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Chronic pain after hernia repair ?

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Reading the posts on this forum is disturbing to say the least, especially in light of the fact that no one seems to know what causes the chronic pain for some after hernia repair, while others seem to be O.K.

It would be nice to know what percentage actually have chronic pain. I have seen figures from 5 to 30%, but no actual study.

It sounds like a very mixed bag

Are the current meshes being used safe?

It sure makes one hesitant to rush in to hernia repair
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replied February 1st, 2010
3 to 5 percent of patietns who undergo inguinal hernia repair will develop some form of chronic pain following their surgery. Putting it another way, more than 95 percent of patients who undergo hernia repair will NOT have probems with chronic pain.


Sincerely/ Robert A. Wascher, MD, FACS

www.doctorwascher.com

www.oncoguard.com



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replied April 10th, 2010
I must strongly disagree with your post surgical pain and complication figures.

I was recently (Sept 09) diagnosed with an inguinal hernia. The bulge is very small, painless and is fully reducible. After I was diagnosed, I was told that surgery was the only avenue to pursue, this rely prompted to dive into the literature to study up before committing to any form of surgery.

After reviewing the medical literature I have come to the conclusion that hernia surgery (open or Lap, using the polypropylene mesh implant or not), has a significant probability that the procedure itself could result in a series of complications the medical field has only started to recognize. Clearly I see that the historic metric for the success of the “repair” has been recurrence, not postoperative pain, which has been recently reported between at 2-10% of the cases for disabling chronic pain and at least 30% of the cases for mild chronic pain. It’s almost like the Docs consider numbness, immobility and pain as an expected outcome. With the large numbers of people going for hernia surgery each year (upwards of 700,000 in the US), and factoring in the reported rate of occurrence of chronic postoperative pain, the result is thousands suffering postoperative pain.

Don't commit to anything without doing your homework first. Review the literature, become informed, and make your own informed choice on the question of surgery. I have located a number of excellent articles and I have found the following articles in particular to be very useful, I can send you copies if you like.

Pain Following the Repair of an Abdominal Hernia
MARK BERNER HANSEN, KENNETH GEVING ANDERSEN, and MICHAEL EDWARD CRAWFORD
Surg Today (2010) 40:8–21

Two excerpts from the above article:

After 1 year, the incidence of light to moderate pain following inguinal hernia repair is as high as 10% and 2% for severe disabling chronic pain.

In fact, chronic pain appears to be more common in comparison to recurrence of the hernia. Following an inguinal hernia repair procedure, greater than 30% of the patient population complained of varying degrees of pain that persisted for at least 1 year postoperatively. Of these patients, 6%–20% were affected in their daily activities.

Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial.
Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M Jr, Neumayer LA, Barkun JS, Hoehn JL, Murphy JT, Sarosi GA Jr, Syme WC, Thompson JS, Wang J, Jonasson O.
JAMA. 2006; 295 (3):285-92

The Asymptomatic Hernia: "If It's Not Broken, Don't Fix It"
David R. Flum
JAMA. 2006;295(3):328-329.

I realize that as a whole, the patient population experience covers a wide spectrum, but you need to consider that after the implant, you may experience weeks of pain and immobility (swelling of the testicles, numbness etc), or worse: permanent pain. This is above and beyond immediate post surgical complications such as constipation (not good after abdominal surgery), infection, hematoma ect. After reading blogs of other folks accounts of having hernia repair implants, I am astonished at their reports of pain, complications and poor quality of life for months or even years afterward.

The big question that you need to answer is; after getting the implant, to what degree would you be able to tolerate and accept being disabled (regarding testicle pain and swelling, numbness, tightness, sensitivity around the incision) and not being able to participate in everyday living for a period of up to 6-8 weeks? Would you have to go on pain meds for long-term, and if so would this cause other health complications?

No matter what the Doc’s tell you this procedure is anything but routine surgery, and if the Docs insist that it is routine, I would be willing to ask the Doc “how many implants have been placed in YOUR body?” Always keep in mind that it's your body, and you are the one making the ultimate commitment.

In may case I have decided for the watch and wait option, my hernia was originally diagnosed in Sept 09, now some 6 months later I’m still OK.
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replied April 10th, 2010
cessnaflyboy, I have had bilateral inguinal hernias for over 16 years. My primary care physician who retired last year told me not to do anything unless symptoms occur.

My new primary care told me to have the procedure done. I consulted with two surgeons. One surgeon told me that there was no need unless symptoms occur. The second surgeon indicated I should have it done.

I find the whole situation interesting and troubling at the same time. In some studies, there was chronic pain anywhere from 5% to 50%, this is entirely unacceptable for the medical community to allow this type of variability without getting a handle on it.

It is understandable if you have a strangulated hernia you must have surgery, you have no choice. However, as you pointed out, and in my own experience there is still no consensus on how to proceed.

Risk verses Reward needs to be evaluated, and the individual must carefully weigh everything

You are so right, "No matter what the Doc�s tell you this procedure is anything but routine surgery"

In fact, I would go further to say that NO surgery should be considered routine

Thanks for the input
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replied April 11th, 2010
JohnI:

In the 16 years that you had the hernias, how have you managed them, use of a truss or belt, monitor your weight, excise regiment etc?

You point about the medical community not having a consensus on how to deal with hernias is spot on, they are still trying to figure out some of the most fundamental questions, and many studies result in conflicting conclusions with one another.

After reading the literature, I realized that the medical community has only in the last few years begun to recognize the existence or the impact of postoperative chronic pain. Also after reading blog after blog of folks who were not aware of the risks, and now have chronic pain and are left with no or little options coming from their original surgeon, it casts the whole issue of getting surgery in a different light.

Of the two internal medicine Docs that I have visited, they both warned me about the hernia becoming incarcerated if I did not have the surgery. However the literature is offering just the opposite opinion.

From the concluding paragraph in Fitzgibbons’s article “Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial.”
JAMA. 2006; 295 (3):285-92:

“A strategy of watchful waiting is a safe and acceptable option for men with asymptomatic or minimally symptomatic inguinal hernias. Acute hernia incarcerations occur rarely, and patients who develop symptoms have no greater risk of operative complications than those undergoing prophylactic hernia repair.”

This article and others on the strategy of watchful waiting has turned me away from having surgery done in the near term (or perhaps ever having it done). Certainly if my health and well being is threatened, then risk/benefit balance would tip towards surgery, but other then an incarcerated hernia, I don’t see the value of a prophylactic repair.

On an interesting side note, I am a pilot (as my user name suggests), and as required by the FAA, I need to undergo a medical exam every two years to demonstrate that I am able to perform the required duties while excising my pilot’s certificate. I was concerned that my hernia would disqualify me, but I was pleasantly surprised to pass my Class III FAA Airman’s Medical Certificate last month without any problem. If the FAA is not worried about incarceration then why should I if my inguinal hernia is asymptomatic? Believe me the FAA usually tips the balance towards staying on the ground if any issue has the potential to affect flight safety.

Thanks for your feedback
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replied April 11th, 2010
cessnaflyboy:

The first 15 years I did nothing to "manage them". After my first primary care retired, and my new primary care said I should have something done, that is when I started to do research as you did.

In addition, I started losing weight. I was 202lbs in Dec 2009, I am now 190 lbs, and 6'' tall. I figured whether I have surgery or not, it would not hurt. I hope to get down to about 185lbs.

The hospital in Canada, Shouldice, screens their patients very carefully, and before they perform surgery, unless you are the correct weight, they want you to lose it before they perform surgery.

I also am very careful about lifting things, and am careful not to overeat.

For the first 15 years I never noticed any buldges I do notice it now, and they fully reduce when I lie down.

Right now I am in a wait and see mode, maintaining a good weight, watching what I eat, and exercising via walking or hiking

I asked one of the surgeons if I would know if the hernia became strangulated, and she told me their would be no doubt if that happened. She also saw nothing wrong in watchful waiting, unless physical symptoms appear.

I still am considering the option of surgery, but am not in any hurry. If I was going to choose a surgery it would most likely be open with a lightweight mesh. The reasons for that are that:

1. Open surgery in most cases can be done under local anesthesia
2. Open surgery has no ambiguity in what the surgeon sees, and what to correct, while laproscopic surgery requires general anesthesia, is more complicated, and if they are in the middle of the procedure and something goes wrong, they have to change to open surgery

I would NEVER tell someone whether they should or should NOT have a hernia operation. I can only speak for myself. I realize there is a probability of the hernia getting worse, and strangulated, in which case I would have no choice but to have the procedure done. The question is would there be more complications then?

The one surgeon did not see any significant risk from waiting, and also indicated that she had performed hernia repair on patients as old as 90 without any problems.

Good luck to all of us

you pays your money, and ya take your chances
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replied April 3rd, 2011
johnny, if buying a car would you take the word of the greasy car salesman or do a bit of independent research , i would surely hope the latter, now im sorry but any surgeon that tried to claim they have done even 10 of these surgeries and had no problems is the biggest liar on the face of the earth, for the love of christ just read this site or google it, litteraly hundreds of people who never had sex again, cant walk and say "it ruined my life" now i'm not gonna tell you not to do it, but i will tell you if i had it to do over again id prefer the hernia killed me to living with this "repair"
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replied April 20th, 2013
Chronic post-surgical pain
I was having significant pain prior to my inguinal hernia repair, but it was nothing compared to what I have been experiencing post-op. it has been a year and 2 months since my repair. Most days I can at least function, but then there are days when I can't get out of bed due to the pain....like being stabbed by a hot knife blade. Reclining and using heat are the only things that help. Had I known it would be this bad, I would've learned to live with the pre-op pain and just take the few bad days...rather than lose the entire quality of life I had before surgery. I have a second hernia on the other side, but I will have my guts falling out before I will ever consider getting it repaired. NEVER AGAIN.
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replied December 31st, 2013
You got that right. The pain before is nothing to now! I guess live and learn. I will not have another hernia done if I get one.
God Bless. Praying we all heal.
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replied December 31st, 2013
You got that right. The pain before is nothing to now! I guess live and learn. I will not have another hernia done if I get one.
God Bless. Praying we all heal.
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replied January 3rd, 2014
I think there are lots of different degrees of inguinal hernia. My first one was never painful but made a really scary bulge when I strained it so I got it fixed. That was 1988 and I swore I never wanted to go through that again. Lo and behold I was having symptoms of double hernia again starting in about 2005 and I convinced myself I could ignore it. Which I really could until last summer when it became two big soft bulges that never went away, and sometimes on each side some harder bulges that became painful to touch or try to hold in, which is what you find yourself trying to do often. It was a topical, burning pain, like a skin irritation. So I knew I had to get some help, showed it to the doctor and he said I was crazy to wait this long, I said "I know, but I'm just dreading having another repair, much less a double..."
As mentioned before I'm in superb shape, a swimmer, at about 15% body fat, which you'd think would help. It doesn't. Recovery has been very slow and painful, but I'm being patient and careful. Seven weeks post op and there is NO WAY I could be working again yet, as a marine mechanic. At a desk, yes, no problem.
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replied January 3rd, 2014
I think there are lots of different degrees of inguinal hernia. My first one was never painful but made a really scary bulge when I strained it so I got it fixed. That was 1988 and I swore I never wanted to go through that again. Lo and behold I was having symptoms of double hernia again starting in about 2005 and I convinced myself I could ignore it. Which I really could until last summer when it became two big soft bulges that never went away, and sometimes on each side some harder bulges that became painful to touch or try to hold in, which is what you find yourself trying to do often. It was a topical, burning pain, like a skin irritation. So I knew I had to get some help, showed it to the doctor and he said I was crazy to wait this long, I said "I know, but I'm just dreading having another repair, much less a double..."
As mentioned before I'm in superb shape, a swimmer, at about 15% body fat, which you'd think would help. It doesn't. Recovery has been very slow and painful, but I'm being patient and careful. Seven weeks post op and there is NO WAY I could be working again yet, as a marine mechanic. At a desk, yes, no problem.
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replied January 3rd, 2014
I think there are lots of different degrees of inguinal hernia. My first one was never painful but made a really scary bulge when I strained it so I got it fixed. That was 1988 and I swore I never wanted to go through that again. Lo and behold I was having symptoms of double hernia again starting in about 2005 and I convinced myself I could ignore it. Which I really could until last summer when it became two big soft bulges that never went away, and sometimes on each side some harder bulges that became painful to touch or try to hold in, which is what you find yourself trying to do often. It was a topical, burning pain, like a skin irritation. So I knew I had to get some help, showed it to the doctor and he said I was crazy to wait this long, I said "I know, but I'm just dreading having another repair, much less a double..."
As mentioned before I'm in superb shape, a swimmer, at about 15% body fat, which you'd think would help. It doesn't. Recovery has been very slow and painful, but I'm being patient and careful. Seven weeks post op and there is NO WAY I could be working again yet, as a marine mechanic. At a desk, yes, no problem.
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Did you find this post helpful?

replied January 3rd, 2014
I think there are lots of different degrees of inguinal hernia. My first one was never painful but made a really scary bulge when I strained it so I got it fixed. That was 1988 and I swore I never wanted to go through that again. Lo and behold I was having symptoms of double hernia again starting in about 2005 and I convinced myself I could ignore it. Which I really could until last summer when it became two big soft bulges that never went away, and sometimes on each side some harder bulges that became painful to touch or try to hold in, which is what you find yourself trying to do often. It was a topical, burning pain, like a skin irritation. So I knew I had to get some help, showed it to the doctor and he said I was crazy to wait this long, I said "I know, but I'm just dreading having another repair, much less a double..."
As mentioned before I'm in superb shape, a swimmer, at about 15% body fat, which you'd think would help. It doesn't. Recovery has been very slow and painful, but I'm being patient and careful. Seven weeks post op and there is NO WAY I could be working again yet, as a marine mechanic. At a desk, yes, no problem.
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