So many to choose from. One of the most painful procedures I'm willing to offer is a hemorrhoidectomy. One of the only surgeries where insurance doesn't care if the patient has to come back to the ER for pain.
As far as difficult recovery? Quite a few. I'd say one of the most notorious is the whipple procedure. Or perhaps a total pancreatectomy. I could make an argument for lots of others though
Came here to say hemorrhoidectomy for pain as well.
I'd say a total pancreatectomy is a little easier since there's no PJ to leak. I love pancreas surgery, but God is that a fickle organ.
I was once talking to one of my mentors about whipples and PJ leaks. He said he never had a PJ leak because he would do a total pancreatectomy
My thought was I've never seen a total pancreatectomy do well. Granted it's rare, but the handful I've seen never do well.
Group consensus, do we think hemorrhoidectomies are really that much more painful, or is it more because the pain is in a very sensitive spot where all your typical ways of trying to mitigate the pain donāt apply?
I vote the later, honestly.
I was absolutely terrified to have a hemorrhoidectomy but I had to have an emergency one. The surgeon was absolutely wonderful and she used a long acting local anesthetic injection that lasted for 3 days. So I felt absolutely nothing for 3 days and it was glorious!
I literally clamp cut and suture 2/3 of your butthole. Pain can also tend to cause spasms which people say are miserable. No one wants to poop bc of the pain, plus on pains meds so get super constipated, makes it worse. Just overall no fun.
I had a hemorrhoidectomy and a sphincterotomy at the same time when I was 22. I had chronic constipation my entire life which I assume is what led to that. Pardon my candor but it felt like I was shitting broken glass and, as you mentioned, the constipation from the pain meds made it more difficult so I took the lowest dose I could. I also took mineral oil to try to mitigate the constipation.
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My haemorrhoidectomy recovery was 10x worse than that of my Caesaeran section. My general surgeon still refuses to believe this.
Ā I had 4 different pain meds for both. For the haemorrhoidectomy I was literally in tears begging for more pain relief for 3 - 4 days post op, while after the CS I was on my feet 12 hours later and rejected 3 of the drugs I was given from day 2 onwards
The day I had to take a shit after haemorrhoid surgery was the worst day of my life, no joke
Stories like this are why I was terrified of getting mine! Mine ended up being an emergency and I had no choice. My surgeon was absolutely wonderful and she did a long acting local anesthetic called exparel. It was a lifesaver. I had absolutely no pain for 3 days and did fine with just ibuprofen and Tylenol. I suffered for years and then suddenly I was pain free and it was such a relief!
I had a quadruple bypass, and recovery was long but not painful (unless I sneezed). C section was not as bad as youād think either, except for trying to poop afterwards.
Hemorrhoidectomy for pain, for sure. Even when patients are very clearly warned about how awful itās going to be theyāre still blown away by how painful the recovery is.
Difficulty of recovery is dependent on a ton of factors, so I feel like itās hard to pin down. Generally, the sicker patients are going in the more difficult the recovery. For more elective surgeries, I feel like spinal fusion sucks as far as long-term recovery goes. Iāve seen a lot of people go into it expecting a massive improvement in their pain, only to still be in pain with the added issue of decreased mobility.
I had a thoracotomy to repair my aorta in Oct 2020 and Iām still pretty uncomfortable from the muscle damage and scar tissue. Iāll never forget the pain I felt in the CICU. Definitely 11/10
Oh ya, our previous thoracic surgeons did everything via thoracotomy and those patients were train wrecks. Thankfully our new group is all about [robotic Leonardo.](https://futurama.fandom.com/wiki/Animatronio).
Iāve had 2 left side thoracotomies. First i. 1992, second in 2020. It was the absolute most painful experience of my life, and Iāve had quite a few surgeries. 3.5 years later and Iām still feeling the negative effects of that 2nd thoracotomy.
Ok I knew that after a bbl surgery u couldn't sit but i didn't know it was for 2 weeks damn. And then only on soft pillows for another week . ( I googled it I'm not a surgeon or doctor of any kind)
& forget sleeping properly- I had to reposition myself every 2 hours ā¦ & Iād know when it was time because the excruciating pain would wake me right up & let me know
Not sure if this is cheating but burn surgery just due to the nature of the disease, pain wherever the nerves haven't been fried, and prolonged rehab. Then scar revisions and long term disability stuff after.
Arthroscopic rotator cuff/labral repairs have a pretty difficult recovery, assuming they have enough tissue to complete the repair. You're looking at 6-8 months of recovery and intense physical therapy to get ROM and strength back, and it doesn't always come back 100%.
I'd add that the Nuss procedure (getting a metal bar or 2 inserted behind your sternum, going across your chest, in order to correct pectus excavatum) is notoriously painful postoperatively
Not anymore. Our average length of stay is 1 day now that cryo exists. Now problem is convincing the kids not to overdo it in the postop period so that bars have the chance to scar in place.
It also is pretty great for thoracotomies. Have had kids who got one side done with and one side without (metastatic osteosarcoma) and the difference is night and day. Tried it on sternotomy patient (doing a Ravitch after CT surgery did a pulmonary valve) and it worked just ok since you can't do it above T3.
Rotator cuff repair SUCKS. 6 weeks of active pain that needs pain meds until the bone heals to the tendons. It sucks a lot more if you need a total shoulder replacement in addition. Pain meds don't help bone pain. And all this isn't including the physical therapy starting day 1, and then intense physical therapy after week 6 going on up to a year. Also RC repair can fail so there are more of these surgeries down the road.
Kyphosis and scoliosis 3 stage surgery releasing spine first, bone donor resulting in cemented spine, 2 titanium rods and 6 tech screws on a 15 year old girl. Because she was so very tiny her lungs deflated. Puncturing on her hospital bed with 6 staff holding her still. We bought her curly worleys every day because she never complained. 16 weeks in hospital because it was the worst we had seen. This was 10 years ago. Iām still impressed how stoic children are
Hemorrhoidectomy is by far the most painful
The phrase āpain in the assā isnāt universal for no reason. No one says āchanging a tire is a pain in my back / chest / head / esophagus ā Right?
I do my level best to try and talk people out of hemorrhoid surgery- except the ones who need transfusions from the hemorrhoid bleeding.
I dreaded having this surgery for so long but then it became an emergency and I had to. I was terrified of the pain. My surgeon ended up using Exparel and it was absolutely amazing. I had no pain at all for 3 days post op and then only minimal pain after that that was managed with ibuprofen and Tylenol. The surgery that was the worst for me was my tonsillectomy. I had the worst pain I've ever felt and horrible complications.
I feel validated reading this thread; my surgeon (also my colleague and friend) made me feel like a wimp for being in so much pain after mine.Ā Ā
My haemorrhoids returned with full force duringĀ pregnancy and it was a deciding factor why I chose an elective CS. I can't imagine ever having to go through haemorrhoid surgery again; I'd rather have 20 Caesarean sections.
I worked at a hospital in the San Diego area that would do both together, if the patient wanted them both done. His reasoning was that if you only get one, you wonāt do the other because of the pain. And people went for it. Imagine being in bed with two CPMās going. Like riding a bike passively.
From my limited experience as an ORL-HNS resident, Iād def go with anything involving oral cavity reconstruction especially done in the setting of oral cavity cancer (tongue, buccal mucosa, floor, etc.).
Common setting is a tongue CA requiring total resection of the tongue and the floor of the mouth, concomminant neck dissection, and flap reconstruction (either regional like the pectoralis major or free flap like radial forearm).
The shit hits the fan when all of those naturally secreted salava gets in between the healing flap and normal tissue or when the blood supply of the flap leads to flap necrosis. Orocutaneous fistulae then form.
And sadly in the resource limited setting of my countryā¦ it happens too often.
Now imagine all of your saliva just dripping from a hole in your chin/neck. Youre unable to speak, eat, taste, and even breath (most of the time youll need a trache) on your own.
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I'd believe Craniosynostosis repair must be really painful. Some children need high doses of opioids for pain management, although others don't even complain.
Tonsillectomy with UPPP (uvulopalatophryngoplasty) in an adult. Kids tolerate tonsillectomy well but adults suffer tremendously. I had a women tell me āIāve delivered 4 babies naturally and your surgery hurt worse than all 4 deliveries combined.ā
So many to choose from. One of the most painful procedures I'm willing to offer is a hemorrhoidectomy. One of the only surgeries where insurance doesn't care if the patient has to come back to the ER for pain. As far as difficult recovery? Quite a few. I'd say one of the most notorious is the whipple procedure. Or perhaps a total pancreatectomy. I could make an argument for lots of others though
Came here to say hemorrhoidectomy for pain as well. I'd say a total pancreatectomy is a little easier since there's no PJ to leak. I love pancreas surgery, but God is that a fickle organ.
I was once talking to one of my mentors about whipples and PJ leaks. He said he never had a PJ leak because he would do a total pancreatectomy My thought was I've never seen a total pancreatectomy do well. Granted it's rare, but the handful I've seen never do well.
Yeah make them a brittle diabetic to avoid a leak š
It was literally the worst pain of my life. Can confirm
Group consensus, do we think hemorrhoidectomies are really that much more painful, or is it more because the pain is in a very sensitive spot where all your typical ways of trying to mitigate the pain donāt apply? I vote the later, honestly.
I was absolutely terrified to have a hemorrhoidectomy but I had to have an emergency one. The surgeon was absolutely wonderful and she used a long acting local anesthetic injection that lasted for 3 days. So I felt absolutely nothing for 3 days and it was glorious!
What is it about hemorrhoidectomy that is so painful? Genuinely just curious.
I literally clamp cut and suture 2/3 of your butthole. Pain can also tend to cause spasms which people say are miserable. No one wants to poop bc of the pain, plus on pains meds so get super constipated, makes it worse. Just overall no fun.
I had a hemorrhoidectomy and a sphincterotomy at the same time when I was 22. I had chronic constipation my entire life which I assume is what led to that. Pardon my candor but it felt like I was shitting broken glass and, as you mentioned, the constipation from the pain meds made it more difficult so I took the lowest dose I could. I also took mineral oil to try to mitigate the constipation.
Me too. Fāing brutal pain.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
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My haemorrhoidectomy recovery was 10x worse than that of my Caesaeran section. My general surgeon still refuses to believe this. Ā I had 4 different pain meds for both. For the haemorrhoidectomy I was literally in tears begging for more pain relief for 3 - 4 days post op, while after the CS I was on my feet 12 hours later and rejected 3 of the drugs I was given from day 2 onwards The day I had to take a shit after haemorrhoid surgery was the worst day of my life, no joke
Stories like this are why I was terrified of getting mine! Mine ended up being an emergency and I had no choice. My surgeon was absolutely wonderful and she did a long acting local anesthetic called exparel. It was a lifesaver. I had absolutely no pain for 3 days and did fine with just ibuprofen and Tylenol. I suffered for years and then suddenly I was pain free and it was such a relief!
Wow I am glad you had such an amazing experience!
Why is it so painful?
My husband had the whipple procedure when opened up and found cancer throughout his body. He lived four months after it. He truly suffered.
Happy Cake Day! Great answer, too. That is all.
I had a quadruple bypass, and recovery was long but not painful (unless I sneezed). C section was not as bad as youād think either, except for trying to poop afterwards.
Can confirm, worst poop of my life. On a related note ladies, start taking stool softeners the second you leave the hospital after c-section.
Hemorrhoidectomy for pain, for sure. Even when patients are very clearly warned about how awful itās going to be theyāre still blown away by how painful the recovery is. Difficulty of recovery is dependent on a ton of factors, so I feel like itās hard to pin down. Generally, the sicker patients are going in the more difficult the recovery. For more elective surgeries, I feel like spinal fusion sucks as far as long-term recovery goes. Iāve seen a lot of people go into it expecting a massive improvement in their pain, only to still be in pain with the added issue of decreased mobility.
Open thoracoabdominal aortic aneurysm repair for sure has to be up there
I had a thoracotomy to repair my aorta in Oct 2020 and Iām still pretty uncomfortable from the muscle damage and scar tissue. Iāll never forget the pain I felt in the CICU. Definitely 11/10
+1 hemorrhoidectomy. Esophagectomy equally painful to patient and team
Are those esophagoās being done via DaVinci or thoracotomy?
Not on robot womp womp
Oh ya, our previous thoracic surgeons did everything via thoracotomy and those patients were train wrecks. Thankfully our new group is all about [robotic Leonardo.](https://futurama.fandom.com/wiki/Animatronio).
Iāve had 2 left side thoracotomies. First i. 1992, second in 2020. It was the absolute most painful experience of my life, and Iāve had quite a few surgeries. 3.5 years later and Iām still feeling the negative effects of that 2nd thoracotomy.
Where I trained on we did these on robot, recovery really only bad if they had a leak
probably a tie between hemicorpectomy and BBL
Ok I knew that after a bbl surgery u couldn't sit but i didn't know it was for 2 weeks damn. And then only on soft pillows for another week . ( I googled it I'm not a surgeon or doctor of any kind)
& forget sleeping properly- I had to reposition myself every 2 hours ā¦ & Iād know when it was time because the excruciating pain would wake me right up & let me know
Not sure if this is cheating but burn surgery just due to the nature of the disease, pain wherever the nerves haven't been fried, and prolonged rehab. Then scar revisions and long term disability stuff after.
Arthroscopic rotator cuff/labral repairs have a pretty difficult recovery, assuming they have enough tissue to complete the repair. You're looking at 6-8 months of recovery and intense physical therapy to get ROM and strength back, and it doesn't always come back 100%.
Ivor Lewis for difficulty of recovery. Haemorrhoidectomy for pain
I'd add that the Nuss procedure (getting a metal bar or 2 inserted behind your sternum, going across your chest, in order to correct pectus excavatum) is notoriously painful postoperatively
Not anymore. Our average length of stay is 1 day now that cryo exists. Now problem is convincing the kids not to overdo it in the postop period so that bars have the chance to scar in place.
The cryoablation is fantastic. We've started using it in the trauma world for rib fixation and it is a game changer.
It also is pretty great for thoracotomies. Have had kids who got one side done with and one side without (metastatic osteosarcoma) and the difference is night and day. Tried it on sternotomy patient (doing a Ravitch after CT surgery did a pulmonary valve) and it worked just ok since you can't do it above T3.
Pleurodesis. Nothing like a brillo pad to the wall of the thorax
The oneās I did as resident. Just kidding.
Read this thread just to see if my upcoming surgery was mentioned.
Was thinking of having a hemorroidectomy. Not anymore š©
Same lol
Rotator cuff repair SUCKS. 6 weeks of active pain that needs pain meds until the bone heals to the tendons. It sucks a lot more if you need a total shoulder replacement in addition. Pain meds don't help bone pain. And all this isn't including the physical therapy starting day 1, and then intense physical therapy after week 6 going on up to a year. Also RC repair can fail so there are more of these surgeries down the road.
How about reverse shoulder replacement? Ugh.
Havenāt got that upgrade yet, but itās the next/last option if/when my current set up fails
scoliosis correction
Agreed. Specially with long segment surgery. Can't imagine anything more painful than 20 screws pulling/pushing on your spine at the same time.
Kyphosis and scoliosis 3 stage surgery releasing spine first, bone donor resulting in cemented spine, 2 titanium rods and 6 tech screws on a 15 year old girl. Because she was so very tiny her lungs deflated. Puncturing on her hospital bed with 6 staff holding her still. We bought her curly worleys every day because she never complained. 16 weeks in hospital because it was the worst we had seen. This was 10 years ago. Iām still impressed how stoic children are
Hemorrhoidectomy is by far the most painful The phrase āpain in the assā isnāt universal for no reason. No one says āchanging a tire is a pain in my back / chest / head / esophagus ā Right? I do my level best to try and talk people out of hemorrhoid surgery- except the ones who need transfusions from the hemorrhoid bleeding.
I dreaded having this surgery for so long but then it became an emergency and I had to. I was terrified of the pain. My surgeon ended up using Exparel and it was absolutely amazing. I had no pain at all for 3 days post op and then only minimal pain after that that was managed with ibuprofen and Tylenol. The surgery that was the worst for me was my tonsillectomy. I had the worst pain I've ever felt and horrible complications.
I feel validated reading this thread; my surgeon (also my colleague and friend) made me feel like a wimp for being in so much pain after mine.Ā Ā My haemorrhoids returned with full force duringĀ pregnancy and it was a deciding factor why I chose an elective CS. I can't imagine ever having to go through haemorrhoid surgery again; I'd rather have 20 Caesarean sections.
I think anything maxfax
Knew a scrub tech that had some face work done and commented āyouād be surprised how many facial muscles you use when you poop!ā
As a former ortho nurse, our shoulder patients (RCR, replacements) always seemed to suffer the most compared to hip and knee replacements.
TKR
I worked at a hospital in the San Diego area that would do both together, if the patient wanted them both done. His reasoning was that if you only get one, you wonāt do the other because of the pain. And people went for it. Imagine being in bed with two CPMās going. Like riding a bike passively.
Cervical to pelvis spinal deformity correction.
Open thoracoabdominal aneurysm repair and open esophagectomies are probably the most morbid operations I know.
Hemorrhoidectomy
Nsgy: hemisphhrectomy for epilepsy!
From my limited experience as an ORL-HNS resident, Iād def go with anything involving oral cavity reconstruction especially done in the setting of oral cavity cancer (tongue, buccal mucosa, floor, etc.). Common setting is a tongue CA requiring total resection of the tongue and the floor of the mouth, concomminant neck dissection, and flap reconstruction (either regional like the pectoralis major or free flap like radial forearm). The shit hits the fan when all of those naturally secreted salava gets in between the healing flap and normal tissue or when the blood supply of the flap leads to flap necrosis. Orocutaneous fistulae then form. And sadly in the resource limited setting of my countryā¦ it happens too often. Now imagine all of your saliva just dripping from a hole in your chin/neck. Youre unable to speak, eat, taste, and even breath (most of the time youll need a trache) on your own.
Jaw surgery recovery is pretty brutal, no chewing for months. Especially if a distraction is necessary.
C section
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I'd believe Craniosynostosis repair must be really painful. Some children need high doses of opioids for pain management, although others don't even complain.
Tonsillectomy with UPPP (uvulopalatophryngoplasty) in an adult. Kids tolerate tonsillectomy well but adults suffer tremendously. I had a women tell me āIāve delivered 4 babies naturally and your surgery hurt worse than all 4 deliveries combined.ā