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  1. #1
    Registered User SolusRex's Avatar
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    Hernia Recovery and Post-Op Durability

    Hey all, apparently I have a hernia. Not super uncommon, I know.
    What's frustrating is the fact that it's a hernia that I previously had repaired. (A hiatal hernia in my diaphragm, repaired via a laproscopic nissen fundoplication.)
    I can't speculate the reason it happened; no one has an internal trip-wire to alert them when it happens. I don't discount it could be from lifting, but it also could be from when I had a violent allergic reaction to something I ate and spent 12 hours vomiting. Or maybe it's from bowel movements, stretching, getting hit by a car on a bike. Who knows. It's a wild world.
    Given that it's a hiatal hernia, and the stress point is different than an inguinal hernia, I wonder what the prognosis is for long-term recovery efforts. The question I wanted to ask is a contentious one and has been posed before, but the previous hiatal hernia threads seem to speculate, meander, and then abruptly end. So I'll pose it more directly:

    How durable is a hernia repair, and does anyone have a strong understanding of what recovery looks like in returning to a normal-ish routine?

    The usual stats:
    I'm reasonably fit. I run 10 miles once or twice a week, and lift weights most other days. I'm around 6'1", 200lbs, 12-14% body fat. I do fairly heavy lifting, but because of my previous surgery from years ago, I am cautious with core exercises, and I tend to avoid pushing myself with heavy deadlifts and heavy squats.
    The doctor said that if I have my migrated nissen repaired/pulled back down, I wouldn't be able to exercise for 3 weeks, and from the 3-6 week mark post-op, I can start working out slowly and cautiously not to strain myself, and avoid "lifting things around heavier than 50lbs for a while."

    Therein lies the rub, though. 50lbs, as a blanket statement, doesn't mean much. I can do a one-arm curl of 50lbs without any strain outside my bicep, but other motions like a dumbbell shoulder press or even a chest fly seem like they would require more consideration because of how much sympathetic movement would be in the chest and diaphragm. And like I mentioned earlier, I feel like strained bowel movements, some types of thoracic and chest stretches, and vomiting have had more pressure on the area than most controlled workout movements. Ideally, it would be good to hear an orthopedic specialist's opinion. Unfortunately, the times I've talked to "sports doctors" and the like, they either have no idea what a Nissen entails or what to advise (and why would they; it's very anatomically different that other types of hernias), or they have the cavalier attitude of insipid inspirational sports quotes with "no pain no gain" mentalities.

    I take it for granted I'll lose a decent amount of muscle after the surgery, especially being confined to a liquid diet for potentially two or three weeks, and I'll definitely baby myself into physical activity again. That said, how comparable is a LNF hernia surgery's recovery compared to other hernia surgeries in terms of durability? Does anyone have experience with limitations due to the crural diaphragm healing process or potential aggravators there? Do the abdominal incisions compare to inguinal hernia surgery incisions?
    Naturally, I'll be taking the doctor's advice, but the doctor's perspective is still limited to a gastroenterological perspective. I've talked to two doctors so far, and to be frank, neither seemed to know what "working out" entails; one talked about doing "push-ups again within weeks," as if that was the apex of routine, and the other talked about not boxing, doing judo, or entering "strongman contests," which again... not really the ballpark of my designs.
    Last edited by SolusRex; 03-10-2021 at 12:46 PM.
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  2. #2
    Registered User SolusRex's Avatar
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    Figured I may as well follow-up, for posterity's sake.

    I had the laparoscopic nissen fundoplication surgery revision to correct the hiatal hernia a couple weeks ago on April 14. It went well. The doctor performs revisions regularly enough to know how to deal with it, and apparently they had to remove a decent amount of scar tissue. The stomach had herniated into my diaphragm is such a way it was basically caught, and the potential long-term impact could be internal damage. So... yeah. I have little incisions all over my stomach, like some belly stigmata, and it's itchy as effing crap.

    I was told by the assistant surgeon that any muscle that is lacerated, even with incisions as small as they perform for the laparoscopic surgeries, only has a maximum tensile strength of 85% after surgery. The other surgeon said it should be 95% good. I suppose it's impossible to say for certain, depending on age, diet, genetics, and whatever else.
    They used a synthetic absorbable mesh on the crural diaphragm in my chest where the hernia is. He said he preferred this to biomesh because it's a little more elastic and takes about 6 months to be fully absorbed.

    I asked about working out again, and the doctor said I could do light jogging or biking at the three week mark, and at around 6 weeks I should be mostly back to normal and can do regular lifting. He said to wait 3 months at least before attempting anything too heavy. Considering the mesh will still be getting absorbed within that time frame, I don't know what to think other than I'll have to wait and see.

    He said there is no strict regulation for lifting, but I do need to be cautious of intra-abdominal pressure. This is no surprise, but studying the mechanisms of intra-abdominal pressure makes me wonder what the limits are (pushing a poo too hard can be as bad as heavy lifting in some cases). He claimed that, medically, there's not great research in the mechanics of that, especially because the diaphragm is so wildly mobile. There is research in mercury levels (how they measure the pressure), but nothing is a direct correlation, and everyone is different. And without cutting someone open months after the surgery, you can't *see* the direct healing progress.
    So it goes.

    Other than that, I've dropped about 10lbs in the past 13 days. I was 196 the day of surgery, and I'm about 185.8 now. I'd guess about 30-40% of the weight loss is body fat, but I can't say for sure. It's funny, I can't see my abs well because of the puffy scars around the incisions. I'm still in the liquid/soft food stage of things, but I'm maintaining solid calories, high protein, high fats, and trying to focus on balanced aminos, collagen proteins, and vitamins to heal the incisions well. It sucks not being able to go to the gym, but I'll probably be back to do some ellipticals or something soon. I miss being able to go after work and lift for an hour or so and listen to tunes. That was the one way I divided my day from working at home to living at home.

    Oh well. I'll probably do another update later. Maybe do before/after pics if I remember.
    Even if no one's particularly interested now, I'm sure someone will care down the road. I see a lot of these threads pick up interest long after they're over.
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