Recovery following keyhole hernia repair

mccormac

nerdag

As a person who has spent much time around surgeons (I'm in my 7th year year as a medical student), I may be able to answer some of your queries:



This isn't exactly "repaired" as yet. The procedure places a piece of mesh which is then essentially "burned" into the connective tissue around the internal inguinal ring. This doesn't repair the defect, per se.

Repair of the defect takes place over a period of a few weeks while the connective tissue regrows around the mesh, which reinforces the weakness around the inguinal canal.

Any stress on this area while it is healing has two effects - delays the repair, and makes it potentially weaker. Stress can be because of repetitive motion (eg. spinning, which repetitively flexes/extends the leg at the hip, and inguinal canal with it), or by straining (eg. tensing up your core abdominal muscles to increase the amount of oxygen you get into your lungs, or get up that last hill). You may remember that when you had the lump, a cough would make it appear/get worse. Same thing happens when you're straining.

Neither is a good thing. The last thing you want is for the repair to fail because you've started riding again too early, because you'l be back for more surgery, and next time, it will be a much more difficult repair because of all the new connective tissue that's there.

Quote:

Originally Posted by mccormac I'm itching the get back on the bike asap but the surgeon is telling me that I shouldn't even think about it for a full month! Part of me is saying that the guy must know what he's talking about and that I should listen to him.

Think of it this way - your doctor has trained for at least 16 years to qualify as a surgeon, and probably practiced for a few more years after that. I think there's a good chance he/she knows what they're on about.

Quote:

Originally Posted by mccormac But inevitably, I did a forum search and his advice is quite at odds with the experience of other hernia 'survivors' out there. See this post for example where the guy claims he was back on the bike in just a few days!

He's probably exaggerating, or his repair was so small that it probably didn't need a repair and he's a fit and healthy young adult, or he'll have to go back to his surgeon for a further repair at some time in the future.

Quote:

Originally Posted by mccormac Some of my cycling buddies reckon that because the surgeon isn't specifically a sports surgeon he's just being overly cautious.

Unless your cycling colleagues are experts in inguinal surgery, I'd take that with a grain of salt.

Surgeons with an interest in sports tend to be trained in orthopaedics, and while they would have done hernia repairs in the course of their training, they wouldn't necessarily be up to date with the latest trends.

Mesh repairs are fairly new - they've only become commonplace within the last five years. Unless you're doing procedures like that everyday, you're not going to have kept up.

Quote:

Originally Posted by mccormac In case it is relevant, he said that the hernia was quite small - just a couple of cm. Any advice very much appreciated!

Smaller hernias tend to heal faster, because there's less to heal. Larger hernias take longer.

The four week resting period your surgeon has recommended should already have factored this in.

At the end of the day, nobody can stop you riding your bike post-op. But if you want the best possible outcome, I'd be following your surgeon's advice.

If you're really dead keen to hop back on, I'd think that gentle spinning on a trainer after a fortnight should be okay, but any road riding would be out for at least the minimum rest period. There's no sense in risking going back under the knife for a second repair if you don't have to.

Thats my (somewhat informed) A$0.02.

HTH,

n

mccormac

Hi nerdag, thanks for your prompt and detailed response.
I hadn't realised that the repair was more of a process than an event - perhaps the surgeon should have explained that a bit better! But with that knowledge now in mind, the off-bike period he's suggesting makes a lot more sense.
Mmm...I was beginning to suspect as much. I'm four days on now, and I can still only barely walk straight. I went for a 2 km gentle stroll this afternoon and I was exhausted after it. The thought of swinging my leg over a seat and riding is just beyond me.
I sort of had that in mind anyway, i.e. two weeks doing absolutely nothing followed by two weeks with the bike on a wind trainer.

Thanks again mate.

flapsupcleanup

That was me that was back on the bike quickly after my hernia repair. No exaggeration. It's been a few yrs now but it was within a couple of days for easy rides and I felt pretty great after a week.

Now of course, you should take internet advice with a grain of salt. That said, I thought about what put a lot of strain on the inguinal area, and cycling really doesn't. Things that strain down there are obviously heavy lifting which we have no trouble avoiding....and straining for a bowel movement which puts a huge pressure on that wall. My surgeon told me that the mesh binds very quickly, like within a few hours and not to worry about tearing it. He also didnt caution me about BM's, squatting, etc. Cycling cant create more pressure there than those activities.

And like the great man said: "Free advice? Worth every cent!"

mccormac

Hey, thanks for the response.
Thing is though, in my case it was on a ride that I felt it go. I wasn't even going uphill - I was just really going for it on a flat stretch (inspired by Jan's Giro t/t performance in truth!). I felt pain immediately but only noticed the tell-tale groin swelling the following day.
Unless you have a two year old!

trulymadly

wow nerdag, what a QUOTING REPLY you gave, lol. Hey there, hope u have been able to get some help!

Cyclesafe

Follow your doctor's advice! I just got the bill for my laproscopic linguinal hernia operation - $6000! Can you imagine what sort of a bike I could have bought???

Enjoy the pics!

Attached Thumbnails

 

mccormac

Mmm...thanks for the pics...I think!

But seriously, just how much do doctors in the US make if the bill for your surgery was $6,000? I don't care how good the guy was because that's just nuts. I haven't got the final bill for mine yet but I was advised of the surgeon's fee in advance and that was roughly $700 US - that's the Australian Medical Association's recommended fee for the procedure. Indicative pricing on the anaesthetist's fee was for it to be something similar.

Cyclesafe

Unquestionably, the medical industry is seriously flawed in the US.

Surgeon $1900, knocked down to $1700 to the insurance allowed amount
Anesthesiologist $900, not covered by insurance, but considered in the deductible
Hospital $6800, knocked down to $5400

My (private) insurance carries a $5000 deductible and I am to pay 50% until $10000 and 0% above that, so I am out $6500. Of course I also pay $6000 a year for my insurance premium (husband and wife over 50).

All this for an operation that from the start of the anesthesia to discharge took 3 hours!

HEWSINATOR

Wow, I got a very large, doc said larges he had seen Inguinal repaired the ol' fashioned was (too big for lapro), and doctor said 4 weeks. So I left it for that long, and I am nervous that I am pushing too hard, riding very easily.

But on another note, I am in Alberta, I walked in and walked out and nothing cost me anything.

mccormac

Yeah, here in Australia I could have had it done free too. But I would have had to wait a month+. I just wanted it done asap and had the private health insurance to cover most of it.

I can't get over that Cyclesafe's policy excess was $5,000 with only 50% cover up to $10,000. My excess is a paltry $300.

discobean7

The major culprits are really the insurance and pharmaceutical companies. They are making billions while everyone else suffers. I read an article on CEO salaries that really got me going the other day. A CEO from one of the big health insurance companies had stock options that were estimated to be worth almost $2billion when he retired. And an oil company exec "earned" the equivalent of $244,000 a day!

__________________
"if at first you don't succeed, redefine success"

nerdag

This is completely off topic, but I do think that another problem is the nature of funding of most medical trainee places. My understanding is that in the US, a majority of the cost of the training is funded by the individual, and depending on where you do your training, you're looking at debts of up to US$400k.

If I was graduating with that sort of debt in my late 20s, I'd want be to paying that back as soon as possible, given compound interest and all, and I think most people in that situation would want to do the same as well.

That being the case, it's no surprise that many graduates end up doing further training in higher paying specialties, and charging a lot of money for the service.

I'm graduating next year with a debt of about A$50k, which is relatively cheap in comparison, but still enough to make lenders think twice about giving me a home loan or whatever.

Anyway, back to bikes.

HTH,

nerdag