[aj9000]

Hi all,

Thank you Dr. Kang for weighing in.

Here’s a report on the outcome of my surgery (inguinal, right side only), in case any are interested.

The day before surgery, Dr. Yunis went over several options with me. We decided that in the case of a direct hernia, he would perform a modified Shouldice procedure in which the cremaster muscle and genitofemoral nerve would be left intact, and Prolene sutures would be used instead of stainless steel. If the case of an indirect hernia, he would avoid division of healthy transversalis fascia. As it turned out, I had both a direct and an indirect, so the former procedure was performed.

Although I hadn’t planned to have general anesthesia, I ended up opting for it after talking to the anesthesiologist.

Recovery followed what I understand to be the normal pattern. Pain was not bad the day after surgery, and I stopped taking pain meds that day. The next day (day 3) I had to resume pain meds (ibuprofen and acetaminophen). Pain was the worst on days 3 and 4, but manageable as long as I moved slowly when changing between standing, sitting and lying down (think Feldenkrais speed). I found that standing up and touching my toes alleviated pain. Around day 5, swelling and bruising of the genital area began, and lasted for several days.

I am now almost 4 weeks out from surgery, and there is no pain, bruising, or swelling beyond a small, hard ridge that is diminishing under the incision.

My only issue is that have a bit of lower back pain, probably because I have not been doing my usual workout and have been sitting and lying down a lot. I go back to the gym today, and will report back on how that goes.

One bit of advice: if you have to fly anywhere for open hernia surgery, schedule your return flight for the morning after surgery, or stay in town for at least a week. Pain apparently can peak anywhere from day 3 to 5, and I ended up flying at my peak.

Overall, I think the surgery went extremely well, and based on my experience I’d recommend Dr. Yunis to anyone seeking a non-mesh procedure.

[aj9000]

Thanks @thunderrose, that helps. I wonder about stationary biking? In any case, I’ll have a chance to ask him when I go in. Good to know that you were at least able to start some sort of cardio after less than 3 weeks.

[aj9000]

@drtowfigh Thanks for interpreting the study. I didn’t know about bromelain/pineapple for fighting inflammation; I will try it — thanks @thunderrose.

[aj9000]

Anybody out there try anything like this to promote healing?

I plan to follow the supplement regimen in the study almost exactly, except I will be starting one week prior to surgery instead of two weeks.

Here are the supplements:
1. ArgiMent AT powder (contains 14g l-arginine, 14g l-glutamine, 500mg vitamin C, 30mg zinc), twice a day
2. An additional 750mg vitamin C, once a day
3. An additional 30mg zinc gluconate, once a day

[aj9000]

Thanks for replies @drbrown and @mitchtom6. I plan to ask my surgeon what’s reasonable to do and how soon — just thought it would be good to get perspective of some others who exercise regularly and had a pure tissue repair.

@mitchtom6 My lifting regimen is not that intense — some bench press and machine-assisted lifting, but no deadlifts, though I have interest in starting to improve core strength.

Your comment made me Google around a bit. Some others also advise to stop or limit weight when deadlifting, but one of Dr. Sbayi’s Shouldice patients talks about resuming deadlifts (405 lbs) after 6 weeks: https://www.stonybrookmedicine.edu/hernia/resources/shouldice-repair-patient-testimonials

I won’t be doing weight like that probably ever, but it would be good to know how to monitor myself to make sure I’m not going over the limit for my repair.

[aj9000]

Hey all, I opted to go with a modified Shouldice with Dr. Yunis. Surgery is in a couple of weeks. I’ll try to post a follow-up after.

[aj9000]

@James, did you have a Shouldice repair? I am currently leaning toward Dr. Yunis because he does a modified Shouldice that doesn’t involve removal of the cremaster muscle. From Dr. Grischkan’s website it looks like he also has modified the standard procedure. Does you know if he removed the cremaster?

@Alephy, I lost a few pounds in anticipation of surgery, and now my hernia doesn’t bother me at all when exercising. Admittedly, it was not large to begin with.

[aj9000]

The study had something like 390 participants, so yeah, not so many people. I agree that these things don’t often control for surgical expertise.

Thanks for the list of doctors — looks like I should reach out to Drs. Reinhorn and Towfigh as well. I scheduled a telemedicine appointment with Dr. Yunis, so now preparing questions to ask.

[aj9000]

Hi Dave, I had the same as Thunder Rose – 4-layer Shouldice. Same motivation: to prevent recurrence. My incision looks like it is about 3 inches, but even at only 1 month out it is hardly noticeable.

If your main goal is to minimize foreign material in your body, there is a hybrid mesh product, Ovitex, that I read about here: https://herniatalk.com/forums/topic/telabio-study-of-reinforced-biological-meshes/#post-27854

It might end up being less material than is used for suturing only in some cases. I considered Ovitex briefly, but there was not enough historical data for me. Either way, you are going to have some stuff in your body – sutures or a plastic mesh – unless you get a biologic mesh, which I understand does not work so well.

Telabio study of reinforced biological meshes

[aj9000]

Thunder Rose – thank you, this is extremely helpful! I read a few posts on the site about your positive experience with Dr. Yunis. I did not know that he avoided resection of the cremaster. I think I will reach out to him for more information.

I have read comments from doctors who say that Shouldice repair is not as “tight” without the removal of the cremaster. Googling around for more information led me to a study, https://pubmed.ncbi.nlm.nih.gov/2180642/, that shows an increase in the rate of hernia recurrence for Shouldice repairs where the cremaster is left intact. The difference is significant, but still not terrible: between 1 and 2 years out from surgery, it looks like the recurrence rate is about 2.6% for repairs that leave the cremaster intact and less than 1% for repairs that involve excision of the cremaster.

Nyhus sounds promising as well. I have not read anything about that technique yet. In your research, did you encounter any doctors with a lot of experience performing the Nyhus repair?

One other question: in one of your posts, you mentioned that you wanted prolene sutures instead of stainless steel. What was your reasoning for this? Are the prolene sutures more comfortable?

[aj9000]

Thanks for the response, Good intentions.

Since I posed my initial questions, I found some information that runs counter to my intuition about exercise. Here, Drs. Towfigh and Jacob claim that almost any exercise is OK, but that coughing and straining are most problematic:
https://www.youtube.com/watch?v=jhXCmTeP1vc&t=10m10s
https://www.youtube.com/watch?v=jhXCmTeP1vc&t=13m15s

Another question that occured to me: with mesh, infection and undesireable foreign body response are two worries; I wonder if there is are similar worries about tissue-only repair with permanent Prolene sutures?