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Open surgery repair on bilateral inguinal hernia 5 weeks ago but still not good…
Hello,
Due to my addiction to sports, I was kindly forwarded from https://forum.bodybuilding.com/ to here to ask my question , so I would like to beg your help in here.
Being proud of signing up the herniated club and to make things short, I’m from Spain (living in The Netherlands), 45 years old. Some time ago I found (well, some surgeon did), that I had a bilateral inguinal hernia (2 hernias, small). It came from the fact that I was starting to develop some pain in the iliopsoas (I guessed), not bulges coming out or anything. To make things fast (my wife is due to deliver baby soon and she needs my help due to kind of premature delivery risk), I went to m country to have a faster treatment.
Last March 13 I had open surgery with 2 meshes. Everything was going fine, but I had a pain after almost 4 weeks. Here in Holland doctors are not exactly the best, but I managed to have an ultrasound and see the surgeon. Radiologist said, from ultrasound, a recurrence on the right, bigger than 2 cm (around 1 inch), much bigger than any of the small ones I used to have. 2 surgeons tried to feel it by touching but they said they couldn’t feel anything, so they couldn’t conclude whether I have a recurrence or not, they guessed from radiologist’s report, but couldn’t feel it by pushing me everywhere around… They said I could come back to see again in 3 months. I checked with the surgeon in Spain who did the surgery and he neglects the possibility of a recurrence, he said is too early to consider any ultrasound valuable, so to speak. He added that someone with my build, (not fat, basically) should be easy to spot a hernia right away by touching, but here surgeons are terrible and also, may be the remaining inflammation is precluding hernia from being felt, I don’t know.
Pain has lowered, but yestaerday (18 April) I was on my 5th week after surgery, and what I’ve done so far is my average 11 km per day on the bicycle to go to work, nothing else, I’m getting depressed from refraining from going to the gym (it’s like my drug), but I don’t dare to go and do weightlifting, 3 days ago I was assembling a chest of drawers (the typical for baby, not too big) and posture wasn’t good, but didn’t require much effort, and next 1.5 days I felt some kind of assortment of pains, not too high though, but the’re there.
I read about people at full steam with sports at my week of recovery and I see myself losing muscular mass and fitness (although my weightlifting wasn’t too much, I was on 18 MET)…
Therefore, I would be more than grateful if someone could give me some insight. If there are any medical able to interpret ultrasound, I wouldn’t mind posting some pics from the ultrasound last week.
Thanks a lot in advance and Best Regards
RPG
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41 Replies
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That’s a shame Spanish, but maybe it’s best in the long run. What if you had complications? Would Dr. Koch help then?
It’s interesting that Naholm appears to monitor and read the posts on this forum, and keep his surgeons informed. But does not participate even though he and his company have been discussed in depth.
https://herniatalk.com/forums/topic/biohernia-hernia-surgery-without-mesh/
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Alephy, thanks for your answer, I enquired the clinic about cutting nerves but what they say is “taking care of your nerves and replacing them outside the suture line”… Replacing them? How come?
About the health system, in fact in Spain the public health system is considered the second best in the world for covering everything with no cost at all and many other things. My surgery was made using my private health care insurance in Spain I have that is totally apart from the social security, that prevents queues and is more handy when you live in a country like holland that treat cancers with paracetamol. I have to say that I was unlucky wth this surgeon I had, living abroad wouldn’t make sense to go to the loop within the public system as you mention…
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I think the best way to avoid a recurrence is to remain fit and slim…especially after a certain age your training schedule must include exercises aimed at keeping strength and elasticity of the muscles and fascia…I also would think twice before touching the nerves in a permanent way (I am surprised a surgeon would suggest this from the start). Btw reading about your original surgery I would not call that an example of a good health system: you were not in the loop on the procedure before or after and you weren’t told about the risks or complications…
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Thanks a lot for you insight Good intentions and deeoeraclea!
This clinic I went in Germany is a team specialized in sports hernias and they do surgeries to professional footballers, etc… How come they can do these procedures when will affect directly to sporters? What the hell? I also pointed out the surgeon that I do not care about pain, I’m an athlete, not living off it though, but I’m used to pain, I do not care about pain, I just want my hernia (recurrence) fixed, I want to preserve my functionality, that’s prio 1… He told me about the mesh removal + Shouldice hernia repair, but then once I had the treatment plan I was scared about the neurolyses, after reading the link from Good intentions it seems that even the nerves to be cut are also involved in motor system. I don’t want to hurry again and I will cancel the surgery with this Dr Mengele and will try to do it in Taiwan (https://joshuahernia.com/?lang=en).
Thanks again guys!!
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This reply was modified 4 years, 10 months ago by Spanish.
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This reply was modified 4 years, 10 months ago by
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I didn’t have exactly the same procedure as you (I have a laparascopic hernia repair with polyester progrip mesh). But, your symptoms are very similar to what I felt. I was fine about 2 weeks after surgery and had returned to heavy squats and deadlifts. But, then, about 4 weeks after surgery I started having a lot of pain in my abdomen in the area where the mesh was located. I was in quite a lot of pain from then until about 5 months after surgery. During this time exercise made the pain considerably worse. Eventually, around the 5-6 month mark, the pain subsided to the point where it no longer dominated my life. Unless a doctor identifies a nerve problem, I think you will be fine after some time. But, it probably is going to take longer than you want it to. Sorry!
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That seems like too much to do for the problem that you’ve described. Of the few surgeons that remove mesh most just remove the mesh, then wait for the body to adjust before attempting to repair any hernias. I think that you are well past worrying about the type of meshless repair. Get the mesh out with minimal damage, that should be your priority.
Dr. Koch seems to be associating your pain with a nerve problem when it might be just the mesh. Read the recent discussion about nerve removal, linked below. It is not recommended except in cases where there is very high confidence that the nerve cannot be saved. Triple neurectomies are the ones that people have reported terrible aftereffects from.
https://herniatalk.com/forums/topic/nerve-removal-how-is-this-an-acceptable-procedure/
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Hello,
I have some update. I went to a different place (), which is the private clinic of Dr Andreas Koch (http://www.chirurgie-cottbus.com/index.php/startseite.html). They saw left part is ok, but right part has a recurrence although not alarming, so to speak… It’s a meshless Shouldice based procedure. Do you think I should go for it?
In treatment plan they propose a complete mesh explantation, also a
neurolysis of the inguinal Nerves, e.e. ileoinguinalis, ileohypogastricus and
genitofemoralis, lysis of the spermatic cord and restoration of the
inguinal floor with a component separation of the intern oblique
muscle and the transverse muscle without mesh or with a
reinforcement with long term resorbable mesh.Do you think this is ok? Is it necessary the neurolysis and the lysis of the spermatic cord? Does it imply losing of sensitivity and/or sexual impotence
Thanks a lot and Best Regards!!
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This reply was modified 4 years, 10 months ago by Spanish.
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This reply was modified 4 years, 10 months ago by
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Consider Dr. Kang in Korea. Good luck.
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Heloo!
Sorry for not having posted since last time, I wanted to wait a wee longer to see how the whole thing evolved and I’m having increasing pain on the right, especially in the spermatic port which makes me think that definitely there’s a recurrence.
I went to Spain and a surgeon said I might have a protrusion that does not mean that is a hernia, I made a MRI there and conclusion was that there’s no recurrence. this happened in August and so long as I do not trust any surgeon in where I live, i.e. Holland (the experts are students, go figure), and I have a 7 months old son, I really have to find a good place. My wife is from Taiwan and I will spend 2 weeks in Xmas with family, so I will go to this place:
https://joshuahernia.com/?lang=enDoes anybody know about it? Apparently it has a good reputation, is a meshless technique, but I don’t know…
Thanks a lot in advance again and Best Regards
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Hi [USER=”2847″]Spanish[/USER] , hope you are felling better and I wish you found a good doctor to work with you. Let us know if you find a better doctor and what is his approach, wish you my best!
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Thanks Good Intentions and Dr Towfigh… I see, may be to know the status of things the best option is to have an MRI so it can be seen what is done, and how is the situation?
Thanks and Regards
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Laparoscopic mesh placement is not near or against the intestines.
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First, you need to know if it’s a recurrence or a different problem. If it’s a mesh reaction problem then more mesh will not help. You’ll still have the problems from the Lichtenstein procedure mesh, plus, possibly, new problems from the laparoscopic mesh placed on the other side.
The chromic discomfort and pain from mesh commonly comes from the irritation of approximate tissues by the mesh itself. Oftentimes the mesh is still “perfectly” placed, but it is inflamed and edemateous. Not rubbing on things it’s not supposed to. It’s where it should be, no recurrence. No fixation to cause problems. But the discomfort and pain exists. That is the problem that many surgeons can not get past – where is the cause of the pain? “It can’t be the mesh.” Even though the evidence is right in front of them, they can’t see it.
You should try to get more details on the actual material used and the procedure, if you can. I think that some doctors describe any anterior placement via anterior approach a “Lichtenstein” procedure. You might have a plug and patch in actuality.
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quote drtowfigh:[USER=”2847″]Spanish[/USER] you want a surgeon to have had laparoscopic experience for recurrent hernia repair after failed Lichtenstein. However, such a repair should not be that much more difficult than a primary laparoscopic repair.
Thanks a lot Doctor, so you mean that previous open Lichtenstein surgery should not interfere with a new laparoscopic approach as it should be done from the back of peritoneum, right? In fact, in Holland, they told me that they would keep the first mesh that is sewed (supposedly because I’m not so sure) to the front of peritoneum. The new laparoscopic one would be attached to the back, right? If so, I have heard horror movie stories about people complaining about back mesh rubbing against bowels and leading to intestine diseases, chronic pain, irritation, etc, what is the chance to get this? How can this be avoided, may be experience plays a role on this sede effect.
I would be more than grateful if you could enlighten me on it.
Many thanks in advance!
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quote idoncov:I suggest that you speak to Dr Brown from Fremont, CA. 650-703-9694. He’s very approachable. You need to find a doctor who does not consider the mesh repair to be an option. There aren’t many these days.
Thanks a lot, but alas I’m now in central Europe, no chance for me and my hernia to go there for the repair… :-/
Regards
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quote kaspa:You’re right, hernia so common, surgery so difficult.
I think your repair is too early to try anything there.
Perhaps you should read Baris account in the forum. After failed attempts to have his hernias repaired, he eventually went to Shouldice Clinic in Canada and they told him that they only reoperate after 1 year to allow for tissue healing.
I’ll have a look, thanks for the advise!
Regards
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[USER=”2847″]Spanish[/USER] you want a surgeon to have had laparoscopic experience for recurrent hernia repair after failed Lichtenstein. However, such a repair should not be that much more difficult than a primary laparoscopic repair.
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I suggest that you speak to Dr Brown from Fremont, CA. 650-703-9694. He’s very approachable. You need to find a doctor who does not consider the mesh repair to be an option. There aren’t many these days.
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You’re right, hernia so common, surgery so difficult.
I think your repair is too early to try anything there.
Perhaps you should read Baris account in the forum. After failed attempts to have his hernias repaired, he eventually went to Shouldice Clinic in Canada and they told him that they only reoperate after 1 year to allow for tissue healing.
Inguinal hernia repair with absorbable stitches – Hernia Talk
https://www.herniatalk.com
Hi, everyone!I’m supposed to have an inguinal hernia repaired in August or September, and my doctor wants to use a mesh, but I won’t allow it. I’m here because I
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quote drtowfigh:If you do have recurrence from a Lichtenstein, and that’s the only reason for your symptoms, then laparoscopic repair is the best next approach.
I guess so, but do you think a doctor still on training is wise to choose? I heard laparoscopy requires experience and on top, in my case, fixing a recurrence would mean adding difficulty and therefore, would demand extra skills, please correct whether I’m wrong, my main worry is having a second attempt and not getting it properly repaired. I never knew that a hernia is as common surgery as difficult…
Thanks and Regards
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