About two years ago, I experienced intense pain in my lower right abdomen during a walk. I feared appendicitis, but the pain eventually went away. Six months later, I noticed a lump in my groin and realized I had a hernia, something more than 25% of men will eventually experience. (I’ve seen some estimates as high as nearly 50%!)

“露馅儿” (lou4 xian4 er) is one of my favorite Chinese phrases. It literally means “to leak/expose the stuffing/filling.” It’s generally used metaphorically to mean exposing a secret, like “spill the beans” or “let the cat out of the bag” in English. A hernia is the spilling of material that should remain inside the abdominal muscles, like the filling falling out of a dumpling.

Squeamish, I did nothing for another eighteen months till I started researching my options and learned:

  • Hernias never heal themselves
  • Hernias tend to worsen over time
  • Hernias can cause serious complications and become emergencies if untreated (e.g., kinking your intestine like a garden hose)

Additionally, I was limiting my exercise to long, fast walks, afraid to jog or play squash for fear of worsening my hernia.

I read medical articles, watched Youtube videos, and listened to hernia podcasts – there’s indeed a podcast for everything now! – then met with an experienced hernia & critical care surgeon who scheduled me for robotic inguinal hernia repair August 8th.

(The “robot” – this Da Vinci system – was not Lt. Commander Data but a device controlled remotely by my surgeon that provides him with superior visibility and manual control than a non-robotic laparoscopic surgery. The robot’s instruments can bend and move more flexibly than handheld tools.)

With robotic surgery, they cut three small holes in my abdomen, one through my belly button where they inserted the high-def camera and gas used to blow up a space inside where the doctor can work, and one on each side where the robotic instruments entered my abdomen. Because the holes are small, they heal faster and cause less pain. Robotic surgery is more expensive but gives the surgeon superpowers to operate more effectively.

Thursday’s surgery apparently went well, and I’ve been recovering and feeling a bit better each day since. Sharing my experience here in hopes it may help someone contemplating hernia surgery.

Advice for anyone contemplating surgery

My advice below is generally applicable to anyone considering any surgery, not just hernia surgery. The main principles are the same, regardless of procedure.

  • Begin by learning as much as you can:
    • Watch Youtube videos on hernias and their treatment so you know enough to feel confident when you find the right surgeon and the right procedure for you. Hernia surgeries are not one-size-fits-all. There are open, laproscopic, and robotic surgeries. There are repairs that place a mesh inside you and ones that don’t. There are different mesh materials, weights/thicknesses, pore sizes, etc. There are different ways of accessing the hernia (TEP and TAPP).
    • Listen to podcasts on hernias and their treatment. HerniaTalk Live with Dr. Shirin Towfigh was very helpful to me. Don’t try to listen to all the episodes. Scan the topics and listen to the ones aligned with your particular hernia issues/challenges.
    • Search Google for publicly accessible scientific studies. I found and read articles like Open versus laparoscopic repair of inguinal hernia: an overview of systematic reviews of randomised controlled trials. This prepared me to judge whether the surgeon’s plan seemed sensible.
    • You don’t need to become an expert on everything, but learn enough that you can tell when you’ve found a surgeon who is skilled & experienced in whatever procedure they plan to perform on you, that the proposed surgical plan is sensible, and that they plan to perform that on you because it’s the best option for you, not because it’s the only procedure they’re competent/experienced at. Sometimes, surgeons must switch procedures in the middle of a surgery, and you want a surgeon who can successfully call an audible while you’re on the operating table. Learn as much about a surgeon before scheduling a visit, and if you’re uncomfortable, visit another. You’re searching for someone in whom you’re willing to entrust your life… because that’s exactly what you’re doing. You may want to avoid surgeons who recently graduated from medical school or are at an age where their physical dexterity may be deteriorating.
    • As you learn details about the operation, you’ll feel nervous and scared. But you want to be informed. Once you’re confident you have the right surgeon and the right surgical plan, you’ll be able to relax – not freak out – on surgery day when they wheel you into the operating room.
  • Visualize success & focus on the benefits of fixing your problem: We’re often advised to enjoy the journey and not fixate on the destination. Prepping for surgery requires the opposite. The journey will be scary and unpleasant, so focus on excitement over your destination. The skilled medical staff will do most of the hard work. Realize all you must do during the surgery is nothing. You’ll be asleep. I was scared thinking about what they would do to me, the pain I would be in even if things went great, and worrying about all the things that could go wrong. After I learned that stressed patients were more likely to suffer post-anesthesia mania, I decided to visualize myself preparing to go to the hospital, traveling to the hospital, arriving at the hospital, prepping for surgery, getting rolled into surgery, etc. and imagining myself as excited/happy rather than nervous by focusing on them fixing my problem. I wanted to be able to joke with my surgical team. I wrote them a letter (see below) but decided to give it to them afterwards so I wouldn’t distract them.
  • Choose your surgeon carefully and ensure they’ve done many similar surgeries: Hernia repairs have a tendency to recur, and there can be very serious complications. Choose a surgeon who has performed MANY hernia repairs, not one who dabbles in them. Your odds will be MUCH better, especially if anything unusual arises.
  • Practice lying down and getting up: I struggled for days with lying down and getting up and slept (very poorly) in a chair my first two nights after surgery. After surgery, I learned the best technique for doing so – this is a good instructional video – but was scared to try it. Wish I had practiced pre-surgery.
  • Figure out where you’ll sleep. It’s painful getting in and out of a tall bed. If you have a bed or sofa closer to the floor, you may find that easier to sleep on. A nice recliner can be great, esp. if it can tilt into a relatively flat position (which mine couldn’t).
  • Don’t expect to get anything done the first three days: My brain was cloudy from the meds and poor sleep for the first three days. I had hoped to use those days to study and read, but I couldn’t concentrate. I basically just watched TV for three days.
  • Don’t let painkillers fool you: Right after surgery, you’re heavily medicated, and the painful inflammatory healing process may only just be beginning. So you may feel much better than expected. Don’t let the pain-masking drugs fool you into pushing yourself hard. I wanted to tilt a box of canned water into an upright position so I could pull out the cans more easily, but the box was more full than I expected, and I instantly regretted trying to reposition the box.
  • Don’t take any chances lifting things: My release instructions told me not to lift anything more than 15 pounds. It should have said 5 pounds on day one. And object weight isn’t everything. Lifting something further away from your body places much more strain on your abdomen than lifting something close. Don’t take any chances! Don’t risk ruining the expensive, painful procedure you’ve just undergone!
  • Know how to sit & stand up: For the first 3-4 days, I struggled to sit and stand. I felt pain and feared damaging the repairs inside my body. One key is to breathe out while sitting or standing. Another key is to take some of the pressure off your trunk by pushing on the chair/toilet seat with your hands/arms.

My experience

  1. Preparation (mid-July through Aug 7th):
  • I suspected losing weight might reduce complication risks when my surgeon went spelunking through my abdomen, so I went on a very low-calorie, high-protein diet (a daily egg; a bit of meat/fish; spinach; beans; lots of Spindrift water with just a splash of fruit) for 2 1/2 weeks and lost a LOT of weight. The doctor’s office weighed me at 183 the day I met my surgeon. Right before they wheeled me in for surgery, I weighed 168. (I later found a study confirming my hunch that complications are – I believe I read – 2 1/2 times more likely in obese patients, and I saw a British doctor recommend losing weight prior to surgery.)
  • I’ve lost this weight once before and slowly gained it back. My long-term health will benefit greatly if I keep it off this time. I plan to track my weight and embrace the feeling of being a little hungry.
  • I didn’t want lots of food in my digestive tract after watching videos of patients who had suffered excruciating constipation post-surgery. The opioid I was given a prescription for (but did not fill or use) sucks the water out of your intestinal tract. I took some CVS-brand Colace (generic name: “docusate”) to help soften my stool and was prepared to add a laxative, but I experienced no significant constipation and never needed a laxative.
  1. Surgery day (Thurs, Aug 8):
  • I tried to remain calm, upbeat, and cheerful. I had general anesthesia and remember only the first few minutes in the operating room before they put a gas mask over my face. I know I had a breathing tube put down my throat because I asked the anesthesiologist pre-surgery. I was presumably still heavily drugged when I left the hospital – I believe they mentioned administering a list of drugs, including fentanyl! – and started taking the maximum dose of acetaminophen (1,000 mg) and ibuprofen (600 mg), alternating between the two every three hours, right after surgery. I felt surprisingly good the day of surgery, but that was likely because I was stuffed with drugs and the worst of the inflammation hadn’t yet hit.
  • I didn’t walk a lot, but I tried to frequently take a quick walk around our first floor to keep my blood moving and prevent blood clots. And I did some slow stair climbing. I even brought three cans of flavored water up from the basement.
  • I couldn’t sleep on my bed due to excessive abdominal pain when trying to get off the bed. I spent 40 minutes trying to get off the bed! So I slept on a lame old Ikea recliner we have. I probably slept four or five hours and woke up very sore, with a sense my blood had pooled in my legs.
  1. First day post-surgery (Fri, Aug 9):
  • I kept taking both acetaminophen and ibuprofen but cut back to 500 mg and 200 mg respectively all day. Pain was pretty bad but manageable with the meds. I didn’t need to fill my opioid prescription.
  • I again couldn’t get into my bed due to the pain and “slept” in the lame old Ikea recliner. Around 4:00 am, I couldn’t bear it any longer and slept the final few hours on a sofa I managed to lie down on.
  • I walked around our house, mostly sticking to the first floor, but I was able to go up and down stairs.
  1. Second day post-surgery (Sat, Aug 10):
  • Woke up to discover everything was quite blurry in my right eye! Feared it could be permanent! Did I have a small stroke from a blood clot? Did my artificial lens (IOL) come loose during surgery? I called and left a message for my ophthalmologist, and she amazingly called me right back and told me that most likely my eye had been (incorrectly) open during surgery and dried out. I used eye lubricant drops, and my vision quickly returned to near-normal. Thank you, Dr. Mirela Krasniqi!
  • I was off meds almost the whole day. I was in similar pain to the day before but this time without any medication.
  • I slept on the sofa, which was lower to the ground than my bed. Still hard to get on and off without putting excessive strain on my abdominal muscles. And the uneven cushions were uncomfortable.
  • I love going for long, fast walks, but I settled on three shorter (~ 20 minute), slow walks. Getting my sneakers on was the toughest challenge. There were some sharp pains while walking, but I enjoyed getting outside and moving for the first time.
  1. Third day post-surgery (Sun, Aug 11):
  • I was off meds all day and felt less pain.
  • Went on four short (20-30 minute), slow walks. Moving a bit faster. Walked up/down the stairs more freely.
  • Later in the day, my brain finally felt clear enough to do something more challenging than watch TV. I did some studying and opened my computers for the first time since surgery. (I’m normally addicted to my computers, but my brain wasn’t calm enough till Sunday to touch them.)
  • Finally felt ready to sleep in my bed. Was able to get in and out without significant pain.
  1. Fourth day post-surgery (Mon, Aug 12):
  • Slept till 11 am when my family woke me! I guess I was in serious sleep deficit!
  • Less pain than the day before, esp. when sitting for long periods, which was still uncomfortable the previous day. Still afraid to move in certain ways. Still occasionally feeling sharp pain if I turn a certain way or something, but feeling reasonably normal.
  • Typed up two blog posts on my laptop, so I’ve finally gotten some of my normal energy back.
  • Took two hour-long walks today, my first two long post-surgery walks, both including a long, relatively steep hill.
  • My calves finally hurt less. They’ve felt close to cramping since surgery, but I had calf pain and a bad cramp when waking up a day or two before surgery. Calf pain can be a symptom of a serious problem, like blood clots or deep vein thrombosis. I suspect my pain may have been caused by a nutritional deficiency from my weight loss. I cut out dairy for several weeks and may have been low on calcium. The past two days I’ve enjoyed some cheese, milk, and ice cream.

Fun letter to my surgical team

Dear Dr. Symons’ Surgical Team:

Hi, it’s James… or, as you know me, “11:30 hernia guy.”

I can’t believe I’m paying you to shut off my brain, bore holes in my chest, and dissect my groin, but here we are.

Thank you for helping me! Hernia repair should let me sleep without fear of strangulating my intestines and return to jogging and squash.

“Robotic surgery” sounds exciting! If I have a choice of robots, I would feel most confident with Data from Star Trek, but Robby the Robot or Sonny from “I, Robot” would also be great. Maybe C-3PO or K-2SO. But please don’t let Futurama’s Bender anywhere near me!

The idea of a catheter freaks me out, so I’d like to draw your attention to a randomized clinical trial of 491 laparoscopic inguinal hernia repairs published in JAMA Surgery June 15, 2022 (JAMA Surg. 2022;157(8):667-674. doi:10.1001/jamasurg.2022.2205):

241 [patients] were randomized to catheter placement, and 250 were randomized to no catheter placement. The median (IQR) age was 61 (51-68) years, and 465 participants (94.7%) were male. Overall, 44 patients (9.1%) developed PUR. There was no difference in the rate of PUR between the catheter and no-catheter groups (23 patients [9.6%] vs 21 patients [8.5%], respectively; P = .79). There were no intraoperative bladder injuries. In the catheter group, there was 1 incident of postoperative urethral trauma in a patient who presented to the emergency department with PUR leading to a suprapubic catheter placement.

If you insist on giving me a catheter… As much as I love surprises, I’d rather it not be a UTI, so would you please splurge and give me a clean one? While you’re at it, maybe clean the blood off the trocars and instruments you used on your last victim… I mean patient… before you wheel me in.

Many over the years have called me — not without justification — “brain-dead.” Let’s please not prove them all right. I’d love it if you could keep my brain stem functional throughout this procedure. Thanks!

I panicked when given an 11:30 surgery slot. I’m sure you’re hungry, but please don’t rush through my groin dissection to beat the crowd to the cafeteria! If you’re feeling hangry, maybe grab a Snickers before you start slicing up my abdomen?

Please don’t punish me for the scheduler assigning me a pre-lunch surgery. If you think you’re upset, I haven’t eaten or drunk anything since yesterday! Not even my morning coffee! Yet you won’t hear me complain – not even once – during the operation, no matter how long it takes (unless you underdose my propofol)!

I’m sure I sound like a hoarder, but I like all my major blood vessels just as they are… arteries and veins. So please remember: “Measure twice. Cut once.”

I’m also a big fan of avoiding life-long nerve pain, so please be careful around my genitofemoral, ilioinguinal, and iliohypogastric nerves!

Surgical checklists prevent errors, so here’s mine: Anesthesia first and then cut me open and let the robot loose on me.

Please don’t bring this paper into the operating room. It’s not sterile, and I dislike MRSA.

Again, thank you!!!!!