Hematoma

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blacknet

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Hello,

Some background:

Almost 8 weeks post bilaterial inguinal hernia surgery using the larposcopy method with mesh. Currently I have several extremely painful 1.5" to 2" hematomas, one behind each incision, 4 in the left inguinal area, 3 in the right and at least 1 in the spermatic cord.

Now for the concerns:

I do know that hematomas is a contradiction to diving. I am wanting to find out if there has been any research done in this matter; if this problem will end my diving career (just the facts of having hematomas); what increased risk, and increased potential medical issue(s), will this have durring any type of decompression event, whether it be direct ascent (recreational) or saturation enviroments (commercial).

Ed
 
Most of the time, hematomas resolve as part of healing. When you have healed satisfactorily and your Doc Ok's you for heavy lifting, (tanks, etc) you can probably resume diving as if nothing had ever happened.

Check with your doc for details of your case, but in general, hernia surgery heals up and individuals can then resume all normal activities.

John
 
Hello,

I realize that but I was suppose to have a pain free surgery, fast 2 week recovery time and no complications, so far not a single one of them has happened.

My doctor (er, rather EX-doctor) is clueless in this matter and can't answer any questions with a strait answer.

Ed
 
Sounds most unpleasant.

Hematoma is a known complication of laparoscopic herniorrhaphy, although its reported incidence is very, very low. Mostly these are eventually absorbed by the body, but occasionally need to be surgically addressed.

While I absolutely hold no expertise in this area, to have "one behind each incision, 4 in the left inguinal area, 3 in the right and at least 1 in the spermatic cord" at 8 weeks post-op strikes me as extraordinary. BillP, our resident surgeon, may have something more educated to say.

If you have not already done so, the first order of business here would be to obtain an expert consultation to shed light on exactly what has occurred & how the complications are best treated.

As Dr. Reinertson has stated, in general, once hernia surgery completely heals and the individual is cleared for heavy lifting & exertion, then he can resume all normal activities, including scuba.

Obviously, you are not yet even approaching that point.

Best of luck with this.

DocVikingo
 
12 years or so ago. I distinctly remember the doctor worrying about the body "rejecting" the mesh before surgery. It did, and he went back in, took it out and used one of the muscles that support the testicles to do the repair. That area and the area where I had my vasectomy can be tender from time to time, but the "bruises" went away once he got rid of the mesh.
 
Howdy Ed:

Sorry to hear about your trouble. I'm not aware of any research looking at hematomas and diving, but I've never heard of hematomas being a specific contraindication to diving. A person with an acute hematoma (just happened) would need to avoid any particularly strenuous activity because straining could potentially lead to further bleeding and expansion of the hematoma. But once a hematoma has organized (and it would almost certainly be organized at 8 weeks) activity is only limited by symptoms. ("Doc, it hurts when I do this." "Don't do that.")

In decompression I would think that an organized hematoma would act as any other poorly vascularized scar from surgery. There might be a slight theoretical increased risk of localized DCS in the lesion, but not an overall increased risk of a decompression illness for the diver. Surgical scars are not considered a reason to stop diving, and I wouldn't know why an organized hematoma would be different- whether it be recreational or commercial diving.

As DocV said, hematoma formation can occur with any operation. The problems you describe are not unheard of with laparoscopic hernia surgery and do not necessarily indicate that anything was done "wrong". Hematomas will usually resolve on their own without further intervention, but they'll do it when they darn well please. Different people heal differently. IMHO, they should be addressed surgically only when they're continuing to expand (ongoing bleeding), they become infected, or the surrounding tissues are being compromised (e.g. losing blood supply) because of the pressure. Otherwise they should be left alone to resolve on their own. Sometimes a hematoma will liquify and the blood can be drawn out with a needle to help it resolve faster. FWIW, people will always develop a "knot" of scar tissue that they can feel in a surgical incision- that's your body plugging the hole. In most people it will eventually go away as the scar matures. But usually that "normal" knot is no bigger than the incision.

Now I'm gonna jump up on my soapbox for a minute for the benefit (I hope) of other readers who might one day need hernia surgery. The following is just my 2¢ from anecdotal experience and not scientific research. The laparoscopic hernia operation is a fine procedure in the hands of an expert surgeon, but IMHO it's primary utility is in marketing. Patients like to be able to go to cocktail parties and say they had the "laser" surgery they saw on The Discovery Channel. In the hands of the typical community surgeon, the laparoscopic hernia repair has a higher recurrence rate, a higher (and potentially more devastating) complication rate, and a higher cost than other types of hernia repair. Those trouble rates are still acceptably low, but higher than with more "traditional" surgery.

I was trained in laparoscopic hernia repairs and I do lots of laparoscopic surgery but I don't fix hernias laparoscopically. Most of the surgeons in my area who started doing laparoscopic hernia repairs have all but abandoned the procedure. I would hope that surgeons who do perform the laparoscopic repair would honestly discuss the relative risks and benefits of various types of hernia surgery and avoid the "gee whiz" factor of laser surgery. As far as using mesh with a hernia repair is concerned, the presence any foreign body can increase the risk of infection, but the body does not "reject" modern prosthetic mesh except perhaps in very rare instances. (I've not seen it in 18 years, and general surgeons see lots of hernias.) While some patients can have problems with infection, overall the use of mesh reduces the chance of problems with groin hernia surgery. The use of mesh can reduce the risk of recurrent hernia by 10 fold.

As Dr. Reinertson said, as soon as the wounds have healed satisfactorily, the patient has been released to lift and strain, and residual symptoms allow, people can return to diving after hernia surgery. I would not consider the mere presence of 8 week old hematomas to be a specific contraindication to diving.

You can read what DAN has to say about inguinal (groin) hernias and diving at:

http://www.diversalertnetwork.org/medical/faq/faq.asp?faqid=48

You can look at what Scubadoc has to say at:

http://scuba-doc.com/hernia.htm

HTH,

Bill

The above information is provided for discussion purposes only and is not meant as specific medical advice for any individual.
 
Hello,

Thanks for all the information that everyone supplied.

DocVikingo, So "extraordinary" that 2 surgeons, 2 gp's call it the "1% catagory and highly unusual"

Overall I would rate the whole experience as tramatic and not something to recomend to others. At the very least they should be informed of complications. After doing some research I have found some material that the society of endoscopic surgeons published stating groin seroma and hematomas are related to extensive dissection and/or inadequate hemostasis.

It's also interesting to note that I told the staff of a drug reaction/allergy (pain killer) at least 15 times (not to count the times my family told them as well) and they gave me the same class rx, sent me home with the same class and rx'd the same 2 weeks later. Now this alone had dissolved any/all trust that did exist. The pharmacist was not happy and called the doctors office to do some serious complaining. The only rx that I took/was given was in the hospital. It had minimal effect on me and some very very intense pain levels. The first I remember in recovery was about 6 people holding me down, giving me o2 and yelling at me to breath.

Ed
 
Just a little info on myself , i had Inguinal surgery on 9/11 of this year. The surgery performed was on the lower left side and i didn't experience any trouble. I was a little sore for about 2 & one half weeks, but i was able to go back to work afterward on light duty. According to info that was on my coverage the type of surical procedure was referred as "left Innguinal Herniorrhaphy with Marlex mesh & plug".

I read above about possible infection from the mesh and not experiencing any problems their.

It's been about 4 weeks now since surgery & the doctor said to hold off from any heavy lifting for at least of 6 weeks.
After that he said to go back to diving.

As of now i experience a little iching but no pain what so ever.

I can't wait to get back in the water now.

Safe diving ot you all:

Sam::wink:
 
https://www.shearwater.com/products/teric/

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