Question :

Pain post ventral hernia repair

Dear Ask The Doctor:
I am 48, healthy and physically fit, weightlifter; 6 weeks out from an open ventral hernia repair with mesh placement. I had post op hematoma, subsequent superficial wound infection which was drained and is healing in using wet to dry normal saline dressings. It is 95% healed in, and looks healthy without drainage. I continue to have a pain never previously experienced until after surgery....it is in the right quadrant, at the level (or slightly below) of my navel and mid way between my navel and my iliac crest. It is sharp, and intermittent. It seems worse after eating. I can get it just while seated in a chair. Nothing in particular precipitates the pain that I can identify. I have no fever, nausea or vomiting. My bowel habits are normal. My GP had a CT scan done to rule out appendicitis, that came back clear. The CT scan was unremarkable overall. The Surgeon did note from the CT scan films that the mesh my operating physician used, which typically in his experience is supposed to be "flush" with the abdomen, is shaped more like a "badminton" with the mesh edges cupped downward into my abdominal cavity on CT. Could this cause pain? The original surgeon who did my surgery is no longer in the practice (took a new job elsewhere). The surgeon who is following me within the practice said he doesn't think the mesh is the cause of my pain - he went on to say that he doesn't typically use the mesh that the other surgeon does, and his mesh is always "flat against the abdominal wall." Do you have any idea what could be causing my abdominal pain? No one seems to know. It is very irritating. The pain started about 2 1/2 weeks after the original surgery. My original hernia was painless, though there was a palpable bulge above my belly button. This post operative pain is in an area that seems to me, totally unrelated. Could there be referral pain from the mesh? A second question: Is it safe to totally resume weightlifting. My surgeon did say I could do whatever I wanted to after 6 weeks...but I have heard others who said their doctor said an absolute NO to any abdominal exercises or heavy weightlifting. I want to avoid the chance of reoccurence at all costs! I am a very active person, and very use to core ex. and weights. What are your thoughts on both the abdominal pain, and the weight lifting/core exercise questions? THANK YOU in advance for any help you can provide.


Answer :

Dear Patient: 
I would advise no exercises which may increase your intra-abdominal pressure as this could cause a recurrence of the hernia. You avoid these exercises for at least 6 months after surgery.
Though it is possible, I dont think the mesh is the cause of your abdominal pain. Some of your symptoms suggest possible gallstones disease although your pain is not in the typical location. Another possiblity is muscular injury. An ultrasound of the abdomen is quite useful inĀ  identifying the two. In fact, an ultrasound if better at identifying gallstones than a CT scan. If a thorough examination and workup does not reveal the cause of your pain then it may be assumed that the mesh is the cuase of your pain and you may then opt for repositioning.


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