How will hernia repair affect backpacking ??? Anyone Know?

[Billy Ray]

Thanks Valerie… I appreciate your input… all this makes me feel more confident to hear it from backpackers who are still hitting the trails…

But I must say, looking at your cactus avatar pic is somewhat discomforting while considering my groin :)

billy

[Diane Pinkers]

My boyfriend is one of the ones who had more discomfort post surgery. He has a pretty low pain tolerance in general. However, while it took months for him to be fully pain free, it wasn't enough to keep him off the trail-more a dull ache after lots of uphill, not a screaming sharp pain. He had his surgery in September of that year, and we really didn't backpack until the next year. It has completely gone away now, though. Definitely more comfortable than before the surgery. So, even those with surgical problems can turn out well in the end. Get the surgery, don't end up in the hospital with a strangulation.

[Billy Ray]

Thanks Diane,
good advice…
I made an appointment today for surgery in March…
Laparoscopic method… polypro mesh…
hopefully I'll be backpacking by mid summer.
Thanks for everyone's responses… most helpful to hear from other backpackers…

billy

[Rob Reynolds]

I had an inguinal hernia surgically repaired with mesh 3 weeks ago on Wednesday. Considerable swelling the first few days but 3 weeks later I am fully back to normal. I ran 5 miles then mountain biked another 8 miles yesterday. No ill affects at all.

My doc is a former college football player and very active – hiking, biking, etc. he strongly recommended going with an full incision and mesh repair given my active life style. He said laproscopic repairs have about a 60% chance of reoccurrence.

[Billy Ray]

Most docs will tell you results are about same for open vs laparoscpoic… for recurrence or or complications… but best study of 1370 says laparoscpoic potentially half the recurrence or complications… but only if by very experienced surgeon w laparoscopic… otherwise same outcomes open or laparoscopic… me thinks surgeons steer patients to open because it takes less skill and is cheaper and faster… I have surgeon friend that confirms this… still… these are all just odds… any given op could be much better or worse
B

[Anonymous]

"me thinks surgeons steer patients to open because it takes less skill and is cheaper and faster… I have surgeon friend that confirms this…"

I'm not so sure about this one, Billy. The surgeon who repaired my hernias has an excellent reputation and many years of experience. He also does a lot of laparoscopic surgery for a wide variety of procedures, so it wasn't lack of skill. His reasoning matched that of Rob's surgeon, and was based on my very active lifestyle. He told me he could do it either way but that he thought the long term result would probably be better with an open incision, and left the decision to me. I chose to go with his advice. Either way, I'm betting you'll be backpacking a lot sooner than you think.

[Billy Ray]

" He also does a lot of laparoscopic surgery for a wide variety of procedures, so it wasn't lack of skill…"

Tom… the 'skill' per the study needs to be specific to hernia repair; not general laparoscopic surgery… the study I referred to specifically indicated that laparoscopic exerience other than hernia does not count towards hernia laparoscopic experience… That study indicated that unless the surgeon does >200 laparoscopic HERNIA surgeries a year then the results will statistically will be about the same between laparo and open… including recurrance… but if the surgeon does >200 hernia repairs by laparoscopic method per year then the results are significanly better than open… study of 1370… basically >200 per year means they virtually specialize in heria repair via laparo…

[Billy Ray]

And this quote from Nathan Avery (a surgeon and backpacker) post earlier in this thread:
"Either open or laparoscopic approaches are totally reasonable. One large study did suggest that the chronic pain rate might be lower with the laparoscopic approach. "
is another reason I am leaning to laparoscopic… chronic pain can not only end your backpacking, it can ruin your life… The study I read about indicated half the chance of chronic pain with laparoscopic… again, if done by a surgeon who does a ton of them laparoscopically

billy

[Anonymous]

"Tom… the 'skill' per the study needs to be specific to hernia repair; not general laparoscopic surgery… the study I referred to specifically indicated that laparoscopic exerience other than hernia does not count towards hernia laparoscopic experience… That study indicated that unless the surgeon does >200 laparoscopic HERNIA surgeries a year then the results will statistically will be about the same between laparo and open… including recurrance… but if the surgeon does >200 hernia repairs by laparoscopic method per year then the results are significanly better than open… study of 1370…"

I don't know if my surgeon does >200 laparoscopic hernia repairs/year, but he was perfectly comfortable going either way, and has an excellent reputation. I was just conveying my experience, which was very favorable. In any case, the choice is yours to make.

"basically >200 per year means they virtually specialize in heria repair via laparo…"

I'm not sure any surgeon specializes in laparoscopic hernia repair. My impression is that hernia repair is typically performed by general surgeons. Maybe Nathan could clarify this point.

[Dean F.]

Another surgeon-hiker, here. Predictably, Nathan and I have been reading the same journals.

For a unilateral inguinal hernia that isn't recurrent I have a hard time advising either way on open vs. laparoscopic. I really do. For bilaterals and for recurrent hernias, yes, I do laparoscopic, but for most others I still do open, for all of the reasons cited. If you are being offered laparoscopic surgery for a unilateral primary hernia then your surgeon likely only does this because so many patients show up in his office who have been googling and decided that they want the newest shiniest thing, and that's a laparoscopic repair. (This is frankly the same reason that the da Vinci robot is getting so big, despite the fact that it is really only of benefit in a few narrow applications.) You would have a hard time convincing me that recovery is quicker by any *significant* degree for laparoscopic. It's surely more expensive and takes longer. The studies that were touted as showing faster recovery times are mostly from back before managed care, when people stayed a few days in the hospital after their hernia repairs, and thus how quickly you could get them out of the hospital was a large factor in total cost of the procedure. That's why they became popular. (And even then the difference was rather small.)

With either one the activity restrictions are the same during the recovery period- about six weeks.

The modern mesh repairs are tension-free, so no one walks around in pain hunched over anymore like your grandfather did with his tissue repair Back In The Day.

And yes, your quote of 20% for chronic pain is off. (Though Nathan and I may be using more formal definitions of "chronic" than you are.) You can find a study to support any position you care to, but a decent quote would be that about 10% have some sort of subacute pain, meaning lasting longer than a month but shorter than a year. A lot of these can be treated with neurectomy. The numbers who have pain lasting longer than a year and need serious management for it is in the low single digits, which yes sounds low unless you're the guy getting surgery.

That said, I would agree that the risk of specifically nerve entrapment as a cause of pain is less in laparoscopic repair. Well, unless your surgeon has a senior monent and puts a tack in the Triangle Of Pain. (Seriously- there is an anatomical landmark called the Triangle Of Pain.)

Which laparoscopic repair is your surgeon doing, TEP or TAPP?

Tom- You're right that you'd be hard pressed to find someone who did nothing but laparoscopic hernia repairs for a living. However there are specialists in laparoscopic surgery, aka minimally-invasive surgery, and there are well established fellowships for it. They might well do that many laparoscopic hernias repairs, but on the other hand it seems to me that some of them consider "routine" stuff like gallbladders and hernias to be somehow beneath them. They want the adrenalectomies, splenectomies, and other prestigious stuff.

There are also a few who specialize in hernia repairs, e.g. the Shouldice Clinic, though not necessarily just the laparoscopic ones. For instance, my example the Shouldice Clinic still does open tissue repairs! (Go figure, the repair is named the Shouldice repair.)

[Billy Ray]

"Which laparoscopic repair is your surgeon doing, TEP or TAPP?"

TEP method…
He will be using Bard 3D polypropylene Mesh.

Turns out I actually have 3 hernias. One on the left that is bothering me and keeping me from doing much walking. One of the right that was done 45 year ago via stitch method and is opening back up… and one very small navel hernia (size of small finger nail). Surgeon said, let's do them all while we're in there. Sounds good to get it all done and not have to go through this again a couple of years down the road. On the other hand, hope I'm just not creating more chance of a negative outcome by doing all 3.

Billy

[Dean F.]

No, it's pretty commong to fix an umbilical herna when doing anything that involves instrumenting the navel. And pretty much everyone uses Bard 3DMax.

I like the TEP. I don't see much point in the TAPP. Why chance the adhesions when you can do a TEP?

[Bob Gross]

"And pretty much everyone uses Bard 3DMax."

Hmmm. Maybe we could use that stuff to make internal baffles for a sleeping bag.

–B.G.–

[Dean F.]

Nah, too heavy. Heck, even ProLite is much heavier than taffeta.

[Billy Ray]

Well… it's a done deal… had triple hernia repair two mornings ago. (left, right, and navel… all laparoscopic)

Sore, but not taking any pain killers. Hard to get up, hard to get down into seated or laying positions… hard to straighten up. Hope to walk a little today. Hope to be on top of some 14ers this summer.

Any healing advice will be appreciated.
thanks for the encouragements to get it done earlier in this thread…

Billy

[Larry Swearingen]

Give it a couple of weeks and follow your Dr.'s orders and you'll be fine.
I've had all three of those done over the years. The last, the umbilical hernia,
about 3 years ago.
I'm 69 and I'll be catching the CDTC Shuttle down to the Southern Terminus of the CDT
in NM a few weeks to start a Section Hike up to Pie Town or Grants. It depends on how I feel
when I get to Pie Town, about 325 miles. If I'm still good then it's on to Grants.

Larry OldnSlow Swearingen

[Billy Ray]

Thanks Larry,

did you find your umbilical hernia repair hurt the most?
That's what is seems to be for me…

billy

[Jerry Adams]

just sitting around and not exercising enough will take longer to heal

exercising too much and damaging yourself will take longer to heal

[Michael L]

Don't lift anything heavy. When you do lift, use your legs. Let the pain be your guide on walking around. Never hurts to be safe, so start slow and build.

[Valerie E]

Best wishes for a speedy recovery, Billy. My husband now needs hernia repair, too — so this time I'll be the "nurse", not the patient!

[Billy Ray]

Thanks for the 'best wishes' Valerie. I'm doing this solo… so I'm both the nurse and the patient… though patience is not my strongest virtue :)

Best of outcomes to your husband.

Billy

[Greg Mihalik]

Billy,
The doc prescribed pain meds for a reason.

Unless you're a "recovering" guy, you won't get addicted on 20 tablets.
You'll be less anxious about moving around.
Your body will be pumping out less "stress" hormones, fewer inflammatory signals.
You will sleep better.
Somewhere between Day 5 and Day 7 you'll realize that you don't need them, and that will be that.

Give it some thought.

In the meantime start planning this summer's hikes.

[Billy Ray]

Thanks Greg,
but the doc said take the meds if needed. That's my judgement call I guess.
Pain meds give me migraines. And cause constipation. you do not want to be constipated after hernia surgery… from my readings that's the most common way to ruin the surgery, have reoccurance, and need another surgery.

b

[Greg Mihalik]

Absolutely your call, especially when you've got history.

Some folks tend to be "hero's", and that doesn't do them any good.

Now, back to planning this summer …

[Larry Swearingen]

Hi Billy,
"did you find your umbilical hernia repair hurt the most?"

Hard to say. My Umbilical was done about 4 years ago and the Inguinals were
done 25-30 years (seperately) ago so it's hard to say. Meaning I was 65 for the
Umbilical and in my 30's for the Inguinals. It's easier recovering when you are
younger.

OldnSlow

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