Back from Internal Hernia Surgery

Hey Guys,

Thanks for all of your great support before surgery. Thanks especially to the Great CB who posted for me, when I couldn't log in at the hospital. Apologies if I've been too late or simply despondent in my e-mails. I go through periods when I just can't bear to type!

Surgery was this past Tuesday. Surgery lasted about one hour. The doc said he found a Peterson's hernia (or "Peterson's Defect") PLUS several other potential mesentary defects waiting to happen. Immediately after surgery, eating no longer gave me any discomfort whatsoever. I was also able to lay down after eating without pain and drink without feeling stuffed and uncomfortable - Liquids now go through very smoothly, as they did right after post RNY.

Other important discoveries from my stay/ tests: Lung capacity is now 150% of average (Does this mean I have three lungs?). Also bloodwork came back pretty normal. Iron is low, but if I were a woman, it would be considered very high, so they said it was perfect.

My reaction or lack thereof , to this surgery and general anesthesia is truly a testimony to the power of the RNY and the power of fitness. Second day after surgery I even flew back to my town (from Tokyo) and went in to work and taught a class . Third day after surgery,  I taught three 90 minute classes back-to-back. Fourth day, went jogging for an hour (doc said OK) and then went to a meeting.

The nurses were cute (all 6-7 on a 10 scale), but in my new physical condition attained since RNY, I got very little attention/ precautionary care. For example, I got up from the OR bed completely unassisted, used no pneumatic boots (no problem there!), climbed stairs unattended one hour after surgery and was hardly checked on that night. Nor was I asked to do any sort of respiratory therapy or breathing tests afterwards.

Basically, everything is good except for a little pain. Because the holes were mostly in the lower abdomen, movement is considerably more painful with this surgery than with lap RNY. Could also be because I have very little padding now on either side of the ab muscles.

What might I pass on to others who are having pain or discomfort months post-op?

You might be among the 5-7% of those who have an internal hernia (could be higher for men). Please read this carefully if you are having any abdominal pain or discomfort 3 or more months post-op:

This is taken verbatim from :

http://www.bcm.edu/gastro/DDC/grandrounds/BCM/2-23-06/09-DIS C.HTM

Apologies if any of the links don't work. Love,  Dave

INTERNAL HERNIAS complicating RYGB surgery:

RYGB can lead to potential spaces through which small bowel herniation is possible.   Three potential areas are: 1. Defect in transverse mesocolon if the roux limb is passed retrocolic (Visual 6) (5); 2. Transverse mesocolon and roux limb mesentery (Petersen's hernias) (Visual 7) (7),  (Visual 8) (7); 3. Small bowel loops at the jejuno-jejunostomy (2). Garza et al. retrospectively reviewed 1000 retrocolic lap-RYGB procedures, of which 45 (4.5%) internal hernias were identified in 43 patients.  Location was transverse colon mesentery in 95% and Petersen's defect in 5% (Visual 9) (8).  The most common clinical symptoms included intermittent, postprandial pain or nausea/vomiting (86%).  Twenty percent had no abdominal tenderness.  Initial radiologic imaging studies were diagnostic in 64%, but a subsequent review of all imaging studies suggested abnormalities in 97%.  CT findings suggestive of hernia included small bowel loops in the left upper quadrant (Visual 10) (9) or evidence of small bowel mesentery traversing the transverse colon mesentery (8).  Blachar et al. had 3 radiologists retrospectively review CT scans in 42 patients, 18 of which had internal hernias in random and blinded fashion (9)  Diagnosis of transmesenteric hernia was difficult and variable, with a sensitivity of 63% and specificity of 76% (9).  All patients in Garza's series underwent operative repair (98% laparoscopic).  One patient underwent a negative laparoscopy.  The mean time from bariatric surgery to intervention for internal hernia repair was 225 days (range 2 to 490) (Visual 11) (8).

 

Hey Dave, Glad to have you back, buddy! Ronnie

Hey Ronnie!

Thanks, you're looking thin, man! Looks great.

Dave

I feel fantastic! Right now, I'm 28 lbs. above my ideal weight. Without WLS, I would never, ever have been able to say that. My current weight is 243, ideal is 215. The surgery works, we all know that. What remains to be seen, at this point, is sustaining the loss long term.  Ronnie

Congratulations on the successful surgery.  Hopes, good thoughts and prayers were being sent your way.  It is amazing how after gbs we lose our desire to eat...and then we start to eat..and get back to somewhat normal...then something happens...and bam.... we seem to be back where we started...  I am glad that this surgery will allow the eating and drinking process to be more of a pleasurable experience.  I would say take it easy during recovery...but it sounds as if you have already gotten back on the horse...and are already winning the race.  Needless tos say, take it easy... and continued best wishes....

Hi Dan,

That's right, I was at a good weight of 172-5, but thought I'd lose some more weight for "insurance" as a buffer zone. I was somewhere between my 30th and 40th straight day of 30 minute jogs when I ate something and then doubled up on the floor for about 3 hours. After that and until this recent surgery, I had discomfort after eating and would often wake up in the middle of the night because it felt like the mattress was pressing on the food and my insides and causing discomfort. That's gone though, now and I'm feeling good. Unfortunately, the lack of trapped gas (caused by the hernia) is allowing me to eat more, but I seem to have gotten in the habit of eating less.

I have to take it easy, the only exercise I'm allowed is jogging until Tuesday!

Dave

Hello Dave, Count me as one of the many guys who were worried about you and sending good thoughts and prayers your way, and who are glad you're back in both of your homes--Japan and the Locker Room. Strange, isn't it, how a bunch of fatties, former-fatties, and semi-fatties who have never met in person can form real friendships in the ether? One of the unexpected benefits of WLS. All my best on your recovery.

Hi Doug,

Thanks! It is good to be back. I was going to mail everyone, but I couldn't log in to OH and I had a lousy touchscreen internet system in my hospital room. Typing on that was a b****. It is wonderful what the internet and OH can do. It's so good to have you guys here.

Recovery? Stomach is sore to the touch, that's about it. I do miss the shaven gut hair, though. Hehe, only two more days until weight lifting can begin!

How's your journey coming these days?

Dave

Dave,

Glad to hear it was a case of catching a problem before it got worse. Sounds like you’re doing great! I also found that with surgeries I had after losing the weight They were far easier to bounce back from. I didn’t have the “Extra Fit” workout routine going on, just the reduced weight, And it was still remarkably easier. With all of you working out, your “Blood-Oxygen levels” Must be optimum!  Healing should race along. Do take it a touch easy. I’m just dropping in as possible while I’m out of town working on a show for the next couple of weeks. Great to see you back on the Board! Best Wishes- Dx

 

Hi Dx,

Hope that's an enjoyable work you're putting together. It must be entertaining working with all of those theatre people - never a dull moment! It must be quite a mix of originality and enthusiasm.

Healing is fast. I'm just relaxing today and tomorrow is a "no-class" day (no lessons). It seems though that the either the anesthesia has shortened my nightly sleep time OR the lack of hernia discomfort has allowed me to get away with less sleep. I will try and get 7-8 hours tonight.

The healing is so fast, that 5th day out, one of my back slapping buddies at the local English teachers academic organization meeting popped me on the stomach, RIGHT where the lap holes are and it only stung briefly. So, I guess you are right, O2 levels are working in my favor.

Best Regards,

Dave