a long period of time (2 months) because I was annoyed by the simple cold / covid remnants. I never got sick outside of a tickle cough I thought (moronically) I could solve by increasing the intensity of my cough. Like you said it could be a culmination of time, a little age, and other activities but there was no indication prior.

Also you had a “sliding” hernia if I remember correctly? A little tricker to detect and possibly took extra steps to resolve? It is where the floor is made up from tissue from other organs?

@William Bryant I plan to go back to doing similar things you mentioned at 100%. I already am lifting massive spools of utility wire when I help my workers load up. No issues. I am not going to live my life restricting my activates because of the possibility of a recurrence. However I need to lose about 20lbs before I do anything too extreme to soften the load on that area.

“Bad pain” (but what I expected) the first 48 hours. Standing the first few weeks for over 15 mins would tense up the area and I would have to sit down for relief. That all went away with time no issues at all. Nothing was overwhelming or more than I anticipated. Only time I really needed help was the first 24 hours.

@ajm All the things you mentioned are common from what I was told and experienced. It all fades with time. Some people freak out about a sensation of “movement” or a “popping” etc. Just scar tissue, nerves, and your body trying to adapt for the most part. I walked up 10 flights of stairs 5 days after the surgery and thought I was doomed because of a little swelling. lol Follow up Ultrasound showed perfect repair.

[ajm222]

Thanks for the update. I am currently two months out from a tissue repair done several years after a robotic mesh removal. Worry every day about recurrence. My doc used absorbable sutures. The area isn’t particularly painful but it’s uncomfortable as I feel a large knot type feeling there, and it feels kind of weak. Sort of like when I had the hernia. Been that way though since the surgery and I suspect it’s all the work done plus scar tissue and may take a long time to feel more natural. Was hoping it would feel great by now but guessing I won’t really know for many more months. Glad you’ve had a good outcome.

[William Bryant]

I totally empathise with Mike about the cutting near manhood.

A lot of people worry I’d imagine.

In relation to pain can Mike say how long the bad pain lasted?

[William Bryant]

Brilliant update Mike M, many thanks.
And ask Pinto for clarifying about the recurrence.

Talking of cause I wonder if mine was self inflicted as I was doing stomach crunches or sit ups whatever they’re called to lose weight plus blowing up balloons to strengthen lungs as I have lung problem. But for work I lugged heavy office machines and boxes and boxes of paper. I’m annoyed with myself about the exercises but who knows it may have been the years of copier lifting and also I hds several chest infections one year with terrible coughing.

[pinto]

I know you have made important posts here at HT and like me a patient of Dr. Kang’s. Many members know of my reviews about Kang as well as knowing I had a recurrence. About that I wanted to correct your point #3 recurrence: In my case never was it a matter of patient responsibility.

I am a former NCAA Div. II basketball player, who is not far from his former athletic state. I continued to play the game until my hernia struck. I am thin of stature and careful of diet. I was in excellent health before and after surgery.

I was careful of activity post-op and exercised only to keep body tone–no heavy lifting, no squatting, or anything to strain my pelvic area. Dr. Kang mused that maybe the absorbable suturing gave way too early. Whatever, it had nothing to do with me personally for I was quite careful in lifestyle.

As an aside, I wonder if you really can say what caused your hernia. In my case was it basketball, golf, dancing, weight training–or simply sneezing or coughing or bladder issues?? Surgeons differ about these causes. So who is to say which one? How can you really be sure it was coughing or even weight gain? You say it so confidently that it reminds of my own personal quandary as to what triggered my original hernia. Anyway, just for discussion I am posting and the wish to clarify recurrence. Otherwise, bro, take it light.

[Watchful]

Thanks, William – I think there will indeed be further improvement. That’s the reason I don’t like writing updates on the pain and discomfort which are too frequent. Once it gets to the “chronic” stage, you need to give it a lot of time to assess how things evolve.

[Watchful]

You would have to ask her, but here’s my impression for what it’s worth.

She has a lot of experience with mesh problems and revisional surgery. This enabled her to develop a profile of people who are more likely or less likely to develop problems from mesh. Things like sex, age, body type. Similarly, she has experience with tissue repair, and tissue repair going wrong. Based on her experience, her assessment in my case was that I should be more worried about the risk of recurrence with tissue repair than the risk of trouble from mesh.

The size of my hernia played a part among other factors in her rejection of tissue repair in my case. I wasn’t 100% sure about one thing, though. It wasn’t clear to me how much her concern about Shouldice in my case had to do with what she thought the results might be in her hands specifically. She did say that some other surgeons would do it, but she wouldn’t, and it wasn’t clear to me how to interpret that. Did she mean that others might be able to do it better, or did she mean that others might be less conscientious or less concerned about recurrence? This wasn’t clear.

[Herniated]

@maxl – Dr. Shirin Towfigh, who created this HerniaTalk web site, is in California. She is a hernia repair surgeon offering either tissue or mesh repairs.

[Alan]

Me, I had two direct and one indirect.

[ajm222]

Thanks, Mike. I’m two months out and still feel weird – like a heaviness and lump in the area below the hernia and in the crease between testicle and thigh. And pulling sensations and tightness. Some mild soreness still. I don’t think my experience is typical at this stage and probably not a great sign long term. I’ve been here before. Just constantly saying to myself – well, let’s give it another month. And then another. And another. I will say there’s been some glacial improvement over that time as opposed to worsening.

That said, surgical team suggested it can take months for things to settle down and feel more normal. And I am SUPER sensitive to any and all discomfort, and tend to amplify it when stressed. I had a single stitch placed in the larger trocar hole where my mesh was removed because it had to be dilated more, and that was very uncomfortable to me for months. Finally resolved. So perhaps I personally just need a long time for my body to ignore these sensations. Very minor things can seem terrifying as a result of medical PTSD. Certainly far more was done in my groin for a tissue repair than just a single stitch. Anyway, everyone’s experience is so different.

Will try and stay calm for the next few months and see if I make steady but slow progress. Just don’t know why this continues to be such a problem. But I’ve had some medical issues in the past that also failed to heal (or maybe they healed but I didn’t anllow myself to move on) until I was able to take some medication that allowed me to stop obsessing. Perhaps that’s all I need. Mind-body stuff can be complicated. And I came into this surgery with some preexisting pain and discomfort to some degree that I can’t expect this surgery to necessarily fix.