Recovery from Hernia surgery?

[GatorJoe]

i am pretty sure i have a hiatal hernia, going to the dr tomorrow to confirm. will probably end up having surgery on it within the month. how long does it take to recuperate from such surgery so youre good enough for scuba? I am going to cancun in june and want to make sure ill be ok.

 

[asiders9]

It only takes a few days, I had two, on the same side, in the same year. You ought to be fine if it's in June.

 

[sabbath999]

Assuming you have ortho surgery (which you undoubtedly will) it is a very quick recover. I had it done and was ready for everything in no time flat.

 

[GatorJoe]

excellent thx. is there a big scar?

 

[TSandM]

Okay . . . Let's back here, because hernias are not hernias. The OP has asked about a HIATAL hernia, which is where the stomach herniates up into the chest through an excessively large opening in the diaphragm. This is quite different from groin hernias, which are defects in the abdominal wall which permit abdominal contents to protrude into the groin.

Hiatal hernias are "repaired" by a variety of procedures, but the most common nowadays is the Nissen Fundoplication, which can be done laparascopically. If it is done in that fashion, there is about a 3 cm incision made in the umbilicus, and a couple of trochar insertion sites (puncture wounds) in the upper abdomen. Postoperative pain is usually minimal, and people are frequently back at work within a week (depending on the work they do, of course). It is still recommended to avoid heavy lifting for several weeks, and many people find that the general anesthesia will leave them lacking stamina for a couple of weeks, anyway.

Groin hernias, on the other hand, can be repaired laparascopically, but are still often done open. As the repair can involve significant tension on abdominal wall structures, postoperative pain is more significant, and the restrictions on lifting are more strict and longer.

 

[cutlass]

For an uneventful laparoscopic repair of Type I (explained more below) hiatal hernia, the standard line is to say that return to light, near-normal activity could begin anywhere from 2 to 6 weeks. Heavy lifting activity, which I would include scuba -- and probably breath-hold diving too -- should be restricted for about 12 weeks or more.

The plain term "hernia" is most commonly associated with an inguinal hernia which is a defect in the lower abdominal wall. OTOH, a hiatal hernia refers to a defect in the diaphragm. Hiatal hernias fall into 2 broad classes. The most common is the Type I in which the gastroesphageal (GE) junction of the esophagus protrudes above the diaphragm. (The GE region includes the "valve" into the stomach; i.e. the lower esophageal sphincter or LES) Type I is often associated with pathologic reflux disease; of patients with such chronic reflux, about 80% will have Type I. The other broad class of hiatal hernia actually lumps Types II, III, IV together. These are rarer, involving other organs protruding above the diaphragm; usually part of the stomach and rarer still, portions of the small or large intestines. (There're other oddball diaphragmic hernias such as the congenital Morgagni's and Bochdalek's.)

There're two main parts to the Type I operation: repair the defect and reinforce the LES to stop the reflux. The so-called Nissen fundoplication is the most common technique for the latter objective. This basically involves wrapping an upper fold of the stomach completely around the esophagus to reinforce the GE. It is now usually done laparoscopically, typically using 5 ports: one for the camera, two for retraction and other duties, and two main operating ports. There're several nearby vessels (esp. phrenic, left hepatic, aorta) and care is taken to minimize any disruption and bleeding; suctioning to clear the field can be tricky. Particular care is taken while suturing the left crus (part of the diaphragm muscle) during defect repair. But almost certainly, the main player to watch is the vagus nerve which runs alongside the esophagus. It will get jostled a bit during the operation and its recovery from irritation has an impact on the post-op course.

 

[dschonbrun]

Because the Diaphragm is involved, you should be cautious here. Remember you are breathing air at ambient pressure, due to the regulator... so the pressure on the diaphragm at depth will be much greater than at the surface. Even through the net force may be the same during inhilation and exhilation, the pressure from each side (Superior/Anterior - Chest vs Inferior/Posterior - Abdomen) will both be far greater than at 1 ATA.

 

[TSandM]

There is no net pressure differential across the diaphragm during diving, so I don't think he has to worry about that.

 

[GatorJoe]

well i went to the dr and they said it was just my xiphoid process coming in. had a chest xray and they said everything was fine. i dont have a lot of pain so i guess it's nothing. weird though that a lump just appears...

 

[DocVikingo]

Because the Diaphragm is involved, you should be cautious here. Remember you are breathing air at ambient pressure, due to the regulator... so the pressure on the diaphragm at depth will be much greater than at the surface. Even through the net force may be the same during inhilation and exhilation, the pressure from each side (Superior/Anterior - Chest vs Inferior/Posterior - Abdomen) will both be far greater than at 1 ATA.

Hi dschonbrun,

This is not my understanding.

Would please explain on what basis you posit such a differential?

Thanks,

DocVikingo