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2 hernia surgeries and now chronic problems
A doctor did a bassini repair and triple neuroectomy on me in July 2014 to try and address symptoms of a sports hernia. Things healed up ok.
Then, in March 2016 the bassini repair stitches tore. Ultrasound confirmed a hernia. In May 2016, a coviden progrip self-fixating mesh was placed in me using TEP. The doctor said the hernia from the torn stiches was the size of a quarter.
Since having the mesh put in I have continuous discomfort and pain from the hip bone to the lower groin. I am extremely limited in my physical activities. The area is very tight and has a prominent scar tissue ridge a couple inches long.
The only thing that makes it feel better is a couple months of rest, however after a rest period if I even do very light exercise the symptoms return again along with swelling of the area. I don’t know if a muscle or the conjoint tendon is straining or its due to the scar tissue. Any input would be greatly appreciated. -
11 Replies
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quote inguinalpete:a coviden progrip self-fixating mesh was placed in me using TEP. …Since having the mesh put in I have continuous discomfort and pain from the hip bone to the lower groin. I am extremely limited in my physical activities. The area is very tight and has a prominent scar tissue ridge a couple inches long.
The only thing that makes it feel better is a couple months of rest, however after a rest period if I even do very light exercise the symptoms return again along with swelling of the area. I don’t know if a muscle or the conjoint tendon is straining or its due to the scar tissue. Any input would be greatly appreciated.I reread your first post and realized that I had been distracted by the other details. It’s very reasonable to assign the tightness to the mesh. All parties that deal with mesh will agree that the mesh shrinks as tissue ingrowth occurs. The ridge, as I mentioned, could be inflammation of tissue in that area. Not like a “scar ridge” from open surgery, just swelling from internal irritation. I still get swelling in the spot where, I believe, that the last patch of mesh could not be removed because it’s all tied up with critical parts. It’s in the area of my original direct hernia. It’s very firm and feels like a tendon, but I really don’t know what it is. But it is real, and visible from the outside. I have realized also, that the wall of the abdomen, the muscles and the fascia, that separate the intestines from the outside world, is actually quite thin. So any swelling will be noticeable. The mesh is not as deeply buried as you would imagine.
The cycling of pain with rest and activity is also similar to what I experienced. Really, stepping back and just considering the mesh and your symptoms, without the Bassini repair and the torn stitches, your problem looks like a typical mesh reaction.
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quote inguinalpete:Physical exam and ultrasound – no hernia. They want to do a CT scan to see if the mesh is folded/balled. You say a 3D MRI may be of use?
The 3T MRI is basically a higher resolution MRI than the standard 1.5 T, the T stands for Tesla which is the measurement for the strength of the magnetic field generated by the MRI machine itself. The contrast injection may or may not matter, I think contrast usage depends on the tissue and structures being evaluated, but often MRI is done both with and without contrast to fully image various structures.
A CT scan may be valuable too, hopefully a doctor on these forums can chime in with their opinion on that or the most appropriate imaging study for your case.
And as [USER=”1176″]Momof4[/USER] points out, getting proper interpretation of imaging is critical. A lot of radiology interpretation is outsourced nowadays which means that often nobody who sees you personally is going to look at the images, they just write up a report and send it out as the diagnosis. Further adding to the frustration of imaging studies, is that some radiologists don’t alway note hernias, sports injuries, athletic pubalgia, or mesh, or even know how to look for those, unless something is extremely obvious. And of course it’s possible that something wouldn’t show up on imaging anyway.
Regardless, after you get your imaging done, make sure you get a copy of it on a disc so that if you need/want to, you can send it to various experts for direct interpretation. Nearly all of the doctors in the list above will review images directly.
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I have had several imaging tests that were read as false negatives. As important, if not more so, as it is to get the proper imaging, it is critical to have that imaging interpreted by a hernia specialist. I don’t think many radiologists are trained to evaluate mesh or look for occult hernias. The best MRI that I had, that actually showed recurrent hernias that were recognized by the radiologist, was done using the protocol provided from Dr. Towfigh. Of course, she actually knows what to look for, Imagine that!!! I hope you can have the right test that will give you some answers. Keep looking!
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Physical exam and ultrasound – no hernia. They want to do a CT scan to see if the mesh is folded/balled. You say a 3D MRI may be of use?
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Have you had any imaging done yet that could help diagnose?
Some potentially revealing imaging studies that are frequently discussed on these forums:
– ultrasound with valsava at location of pain
– 3T MRI (with or without contrast, contrast shows different tissues I think)
Keep us updated on your case and progress.
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The stitches seemed to tear out gradually over a few weeks. At the end point the pain level was very high and I could barely walk up stairs. I need to get diagnostics done to determine my current issues are from the mesh or the damaged inguinal floor. After that I will choose a course of action.
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[USER=”2514″]inguinalpete[/USER] I’m sorry you’re going through this. Just out of curiosity, did you feel a sensation of tearing when the original repair failed, and that started the onset of your current pain and discomfort? Or did the current pain and discomfort start after the second surgery only? This could help to provide a clue as to what is causing discomfort.
Unfortunately you may need to travel to a regional expert with sufficient experience managing recurrences and re-do surgeries, as it’s a separate field of expertise. If you don’t mind sharing your general location perhaps a few surgeon names could be passed your way.
As a starting point, here are a handful of surgeons spread around the country who are typically considered well experienced in re-do surgeries:
– Dr Shirin Towfigh in Los Angeles CA (she runs these forums)
– Dr David Chen at UCLA, CA
– Dr Robert Martindale in Portland, OR
– Dr David Grischkan in Cleveland, Ohio
– Dr Bruce Ramshaw in Knoxville, TN
– Dr Igor Belyansky in Annapolis MD
– Dr Jonathan Yunis in Sarasota, FL
– Dr Brian Jacobs in NYC, NY
– Shouldice Clinic in Toronto CA (I believe they only do open surgery)
There are certainly others as well, and perhaps some closer to you.
I don’t know enough about the wildly complex anatomy to comment much on the Bassini repair in general, but I’d figure under proper hands it should have a low recurrence rate and reasonable success as that was the standard procedure until fairly recently, but like most tissue repairs it is becoming increasingly rare to find surgeons who have the routine experience in the USA. I think the Shouldice repair is basically the Bassini repair but with another layer of suturing as a reinforcement mechanism.
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A bassini repair and triple neurectomy for what he diagnosed as a sports hernia. The surgical report states that all he found in the inguinal canal was that the inguinal floor muscle fibers were somewhat spread apart. He basically destroyed my inguinal canal for a minor issue. The stitches later tore out leaving a quarter sized opening. A mesh was placed to try and fix the issue. I agree with Drtowfih’s idea that the inguinal floor is not supported by the mesh, not to mention the bassini method stitches together tissues in an un-natural arrangement.
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After initial laparoscopic inguinal Hernia surgery, there should be no ridge. If you feel a bump, there may be a lipoma in the canal.
After ipen repair, a “healing ridge” does occur. It can last months but goes away usually. It represents the scar tissue and multiple levels of suturing that goes on.
[USER=”2514″]inguinalpete[/USER] Bassini repair is not performed for sports hernias. You probably had a typical hernia. Also, triple neurectomy is not commonly performed for sports hernias, as the genitofemoral Branch is never involved in such problems. Anyway, the Bassini involves completely opening the inguinal floor and resewing it. If it fell apart, it’s possible the entire inguinal floor is disrupted. So, perhaps patching laparoscopically is not adequate. The floor needs to be reinforced as a scaffold to support the patch. It’s a thought.
A valsalva imaging can perhaps help with this evaluation. And then perhaps an open tissue repair to help support the mesh patch.
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Was your original surgery for an inguinal hernia, or a sports hernia? Did the symptoms go away after that surgery, but reappear with the recurrence? Do you mind sharing who performed that original bassini procedure?
I have read Dr Towfigh discuss on these forums using Bottox injections for tight repairs, I wonder if that could be helpful in your scenario?
Where are you located? Perhaps a regional expert could be recommended that may be helpful to you and your case.
Best of luck and keep us updated on how you’re doing.
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I also have a similar “ridge” that seems to follow a muscle feature. I don’t know my anatomy well enough to know exactly what it is. It’s in the same area as the original direct hernia lump. I had TEP placement of Bard Soft Mesh, both sides, but the side with the hernia is the only side that got the ridge. Initially, it only appeared after exercise, then reduced with rest, like a void that was filling then deflating. But eventually, over months and years, it became permanent. It was not a recurrent hernia, just a spot that swelled.
With TEP they often like to place as big of a piece of mesh as they can fit in there. To allow for shrinkage and movement. Do you know how big yours was? Do you have your medical records?
Your story seems to imply that the “sports hernia” repair caused your inguinal hernia. Since you’re out of the ordinary now you should probably find a surgeon who is an expert in both of your problems. Many surgeons are very well-trained in specific procedures and will try them on you but may not get he fine details right to achieve the best outcome for you. You don’t want to get in to the “more mesh will fix it” cycle.
Dr. William Meyers of the Vincera Institute is an expert on athletic pubalgia, aka “sports hernias”, and would be a good place to start if you can get there. He’s in Philadelphia.
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