-
Can a cord lipoma cause a visible bulge, and grow back?
As I mentioned before, I thought I had a recurrent hernia recently (after mesh removal) but my surgeon diagnosed a cord lipoma instead. But I do have a visible lump that seems to get somewhat larger after greater physical activity. The lump though has been present since immediately after the removal a year and a half ago. Also, I supposedly had a cord lipoma removed at the time of my original mesh surgery 4 1/2 years ago. I had thought it would be unlikely for a lipoma to grow back if properly removed. And I also thought that cord lipomas were not typically physically visible and resembling a hernia bulge.
My surgeon said he could remove if it’s bothering me, and I do have regular soreness still in that area. But I just can’t be sure if the soreness is coming from the lipoma or not and if the bulge is in fact related to the lipoma. If not, it would be pointless to undergo surgery regardless of how minor. I do also have some slight testicular discomfort and wondering if that too could be related to the lipoma, or the removal surgery. He didn’t seem real clear on any of that.
-
13 Replies
-
One interesting thing is that Dr. Chen at UCLA tightens the internal ring with stitches when it’s loose. He does this as part of his Lichtenstein procedure, so the mesh is in addition to this Marcy-like step. A natural question is whether the mesh is really needed if all the patient had was an indirect hernia. Maybe tightening the ring is enough?
I don’t know the answer, and the strange thing is that such a simple approach isn’t really practiced or studied (other than by Kang and one Japanese study), so surgeons are quite possibly performing much more radical procedures than needed.
I actually asked a couple of top hernia surgeons about this. One didn’t have an opinion, and the other said it might work ok, his hunch is that it would work better in young people, and more research is needed. Seemed pretty shocking to me that this is the state of knowledge after so many decades of hernia repair.
-
it’s a great question. i don’t understand myself.
-
If such a lipoma can be treated with a simple tissue repair (sounds like a Marcy) instead of an extensive Shouldice, why wouldn’t the same apply to a small or medium size indirect hernia as well? I find it all very confusing.
-
Met with Dr. B., and I think he now appreciates how much this is bothering me and that I am serious about another surgery, so he’s ordered a CT scan to get a better look. But he suspects the bulge is retroperitoneal fat making itself known, and that he could go in and get rid of the fatty tissue and stitch up the space and strengthen it a bit. Probably won’t solve all of my issues, but would reduce the bulge and the squishy feeling I’ve had lately, and could potentially help with some other things, while the chance of anything getting worse would be low. I always suspected I might need something done to strengthen that area after removal.
He said (and this is still where I and I assume others have a lot of confusion) it wouldn’t be like a full hernia repair, even though he would call it that on the report. He wouldn’t need to fully open the inguinal canal and do a big shouldice-type repair with all the stichtes and layers of tissue etc. etc. It sounded like maybe he’d just be dealing with the fat and then closing the opening to the internal inguinal ring, or something like that, with a small number of stitches? Perhaps that’s similar to one of the simpler types of repairs (Basssini, Marcy?). But we will see what the scan shows and go from there. I will ask him more questions next time.
I think I likely have some chronic discomfort that will potentially always be with me to some degree, but I would like it to get to where it’s mostly discomfort and not pain and soreness. I am wondering if some of the testicular tenderness/sensitivity is related to pressure from this fat/lipoma along with some of the other soreness. If the surgery is less involved than a big hernia operation, with low risk, it would seem worth it to me to give it a shot. And then I could also feel a little better about the strength of the area.
-
This is a very interesting case and I am sorry if you are experiencing discomfort. it would be interesting to hear Dr Towfigh respond to these additional comments and I hope she well. Thank you for posting.
-
Thanks, Dr. Twofigh. That’s interesting. As I said, it’s a bulge that’s been there since the removal. But seems to get larger with more intense activity and lots of standing. But Dr. Belyanksy didn’t detect a full hernia.
I still wonder if it’s unusual for a lipoma to grow back as I had one removed on that side when the mesh was initially placed in 2018 before the removal in ’21. And I wonder if the removal has made it easier for the fat in that space to push against weakened tissue and cause the bulge in the first place, if that’s what’s doing it. If so, I wonder if his suggestion to remove the lipoma if it’s bothering me and just use a couple of stitches to reinforce the area would finally shrink that spot down and strengthen that area better. I am also having continued soreness and testicular discomfort. Could be coming from the pressure from the lipoma I supposed.
Talking to him Tuesday and will get his thoughts.
Thanks again
-
Cord lipoma refers to fatty tissue adjacent to a spermatic cord in males. This is often the cause of the bulging seen with hernias. The fat comes from the insides (retroperitoneally) and is really the herniation of preperitoneal fat. It is rarely just a lipoma unattached to anything, like one sees on an arm, leg, or back. The name is really a misnomer. In rare occasions the lipoma is a real lipoma or liposarcoma (malignant tumor) and not a hernia.
-
Maybe ask again for imaging re Jacks link.
-
I’d never heard of cord lipoma before.
It would be interesting to hear @drtowfigh’s thoughts on this.
This study states:
‘ A spermatic cord lipoma is found in 20–70% of all inguinal hernia repairs.
Spermatic cord lipoma seems to originate from preperitoneal fatty tissue within the internal spermatic fascia in topographical proximity to the arteries, veins, lymphatics, nerves, and deferent duct within the spermatic cord. Reliable diagnosis cannot be made clinically, but rather with ultrasound, CT, or MRI.’
-
Perhaps. I’d still like to understand what this bulge truly is, though. It would seem a simple matter to be able to understand why there’s a bulge in that spot and what it is. But like everything hernia related, there are no simple and straightforward answers for something that’s supposed to be straightforward and simple.
The bulge itself seems unlikely to be caused by the lipoma. So perhaps it’s a result of damage to the area from removal, and fluid or blood or something is filling that spot and increasing the size upon heavy exertion. That spot was always a bit puffy after removal. Perhaps it’s an open space resulting from the surgery that’s prone to issues. After a year and a half though you would generally think the area would settle down. I know we all say here a lot that healing takes a long time. But tissue really should stabilize after less than a year. Maybe far less. But you would also think imaging would be in order to see what’s going on there. But my surgeon doesn’t seem to think it’s needed.
Dr. Belyansky and his staff have said don’t do surgery unless it’s a bother. But it’s definitely a bother. Unfortunately what I don’t know is if the discomfort is coming from the lipoma or the bulge or something completely unrelated. I just hate the idea of suffering needlessly if there’s an easy fix. Surgery to deal with the lipoma, as I mentioned before, is minor according to him. He said it would not be a true hernia repair where the whole inguinal canal is operated on and opened up. It would just be excising the lipoma and then a couple of permanent stitches. Might be worth doing it just to see if it helped, given the likelihood that a worsening of my condition would be unlikely with a minor open surgery, and maybe he’d see anything else going on in there out of the ordinary. But I still appreciate that any surgery has risk.
It seems to get biggest after these 4 mile runs I’ve been doing. Not as bad when I run less or rest. The other discomfort is there off and on regardless of activity – doesn’t seem to be a clear connection. Soemtimes heavy activity hurts, sometimes it helps. But you may be right that I am just going a tad too hard. But the bulge is still there and I’d just love to know what the heck it is.
-
It seems too early to consider more surgery. Is it possible that you’re trying to exercise your body back to its old self and overworking the surgery area? I have found that the occasional extended rest time helps when aches and pains in the surgery area start to build up. It’s getting close to five years since mesh removal for me and I can still feel adjustments down there as time and activities go on.
-
Apparently quite common after hernia surgery and should be treated like a hernia according to this
https://pubmed.ncbi.nlm.nih.gov/15105999
Not sure why but thats what it says
Log in to reply.