Bi-Lateral Inguinal Hernia Complications – Advice Sought

[drtowfigh]

Its possible the MRI is not correctly interpreted. Get a second opinion if you’d like.

[Josh V]

Hi Alephy,

Thank you so much for your post. Sorry to hear about your pain!
No, my pain is actually deeper, it’s a constant deep pain which originates from the left side mesh, down to my groin, up my entire left side, and wraps around to my lower back. I do have some sharp pain near the mesh, a little soreness in the upper abdomen. No restriction in movement. I’m beginning to wonder if the mesh has in fact failed.

What I cannot understand, is why, after a CT scan and MRI I’m being told there is nothing wrong, even though I’m clearly in so much pain.

[Alephy]

Hi Josh,

The back pain can be caused by the muscles unbalance as well as a fascia problem (the fascia is always affected in one way or another when having surgery).
I am wondering, is the pain you experience in the groin like a shooting electric current? (forgive my bad analogy)
Is the back pain in the form of spasms? (these can be truly painful, I had this level once and ended up at the ER)

[Josh V]

*Excuse the spelling/grammar. I’m unable to edit them!

[Josh V]

Hi Good intentions,

Thank you kindly for the information, I will certainly look into the mesh.
I apologise if the description of my surgery was not clear enough. I will try to elaborate below for the benefit of future sufferers who may benefit.

In 2012 I had testicular cancer, for which I had an orchiectomy in my right side folowed by 4 months of chemotherapy. Around 2014 I developed an inguinal hernia on my right side. By 2018 I developed a second inguinal hernia on my left side. In 2019 I had a bi-lateral TEP laparoscopic hernia repair for left and right direct inguinal hernias. My surgeon in a follow-up appointment told me that he had used two pieces of mesh on the right side becasue the hernia was so large.

Ever since the operation for the last almost 2 years, I have had pain on both sides, so much so that at it’s worst it would be debilitating. It would be at the location of the hernia mesh, and travel down to my groin, up the sides of my abdominal wall, as around my back. I was referred to another consultant who after examination said that it’s most likely that the mesh had no settled and was crumpled, hence causing the pain. He advised Ultrasound guided steroid injections. The injections if anything made the pain on my left side much, much worse. I suspect that I have less pain on my right most likely because of the nerve damage from the previous orchiectomy. Constant pain, the bruising (in the pictures), severe constipation have made life over the last 6 months unbearable. I am very fit and healthy and have spent most of my life lifting weights, running, hiking, yoga meditation etc. Also as a professinal (wind instrument) musician I gig almost every day. Right now, I’m unable to lift more than 3kg without lasting pain, playing my instrument for anything longer than 30mins leaves me in pain.

I had an MRI last week, I just spoke with my consultant who can’t find anything worng, but suspects that it could be scar tissue. He suggested that a further lapropscopic surgery may be necesary to remove scar tissue and if needed mesh. From the above above replies it certainly seems that I need to research more on the mesh, follow up on surgery notes and look for a specialist in London who may be able to help. For me, mesh removal would be a last resort.

Many Thanks!
Josh.

[Good intentions]

I just realized that I wrote TEPP instead of TEP, copying what you wrote. But, it might be that you actually meant TAPP.

TEP does not let the surgeon come in to contact with the bowels during the procedure. TAPP requires the surgeon to move the bowels aside so that they can get to the area of the repair.

That is an important distinction. TAP is more likely to lead to adhesions, where the bowel becomes attached to the abdominal wall. Adhesions can be very painful. There are mesh products designed specially to avoid adhesions.

So, the exact details of your operation are important. Good luck.

https://www.cochrane.org/CD004703/COLOCA_two-different-laparoscopic-techniques-for-repairing-a-hernia-in-the-groin

[Good intentions]

Parietex is a brand name used by Medtronic for a wide variety of products. I attached a link below.

I asked about the left side because you said “bilateral” repair. Bilateral means both sides. Sometimes a surgeon will explore the other side and do nothing if they find nothing, but sometimes they will go ahead and implant mesh on the other side anyway. Also, it is common to overlap the two pieces of mesh at the midline when they do a bilateral repair. If you only got two pieces of mesh and they were both on the right side, that would mean that the left side was opened and closed without implanting mesh. There would still be healing and scarring afterward though. The TEPP procedure opens both sides equally at the start just due to the nature of the blunt dissection, from the navel entry point.

I had a bilateral TEPP mesh implantation in late 2014. The hernia was not very large, a direct hernia on the right side, and there was no hernia on the left side. But the surgeon implanted two large pieces of mesh and overlapped them at the midline. It’s just “what they do”, recommended in various training videos for TEPP mesh implantation. There is often some small defect that can be rationalized as a potential future hernia. Some surgeons implant mesh prophylactically even though it is not recommended, in general.

If you got the Parietex with the absorbable polylactic acid grips, Progrip, that could be the source of your pain. Others have reported pain after getting Progrip. The polylactic acid breaks down into small molecules which then have to be further broken down until the body can remove the fragments. The process would occur across the full surface of the mesh.

https://www.medtronic.com/covidien/en-us/products/hernia-repair/mesh-products.html

• This reply was modified 2 years, 11 months ago by  Good intentions.

[Josh V]

Thank you so much for all the advice.
I had an MRI last week, and just spoke with my consultant, who said that they could not find anything wrong. I’m a little baffeld how I can be in such debilitating pain and they cannot find anything. He did say that it could be scar tissue which is causing the pain on my left hand side, and that it may be necessary for further laparoscopic surgery to remove the scar tissue.

To answer previous questions, the surgeon used two pieces of mesh on my right side becasue 10 years ago I had an orchiectomy (and chemo) for testicular cancer. Apparently, the hernia was so large that the surgeon overlapped two pieces of mesh. The tye of repair was tension free, using Parietex mesh. I don’t know if tacks were used.

If it is of any help, I’ve uploaded some images to Imgur.

https://imgur.com/a/FoKQVsv

I will search the forum again, and also keep you posted on developments. I will be having an in-person consultation in the coming weeks. If there are any specific questions I should be asking, please do let me know!

Many thanks for all the advice.
Josh.

Hernia Pain

[drtowfigh]

All of these are great suggestions. It is uncommon to have nerve damage with lap TEP, but it can happen. Did you have tacks? Why did you have 2 meshes on one side?

I wonder if the needle from the steroid injection caused bleeding. And thus your symptoms and signs were related to a small bleeding episode.

Imaging and details of your history need to be reviewed carefully.

[Good intentions]

Are you taking pain medications? They can cause constipation.

Have you tired resting completely, avoiding all undue effort, to see how the areas respond? I know that it is difficult if you have been active in the past, when physical activity made you feel good, but it might offer some clues.

It has been documented that mesh alone can cause pain. Doctors and surgeons have difficulty understanding pain if they cannot see a nerve that is being impinged, plus they have been trained that mesh can not cause pain. But, for example, simplistically, if a person gets a bee sting it is painful, even though there is not a specific nerve that can be identified. The inflammation itself causes pain.

You said that you had bilateral repair using TEPP. That would mean that you had mesh placed on both sides. It is very common, TEPP offers the ability to place mesh over very large areas of the abdomen. General thinking today is to place as much mesh as they can create a space for. To avoid future hernias.

Can you get your surgery notes? The type of mesh and how the doctor fixated it might offer more clues. There are many types of mesh used for laparoscopic repair. 3D shaped mesh, flat mesh, self-gripping mesh, biologic mesh, composite meshes that are partially absorbable…many varieties.

Spend some time reading past posts on the website. There is a lot here, people have been posting about mesh pain here for at least the last 6 years. There is a lot of good information already posted. Nothing has changed, except for a few new materials that also cause pain.

[Josh V]

Hi Mitchtom6,

Thanks for the kind reply. Sorry, I will elaborate a little more.

I had TEPP lapropscopic bilateral hernia repair. Due to a previous orchiectomy on my right side (testicular cancer) I had two peices of mesh placed on the right. After the initial recovery I had a lot nerve pain on both sides which would become quite severe at times. The doctor who did the surgery did an MRI and said there was nothing wrong, and was refered to another doctor.

This second doctor did a physical exam and said it was most likely crumpled mesh on the left hand side, and suggested steroid injections.

I had ultrasound guided steroid injections in October, after which the pain were severely worse. Added to this I cannpt open my bowels, pain and a kind of bruising all the way up my left side this goes all around to my lower back. I have a constanst pain on my left at the side of the hernia mesh.

I don’t think at this point I want to go through mesh removal surgery, before finding out excatly what this could be, and why my condition was made so much worse by steroid injections. I have thought it was a Spigelian Hernia, mesh failure, or a ruptured epigastric nerve leading to clotted blood, but it’s been 6 months with no improvement. Perhaps if there are any speciaists in London that anyone could recommend, or if anyone has anything similar.

Many thanks.

[mitchtom6]

Josh,

Very sorry to hear of your situation. When your consultant said the mesh was crumpled, was that confirmed via imaging, or was that just his/her best guess as to what the issue was? i.e, has this been confirmed or is it speculative at this point?

In either case, Coritzone would be my go-to, non-operative suggestion, but it sounds like you have already tried that to no avail.

To clarify, was your mesh put in laparoscopically/robotically? Or, conversely, did you have open surgery? If it comes down to mesh removal, you will want the mesh removed via the same method in which it was placed. Make sure any surgeon you consult is aware of the method used during the implantation. I once had a surgeon want to remove my mesh via open surgery, even though it was placed laparoscopically. My second opinion was shocked to hear this and unequivocally said that was a bad idea.

Also, find a true expert in this procedure. You will most likely need to travel, and may need to pay out-of-pocket, especially if you are going to move internationally.

Hoping that you find some relief. In the meantime, if things get too bad for you, consider asking for some Cymbalta, which is an anti-depressant that can sometimes help with chronic pain. I went on it after my groin injury and it helped me to cope. I was previously opposed to those sort of drugs, but I finally gave in and it did make a difference after a few weeks.

Hoping for your full recovery.