My bilateral hernia surgery with mesh

[spinotza]

Hi all,

I’ve been a long time member of this forum and have been watchful waiting for 5 years on my bilateral hernia. Recently the pain became too much and I decided to take advantage of my private insurance and booked surgery at the St Mary Hospital in London.

I saw my doctory once before the surgery and he offered open surgery with mesh under local anaesthetic and I took the plunge because that’s exactly what I wanted.

Day 1 – Had surgery at 10.30. Although I was scared the local anaesthetic did it’s magic. Eventually they added sedation and it knocked me out and I came back at the end. I didn’t feel any pain during the surgery.
I was carried out to the patient room and discharged a couple of hours later.

I feel sore but hoepful. Doctor says there were no complications. I feel the incision pain right now but I no longer feel the hernia pain when I am walking.
I have ibuprofen, paracetamol and tramadol and now I’m home. I will take my recovery very very slowly and will mostly report on how the pain levels are going.

Good things so far: no swelling as far as I can see but maybe that comes later and no bruising but again probably comes later.

• This topic was modified 1 month, 3 weeks ago by spinotza.

[Good intentions]

Good luck.

Was it a Lichtenstein repair? Do you know the type of mesh used?

[spinotza]

Thank you. I’ve read so much about this I know the hardest days are the seocnd and the third if everything goes well so I’m garing up.

It was Lichenstein. I will come back with the name of the mesh, unfortunately I forgot although I did ask.

[David M]

This sounds good, Spinotza. I’ll add that in this time of proliferating sock puppets, you sound real to me. Can you give us more detail about how big your hernias had progressed and whether they were direct or indirect?

[spinotza]

Hi David. The right side was very large from the beginning and the left side was invisible to me except for when I would push hard I would see the movement of the hernia.

I’ve been wearing hernia boxer shorts for the past 5 years which had pads and added compression. Wit the boxer shorts I could even run for a bit, I could go to the gym and I became very strong and athletic right before the surgery. I would say that the right side was almost tennis ball sized and maybe it got a little bit larger over 5 years but maybe it didn’t I couldn’t tell much of a difference.

But the pain changed. Even with the boxer shorts I would feel more and more sore at the end of the day and I was getting diminishing returns from not opting for surgery.

My own conclusion was that I need to get the most experienced doctor that performs daily such surgeries, get an open surgery with local anesthetic and be in great physical shape: swimming, no smoking, calisthenics.
I’m 34. Initially I wanted a mesh free repair, perhaps the Kang one but I couldn’t afford to travel to South Korea and the private insurance meant I had a lot leeway choosing a doctor in the UK.

[Good intentions]

spinotza has been on the forum for over two years. The easy test is to click the name and look at their posting history.

https://herniatalk.com/members/spinotza/

[spinotza]

At the check up the doctor said he won’t know if the hernias are direct or indirect until the surgery. I will ask him at the follow up as well as the name of the mesh.

[spinotza]

I added more details in a reply but I wanted to make it very very clear I am in no way denying the problems people have had with mesh they have all my sympathy and it could happen to me too! The choice I’ve made was under the constraints and personal circumstances I have and I can only hope for the best.

[David M]

Sounds great. Mine is right side tennis ball, as well. My exercise consists of purposeful walking and that doesn’t seem to really have a pain effect. Due to some recent coughing it may have gotten a little bigger. There does seem to be slightly more pain as the day wears on. The pain and turgidity of the hernia might be being affected in my case by the meal cycle.

Anyway, looking forward to hearing your continued improvement.

[G]

spinotza, good luck to you. I never really had pain with my hernia, but it did keep getting bigger. Mine was indirect. I had it successfully repaired. It will be interesting to find out if your two hernias were indirect or direct. Now for the good news, you won’t need to keep pushing your guts back in anymore. That really is a game changer. I had a tissue repair (no shouldice, no desarda) not a mesh repair. I noticed with lots of socialized medicine and with the prevailing USA managed healthcare system, mesh seems to be the primary if not the only option in many cases. It takes courage and tenacity to actually “pull the trigger” and get the surgery over and done with. Pat yourself on the back spinotza, job well done. Here’s wishing you a complete and speedy recovery.

[spinotza]

Thank you for the kind words, you encapsulate well how I feel right now.

I will return to update this thread when I find out some useful information like what mesh I used or whether the hernia was indirect or direct but the latest is the following:

Slept poorly because the official recommendation is to sleep on the side which hasn’t been operated on which is difficult when you have bilateral hernia.

The smaller barely visible hernia incision hurts the worst, because of course it does while the one which was the size of a tennis ball is giving me almost no pain.

Finally, walking has been difficult. Had to use a heatpad to numb the pain and a walking stick to lean on but eventually I managed to do it. That’s it, things are getting better so I’ll rest and see where I am in a couple of days 🙂

[spinotza]

Day 5 – I finally relieved myself of constipation which was the last major hurdle. My advice for anyone facing this issue is to bring the heatpad into the toilet and press it against the belly, it helped me a lot.

Today I did my longest walk to the pharmacy as well which feels like an important milestone. I am back to using my compression boxers which provide a lot of pain relief when I am walking. I am down to 1 paracetamol a day and I find myself lucky to be having such a quick progress, which is probably determined by my age (34) and height/weight( 1.80/75 kg) according to my own theories.

[Oceanic]

Laxatives are your friend after hernia surgery, take them on day 1 post op especially if you are taking opiate based pain meds

[spinotza]

Duhh. You are right! I should have mentioned I took Movicol laxative and docusate stool softner which made it possible.

[William Bryant]

Also plenty of fruit and fibre. Orange juice is good for me.

What was the name of your surgeon.

Was it open with mesh rather than keyhole with mesh?

Good news is when mesh works it works really, really well.

[spinotza]

Yes it was open with mesh at the British Hernia Clinic In London. They have a pretty archaic website in which they talk a lot about how their method is so special, but it’s actually a Lichtenstein open surgery with mesh which a lot of places offer. They do have decades of experience though and specialised doctors.
I made the mistake of not starting laxatives from Day 1 and I think that’s why it took so long. OTOH the pain in the first two days was too much to sit on the toilet.

[William Bryant]

Thanks, yes the British Hernia Centre. They do say that open mesh gives best results and I think it seems that’s right. Certainly from the stories on here it seems lap is more problematic.

They are high volume and specialist so that goes in their/your favour.

I read somewhere, someone went there from America due to their good reputation.

Fingers crossed for you that recovery continues well.

• This reply was modified 1 month, 2 weeks ago by William Bryant.

[David M]

Spinotza
I reread your initial reporter to find out if your were conscious during the surgery. I take it that you were sedated for the most part and probably wouldnt remember much. Did you choose to have sedation beforehand, and could you have chosen otherwise if you wanted. What kind of sedation, if I may ask?

[spinotza]

I remember the beginning when the cuts started and the last 10 minutes when I woke up. I believe I was administered midazolam. I didn’t choose it was recommended. We were perfectly aligned from the start because I didn’t want general anesthesia.

Let me tell you something: I am so glad sedation exists. I was kinda getting pannicky when I realised this is about to go down but this anesthesologist was sooo cool and he asked me if I want a sneak peak of the sedation drug and as soon as he gave me a little bit I felt like I flew to ceiling and I could take anything and started smiling. Then they started injecting me with the local anesthetic and I felt it a little and then after a couple of minutes he injected more sedative and I think I fell asleep. But towards the end I started asking how’s it going is the first one finished? And he said actually we’re about to finish the second one. And I asked if I should be speaking and he said better not so I remained quiet and waited. It was very nice.

What are the downsides to sedative? From what I understand from reading I was perhaps fully conscious the entire time but I just don’t remember the majority of it. But doing it with no sedation requires self-discipline of steel imo.

• This reply was modified 1 month, 2 weeks ago by spinotza.

[David M]

Very interesting Spinotza, especially the statetment that you might have been conscious but didnt remember it. I know that in the biohernia Shouldice on YouTube, the surgeon said something about asking the patient to cough to see how firm the stitching was.Ive been curious about whether this is ever done after the plication of the transversalis fascia in the Lichtenstein. From your post, it seems that they could have had you cough and you not remember doing so, but who knows? This wouldn’t be a necessary thing for the surgery, anyway, but it might give some feedback to the surgeon, perhaps.

[spinotza]

I received the medical notes. Right side: A “moderate-sized direct” hernia,
Left side: A “massive indirect” hernia. Sooo I had both types 🙂
The notes also mention Ilioinguinal and iliohypogastric nerves identified and spared on both sides as well as the cord structure.
The meshes are described as “parietene”. Don’t know if this is a brand name or not.

In other news Day 7 and I feel really good. No pain killers, no constipation just soreness if I walk too much.

[David M]

Wow,everything sounds great!

Do they say anything about dividing the cremaster in line with the fibers on the right side looking for an indirect on that side? I’m still not sure how it works, but I think there are three basic possibilities with the cremaster. 1)leave it alone aside from seperating it from the transversalis fascia adhesions. 2)cut it along the fibers to help look for an indirect (in which case it heals back, I guess?) 3) cut it in half perpindicular to the fibers like the do with shouldice

Good to hear how well it’s going.

[Good intentions]

Sounds like they followed the basic Lichtenstein instructions. Here’s a video from Dr. Chen of the Lichtenstein Amid Hernia Clinic at UCLA with his recommendations and how it’s done. He talks a lot about handing the nerves.

Also a link to the Medtronic product page.

https://www.medtronic.com/covidien/en-gb/products/hernia-repair/mesh-products/parietene-macroporous-mesh.html

[spinotza]

I think if they had done anything with the cremaster it would’ve been in the notes. It’s been 10 days since my surgery and I’m 99% pain free. It would be 100% if it weren’t for some random flashes of pain which aren’t too bad but got to stay honest. Sneezing doesn’t hurt anymore.
Yesterday I went for a swim, I also did a light jog. I know I keep repeating this but: compression boxers. I used them during watchful waiting and they still make me feel far more confident than if I was just wearing loose fitting clothes.

• This reply was modified 1 month, 1 week ago by spinotza.

[David M]

Spinotza,

Thank you for the upbeat, positive sounding report!

[spinotza]

Dconfused77, pain on exertion for Lichestein on average is 10%, right? This is for all doctors regardless if they are experienced or trainees. The likelihood of suffering from pain will be lower if you are operated by a specialised doctor.

I don’t think mesh related issues are exaggerated but we need to understand the statistics. 10% people suffering from pain is too much for such a common operation and the field’s understanding of mesh needs to evolve. However 90% of people who have this surgery will go on with their lives and never join this forum.

This is what happens for many many support groups, for every single type of surgery. You can find these groups on facebook where those with a bad outcome will complain and those with a good outcome just go on with their lives so it’s very lopsided on the Internet.

As you said mesh lowers the chance of recurrence and I’m only 34 and incredibly active – swimming, calisthenics, cycling, running, tennis are all things that I enjoy and perhaps a pure tissue repair was not the best option for me if I wanted to get back to some of these activities. But for someone who just likes walking and relaxing then the option changes drastically, no?
Dr Towfigh has created a wonderful place for us to discuss about our problems with hernia surgery and she made a recent video where she argues that surgeon is more important than technique and having someone who listens to you and what you want from the surgery is key: https://www.youtube.com/watch?v=x7x_RfsT43s

One of my favourite positions is sitting cross legged and no I don’t feel the mesh at all. I hope you make the right decision for yourself but you need to detach yourself a bit from this forum because you already know enough to make a choice and more anecdotal evidence (n=1) is not going to help.

• This reply was modified 1 month, 1 week ago by spinotza.

[spinotza]

@Dconfused77 I will update my thread and answer your questions. I don’t really deserve new topics as I don’t hold the golden key to hernia surgery. There are people here who have more understanding that I do about every single component of the surgery. I do have to agree with other forum members that you don’t present a fair balanced description of neither Shouldice, Desarda or Kang and that doesn’t help people on this forum trying to make their own decision.

– who is the best doctor at the centre. The most experienced. I am calling for a consult early next week. I have had a hard time finding any reviews on the Centre -did you find some?
There are some reviews on google reviews if that helps:
https://www.google.com/search?q=The+British+Hernia+Centre+review&oq=The+British+Hernia+Centre+review&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIGCAEQIxgnMg0IAhAuGK8BGMcBGIAEMgcIAxAAGIAEMggIBBAAGBYYHjIICAUQABgWGB4yCggGEAAYhgMYigUyCggHEAAYhgMYigUyBggIEEUYQNIBBzg2NWowajmoAgCwAgA&sourceid=chrome&ie=UTF-8#lrd=0x48761ab257909da7:0x77fca0ce9c80cf8d,1,,,,

I don’t know who the best doctor is at the centre but I do know all of the ones available are specialised in hernia surgery.

How are you feeling today -back to 100 percent?

Definitely not. I can walk for as much as I want to and can even light jog but the evidence that healing is not complete is that I feel some light pain when I get out of a chair or out of bed. It’s been 2 weeks and this is normal and it’s likely a matter of time until this pain disappears.

Can you feel the mesh if you twist or turn or lie down?

I can not feel the besh if I twist or turn or lie down. Or at least I don’t think I can. There is nothing that I feel that feels like : aha, this is the mesh.

Hope that helps! Goog luck to you!

• This reply was modified 1 month, 1 week ago by spinotza.

[pinto]

Spinotza, I’m happy for you you’re in a good place. You did your best under the circumstances and really took control of it all. I’m sure yours will be successful. If you don’t mind, I’m wondering if you really were able to choose your own surgeon or trusted the Center to make the choice for you. It sounds like the latter but just wanna be sure.

[spinotza]

Hi Pinto. My insurance meant that I could choose any doctor from the centre as they were all affiliated. I was happy with the one they suggested so I went with him!

• This reply was modified 1 month ago by spinotza.

[spinotza]

3 week update:
I will quiet down from now on as recovery is going very well. I’m back to swimming, jogging and weight lifting. Of course nowhere near to the intensity before surgery but still I think exercise is good for me if nothing triggers pain. I listen to my body and my body is ok with what I’m doing.
Yesterday and today I had zero pain.

I’ve been very careful with my diet and I went down 1.5 kg since surgery and now I’m 180cm and 76kg which I think also helps.

I’m emphasizing a lot fitness, no? Well I got my bilateral hernia in 2017 when I weighed 88 kg, I was depressed and would get sick and cough a lot.

I know it’s annoying to say this if you have a hernia,but I watched waited 5+ years and the most important thing I learnt was how to take care of my body even with an injury. There is always something you can do to improve your physical state and this will help both your surgery and recovery!

My long term goals are: go back to swimming 2 km, play a full tennis match and finally hopefully I’ll get back to doing hand stand exercises although that might be a bit too risky.

• This reply was modified 1 month ago by spinotza.

[spinotza]

So you’ve made some good points that I am glad to answer.
It’s pretty simple: pain was getting worse, not enough money for abroad no-mesh and was heading towards emergency NHS surgery with no choice over the procedure, possibility of a trainee operating on me.
OTOH I had private insurance, could choose an experience doctor that performs these operations on a daily basis which I think is one of the most important factors in outcome.

So I did and was convinced when the doctor suggested open instead of laparoscopic which is the trendy option these days but not at all what I wanted. Open with local anaeshtesia to me was ideal, even if it was with mesh. I also liked the fact the my doctor is an academic as well teaching at Imperial.
British Hernia Centre website is exaggerated they should stick to the numbers and references to peer review papers which they have in fact published over the years. The centre is a jewel however located in St Mary Hospital with excellent facilities.

So I’m recovering well, I don’t need any painkillers, I feel better than before the surgery and I couldn’t feel happier. I am more worried of recurrence then anything else because the little pain that I have every now and then it’s entirely manageable and will probably disappear soon since it hasn’t even been 2 weeks.

As for everything that has been said on this forum about mesh problems + all the studies, I acknowledge the very real possibility of things going wrong and I accepted it as risk that I was willing to take rather than a certainty.

• This reply was modified 1 month, 1 week ago by spinotza.

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