Transformation 45
Inguinal hernia in men, especially on the left side, is very common, and hernia repair with a prosthetic plastic mesh is the most common surgery performed. But searching online for information about hernia repair and recovery is frightening. There are an alarming number of stories of chronic debilitating pain, “meshoma”, reduced sexual function, severe reduction in normal activity, not to mention sports activity, and a general degeneration in quality of life. One oft-quoted statistic suggests that as many as twenty-four percent of hernia repairs result in chronic pain and other serious complications. The personal stories on many medical websites are heart-breaking.
I developed left inguinal hernia in late 2010, and did the usual online searching about the condition. I came across story after story of people whose lives were disrupted, sometimes in horrible ways, from their hernia repair surgery. But the chances of complication were generally reported to be very low. In addition, hernia cannot heal on its own. The only “cure” is surgery. It seemed I had no option, so despite the online warnings, I decided I would go ahead with surgery. This and subsequent articles detail my experience with hernia repair surgery, and how it compares with others.
Discovery and diagnosis
In December 2010, while showering, I discovered a medium-sized painless lump just above the left side of my groin. I thought at first it was a very enlarged lymph node, but soon decided it was a hernia, which was confirmed after a visit to my GP, Joseph Chemparathy. He scheduled an appointment with a general surgeon named Dwight Prodger.1 “He’s the best,” my doctor said, “though you may have to wait longer for an appointment.”
I finally managed to see Dr. Prodger in May 2011, after my initial appointment in April was moved by his office. A quick and uncomfortable exam confirmed hernia. He warned of an approximate 2.5% chance of infection, and a greater than 3% chance of bleeding. He said recovery time would be four weeks. No other complications were hinted at. I decided to schedule the surgery.
I opted for a date of August 26, so that my planned summer of hiking toward the Bruce Penninsula would not be interrupted. If I had to do it again, I would opt for the soonest surgery date available. Over the course of nine months, the hernia got progressively worse, probably exacerbated by weekly seven hour, twenty-plus kilometre hikes along the Niagara Escarpment. I had almost continuous pain through August, and increasingly acute incidents while bending when I could feel a portion of the small bowel move in and out of the hernial sac, the visible protrusion of the hernia.
I also swam up to two kilometres a night three nights a week, but I actually think that helped the reducibility of the hernia. That is, the intestine and other tissue usually returned to the abdominal cavity from the hernial sac after swimming, probably due to the horizontal stretching action taking place.
Day of surgery
My procedure was open repair of left inguinal hernia, with a prosthetic plug-and-patch mesh installed. It required general anesthesia, which surprised me, since it seemed to me that most repairs were done with only local anesthetic. When I asked Dr. Chemparathy about this, he suggested that my mesh repair required “extensive dissection” which required general anesthesia.
Mesh was placed behind the abdominal wall at the site of the hernia, a mesh plug was inserted into the hernia, and mesh was placed over the abdominal wall at the site. The surgical wound was closed with seven staples. The procedure took about forty-five minutes.
Immediately after waking up in the post anesthetic recovery ward, I could definitely feel the surgical site. It wasn’t excruciating pain, but it wasn’t comfortable. It felt almost as though I had a severe cramp in the area.
The nurse asked if I felt pain, and I answered that I did. “Are you sure?” she asked. “You got quite a lot of anesthesia in surgery.”
“I feel pain, but it’s tolerable,” I answered. She offered morphine, which I accepted. I got the sense that her question about pain was routine, to ensure that I actually needed morphine. Understandable, but odd, because yes, I was sure I was feeling pain.
Immediately after morphine was administered via the IV drip, the pain subsided, but was still noticeable. I was in the ward for about forty-five minutes, and was administered another round of morphine before being sent to the general ward. It hurt much less after the second dose.
As mentioned, the pain was tolerable. I’d describe it as moderate, or perhaps a five on a scale of zero (no pain) to ten (worst pain I ever felt).
In the general ward, a nurse gave me a prescription for Ketorolac, Percocet, Docusate Sodium tablets, and Lactulose liquid. Ketorolac is an anti-inflammatory and pain medication; Percocet is a morphine-based opiate, which, I was warned, can cause severe constipation. Docusate Sodium is a stool softener. Lactulose is a no-kidding-around laxative.
Constipation is not something one wants to deal with immediately after abdominal surgery. In the many months leading up to my operation, I’d read virtually everything about the surgery. I knew about its potential complications both acute and chronic, the recovery period and what I might expect, and the average long-term outcome, but I hadn’t anticipated an interruption to bowel routine at all. It turned out that its prospect was probably the worst thing I had to endure.
I was discharged from hospital after another forty or fifty minutes. Alex helped me dress. It would have been impossible to do so alone. It was difficult to stand; the pain was more severe when standing or sitting. Getting into the car was difficult, but not as problematic as I thought it might be. Driving home over a less-than-perfect road was probably the worst part of the day, since each pothole sent me swerving side-to-side in my seat, putting pressure on the surgical site. Not pleasant.
I was in hospital a total of about four and a half hours, from being admitted at about 8:00AM, to surgery at about 10:00AM, and finally being discharged sometime after noon.
At home
I was able to walk around somewhat when I got home, though it wasn’t very comfortable to do so. I lay on the couch in an upright position for a long time. This was the only position that was possible. Sitting was out. Standing for too long was out. Walking was painful. Lying upright was most comfortable.
I had some food, and stood in the back yard for a short while, but eventually I had to make my way upstairs to my bedroom. Climbing fourteen steps was difficult — it had to be done one step at a time — but much easier than I’d anticipated. I laid in bed for another long while, then made my way downstairs in the evening, where I did some light chores — moving dishes around, that sort of thing. I’d read that walking was absolutely essential in the first few days, to keep the blood circulating, to prevent constipation, and to generally help the surgical site heal more quickly. It wasn’t very comfortable, but I was determined to stay as mobile as was possible.
First night of sleep
I was in bed by about 10:00PM that night, and had taken three 10 milligram doses of Ketorolac by then. I’d decided against the Percocet, since I thought the side effects were worse than the benefits. I didn’t take the Docusate Sodium or Lactulose, as I didn’t think I’d need either.
The only possible sleeping position was lying upright, with my back supported by the headboard. Lying flat was not possible, and lying on either side was absolutely out of the question. I was asleep fairly quickly.
I awoke about 4AM, and had to use the bathroom. By this time, the local anesthetic as well as the Ketorolac had largely worn off, so I was in some discomfort. Getting out of bed from my half-lying-down, half-seated position was very difficult, shuffling to the bathroom was unpleasant, and trying to sit down once arrived was excruciating. Only by supporting myself on an ideally-situated toilet paper roll holder and the edge of the bathtub did I manage to ease down enough to go.
I was happy to go — one of the complications I’d read about was swelling at the site that pressed against the bladder and resulted in urinary retention, requiring a trip to the emergency department for insertion of a catheter. I was actually very apprehensive about that, and so was glad to pee, painful as everything was. Getting back into bed was also difficult and uncomfortable, but I fell asleep fairly quickly until about seven-thirty.
There were some surprises in store for day two.
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