Chronic inguinal hernia pain – UK surgeon(s) or Muschaweck?
12/12/2020 at 5:57 am #28284
Hi there, season’s greeting to you all.
Hoping for some advice from this community as regards surgeons/surgery for chronic hernia pain in the UK.
Relevant medical history as follows:
1998: Indirect inguinal hernia right side, open mesh repair via Lichtenstein
2007: Several small sports hernias right side, anterior laparoscopic repair
1998 surgery definitely solved my issues at the time. Tweaked something in 2005 and suffered chronic pain which resulted in 2007 surgery.
Despite the latter op (which was initially exploratory in nature owing to lack of a 100% diagnosis of what was causing my problems) letting me resume some sporting activity, I don’t feel it ever got to the bottom of the issue and I’ve had had to ‘manage’ my chronic pain ever since. Some days/weeks/years worse than others.
I tweaked something again this summer and for the last 6 months the chronic pain has been worse than ever. Various symptoms but overall a sense of weakness and pain within my right inguinal canal – focused on the superficial ring.
I don’t believe I’ve had/am having mesh reaction like some of the poor souls on here and (thankfully) any nerve-related pain seems minimal.
This definitely feels to me like either some kind of mesh folding or entrapment with some kind of internal structure (e.g. spermatic chord), a partial recurrence of the hernia (though nothing protruding so not obvious if so) or some major scar tissue build up/inflammation.
The pain is mostly of the aching, tearing variety, dep throbbing very occasional burning but no pins and needles. Massively exacerbated if I do anything strenuous. All pretty much localised to around superficial inguinal ring right side. Needless to say, sticking a tentative finger up into the canal makes me hit the roof(!)
It is now affecting my life pretty much 24/7 and needs sorting immediately. However I don’t necessarily want to have the mesh removed or any neurectomies performed if I can help it. I’m scared of making a bad situation even worse.
I am a 41 year old male who otherwise fit and healthy – although increasingly limited in the type of exercise (only light running now) I can perform which depresses me lots. I am determined to sort this as best as I can once and for all while my body is still (hopefully) young and healthy enough to deal with the trauma.
I have good private healthcare and am booked in to see my 2007 surgeon in January 2021 for an initial consultation. However I wonder if this is the right course of action; he’s certainly a capable surgeon but he’s more of a weight-loss specialist than a dedicated hernia expert.
I have also identified a number of surgeons from the Gilmore Groin Clinic Team in London (specifically Mr Emin Carapeti) and the British Hernia Centre who are also covered under my healthcare. They seem to have a detailed understanding of hernias and even specialism in techniques like shouldice repai; however I can’t find any feedback about their work on relevant forums etc.
Finally, I have read/listened to a lot of material from the well-known Ulrika Muschaweck – I would have to pay privately to be seen/operated on by Dr Muschaweck (thanks Brexit!) but this is something I would definitely do if it was the best course of action. She does seem to be ‘world class’ in terms of her subject expertise and her claimed successes are impressive in statistical terms.
Travelling to the US would be a stretch too far for my finances.
My question – and sorry for taking my time getting there – is this:
What would this group do? Do anybody have a similar story to myself; if so how did you (hopefully) fix it? Has anybody been operated on by either Mr Carapeti or Frau Muschaweck and would they recommend? Are there any other UK surgeons with extreme specialism in this area you would recommend?
I feel like this is ‘it’ (third time lucky?) and am desperate to make the right decision; I would certainly appreciate any feedback or advice this forum may have.
Happy Christmas to you all.
12/12/2020 at 12:50 pm #28286Good intentionsParticipant
I would start with a consultation with Dr. Muschaweck if you can arrange it. Even if you choose a different option for surgery, the knowledge that you’ll gain about your condition will probably be very helpful. I went through a similar thought process as you, collecting information and considering options around the world. I had considered Dr. Muschaweck for both my original hernia repair and for mesh removal.
One realization I came to and still believe is that most of the surgeons and doctors involved in hernia repair are thinking in terms of the “average” person. A person who just needs to drive to work, do, at most, some light labor, some light gym work maybe, a jog or two during the week. They don’t comprehend that an average person can put as much strain on the repair area as a professional athlete, if they are physically active. You can tell them that you are an athlete but all they will know is the “standard of care” for the average person.
So, if you are planning rigorous physical activity go to a surgeon who repairs athletes. If you want to continue with light jogs and desk work, go to one of the big hernia repair centers that serves the average person.
Do you know what was done for the “sports hernia” work in 2007? There was a time not long ago when surgeons thought that mesh was a good repair tool for that condition also. And, the thinking on athletic pubalgia has changed quite a bit over the years. They might have tied some things together that are now causing tension.
You should consider also, Dr. Meyers at the Vincera Institute. He is known for fixing athletes and is aware of mesh problems and athletic pubalgia. He is kind of like the Muschaweck of the United States. I pasted the link below.
Good luck. 41 is young, take your time to make the right decision.
12/13/2020 at 6:24 am #28288
There is a guy on here from the UK as well that was diagnosed with just a small inguinal hernia and went to Dr. Muschaweck to ”get ahead of it” before it gets worse. He’s been communicating with me and has said that before that surgery it wasn’t even hurting him he was simply concerned about it growing and getting worse but he said he was otherwise at the peak of his form/fitness.
He says that ever since he got her surgery he lost complete function in his internal oblique/that side of his core and has been in chronic pain and dysfunction since. She performs a neurectomy during her procedure even if you have zero nerve pain as her standard procedure (which can be viewed in her presentation about it on Youtube) and obviously downplays the effects of it claiming the famous ”they’re just sensory nerves” most of these doctors do. When he went back to her to discuss about how completely dysfunctional he is as a result of her surgery – she said ”If I told patients of all the possible side-effects of my procedure nobody would get the surgery” – which to me is absolutely insane and criminal.
I would proceed with caution here. Her name is established and she will drown you out with ”I’ve never had this happen before I’ve done 100000 of these” crap if it ends up like that guy. He’s around on the facebook group ”sports hernia awareness & support” if you would like to talk to him about his experience.
If you google research people like Dr. Meyers (who has his share of bad reviews as well) – he does nearly all the NBA/NHL/MLB players with these groin injuries and he categorically refuses to cut nerves out, even if a previous mesh is scarred onto it he would rather leave a bit of mesh in/around than cut/damage the nerve. I think that says a lot in itself.
If you’re in the UK I would highly consider Dr. Lloyd and Dr. Simon Marsh. I’m a pro dancer who has had his groin destroyed by Dr. Brown in the States and I’m very highly considering going to consult with both of them. I don’t believe I’ve come across a single bad review or horror story from them – they seem like solid people who would try to help you out and that understand that the goal is to restore function – not drown out pain.
All the best.
12/13/2020 at 11:44 am #28289
Guys, thanks so much for the detailed and thoughtful replies. It can get pretty gruelling living with this stuff – every day is a slog at the moment which utterly sucks when you have a family who is excited for the holidays, relies on you being fit and well and doesn’t realise understand why Daddy is so darn pissed off all of the tim. I am sure many of you are in the same boat.
To make things worse I also have a large varicocele on my left testicle (apparently a result of the original inguinal hernia?) which, while bothering me for years, has decided to take it up a notch since this latest episode kicked off(!) (Having it looked at by urologist in the coming weeks with a view to having it removed.) I will get this sorted before the hernia issue as I’m interested to see if it has any impact on things (doubt it but you never know).
Good intentions I believe I had several (3?) small sutures for the sports hernia, not mesh (thank goodness). I am getting twinges from the sites of these sutures as part of my latest ‘episode’ but I feel like this is more like referred pain than the source if you get my drift? Sadly as I mentioned I can’t justify the cost and time to travel to the US.
Peter C that’s v interesting about Muschaweck and nerves – like I said I really wouldn’t want them snipped unless it was unavoidable. Sounds like she does it as standard which is setting alarm bells ringing. I will join that group you mentioned and have a look.
I did stumble on Dr Marsh before – he was one of the the people on my list. He is also Bupa covered which saves me £10k vs Muschaweck. It’s good that you rate him; will do some more digging there too.
I also wanted to throw another name out there – Andrew De Beaux based in Edinburgh. Has v. good pedigree from what I can see, and pragmatic also. Anybody on here have anything to do with him?
Thanks again for all the input both of you; it really is much appreciated. Peter I am sorry you are so poorly and hope your consultation with Lloyd/Marsh goes well – please keep us in the loop.
12/13/2020 at 2:47 pm #28290Good intentionsParticipant
Peter C makes a good point about Dr. Muschaweck’s thought’s on neurectomy. He jogged my memory about her reply to my query about mesh removal. Actually, her reply is why I decided she would not be a good option for my problem, I pasted it below. I could tell just by the way the mesh felt inside me that my problem was not due to a specific neve or set of nerves. And that is what Dr. Billing found when he removed the mesh. All of the mesh was surrounded by edematous tissue. In other words everything it contacted was irritated, not just a nerve.
But, she still seems to know how to repair hernias. That is another thing I’ve learned. Doctors can have great expertise in one specific area but just be average in others, thinking along with the crowd. With the mesh companies controlling the discussions, the meetings and topics presented, they control the overall situation, hindering open sharing of information so that people can learn. So, a person has to be very focused on what, exactly, their problem is and choose an expert in that specific area. Your problem still seems a bit undefined. So, a consultation, for information, with her might still be useful.
Here is what she said in response to my question about mesh removal.
“Unfortunately, these mesh complications are very common and sometimes really difficult to treat. We see a lot of patients with these problems, you are describing.
The pain cause always is a nerve irritation because of the mesh, which can be dislocated and can cause a stretching of the nerve. This can be solved with open surgery and neurolysis and possible neurectomy.”
Before surgery, a dynamic ultrasound should be done to see the mesh and a possible dislocation, which we perform by ourselves.
Would it be possible for you to come to Munich?”
- This reply was modified 1 year, 9 months ago by Good intentions.
12/13/2020 at 5:31 pm #28293
@good-intentions When I consulted with Dr. Zoland a few weeks back he was very candid about the subject and basically told me that some of these surgeons are very eager to cut nerves but that even a nerve block is not the most accurate diagnostic tool and is so vague that it can be completely useless because at the end of the day – any pain you feel is transmitted through a nerve.
That doesn’t mean nerve injury and definitely doesn’t mean the nerve needs to be removed. Injecting the nerve blocks the receptors and pain input you would feel on the entire path of the nerve from the point of injection down – but how does that help you find out where exactly there is an injury or tissue that is aggravating said nerve? It doesn’t. So even if they do a nerve block and you get relief – that just means that the issue is somewhere along the path of the nerve. You’re not really closer to a resolution.
And he said a lot of these surgeons that allow themselves to perform these neurectomies so candidly do not care about the long-term well-being of their patients – don’t have that in mind. They choose to think ”there is pain, whats the fastest way to get rid of it” without acknowledging the consequences down the line for the person’s health and overall function.
Which to me is the most open/candid/honest thing any of these doctors has said so far. This whole focus on nerves can be real but its also the lazy man’s response to everything because they don’t want to go through the trouble of investigating it and quite frankly they don’t always understand the dynamic of the different forces the muscles in the groin produce. Its like your car engine starts smoking and you just take out the part that caught fire and tell the person to keep driving. Assuming the car even starts – how long do you think it can go without a critical part of the whole ensemble without having further failures and completely shutting down. You see these horror stories of people who went in with an injury and they come out of surgery with bilateral triple neurectomy and I could almost throw up about how disgusted I am at the thought of it. Its lazy mutilation camouflaged behind the ”medicine” umbrella – nothing less.
@rob-t-uk No problem mate. I’m currently in Canada so its a long shot for me to travel across the ocean to come consult but I’m seriously considering as I see no other options here in the states aside from Dr. Meyers. I heard good things about both Dr. Lloyd and Dr. Marsh – I would even consider consulting both if I were you.
- This reply was modified 1 year, 9 months ago by PeterC.
12/14/2020 at 5:51 am #28295
Actually to carry on from my previous response and the car example – its like your car engine caught fire and they take away the indicator that lets you know theres a fire/smoke in the engine and they tell you go back to driving it. which is even worse.
12/14/2020 at 1:23 pm #28298
Thanks again both. Dr Muschaweck’s secretary got in touch today and asked if I was able to attend a consultation in London early Jan with a view to an op soon after but things seem to be moving a bit fast to me on that front. Peter I did also see the guy you were on about on that FB group; his story was pretty scary and I definitely take your point about the non-essential neurectomy which – like I said – scares the shit out of me. That said, obviously Muschaweck does also have her (thousands) of supporters. Instead, I think I’m going to do the following:
– Get the varicocele sorted in the first instance, and see what impact – if any – that has on things. If nothing else, getting rid of the chronic 3/10 pain that’s dogged me in recent weeks (and finally getting rid of the horrendous dragging that’s dogged me for decades) will be some relief. It also gives my inguinal pain a bit more time to hopefully subside (not that I think it will; this definitely needs surgery IMO).
– Get in touch with Marsh and Lloyd and enquire about consultations/ultrasounds. Get said dynamic ultrasound done – hopefully it’ll be pretty conclusive; if not I’ll continue dialogue and go for further consultations.
– Decide on final course of action after all that.
Funnily enough, the right sided inguinal pain has been better the past few days than for weeks/months. I think it’s because I’ve temporarily given up on wearing underwear and just gone with tracksuit bottoms. Seems to make a world of difference in terms of alleviating pressure on the right inguinal area and, therefore, the pain emanating from it.
Interesting, if not particularly helpful. Does that ring bells with anyone?!
Thanks again for all the help guys.
12/14/2020 at 3:01 pm #28301
@rob-t-uk I think thats exactly how I would handle it if I were in your shoes. Very sound thinking. Its a red flag when a surgeon wants to schedule you for surgery the next day without having even had a look at a single scan or yourself in person.
Marsh & LLoyd consults sound like a great idea for now. Hopefully they give you some answers.
Always happy to help – good luck with everything!
12/27/2020 at 12:36 pm #28344
Hi everyone, hope you had nice Christmases. Small update from my side.
Went to see a urologist last week about my left side epididymitis and potential varicocele embolization, but obviously mentioned my right inguinal canal issues while I was there.
He does a quick check for obvious hernias, and to my massive shock finds a small *left* sided direct hernia just to the left of my pubic symphysis.
I never even had an idea. When it rains it pours!
When I got home it took me a while to even find the hernia again. Since then I’ve touched it a few times but today I gave it a small push and I think it slid in (and not sure it’s come out again to my knowledge) Since then I swear the chronic pain in my right inguinal canal which has been particularly horrid for the last 6 months diminished significantly. It seems a bit like a dream tbh.
I have an ultrasound next week so I’ll hopefully find out for sure what’s going on in the right inguinal canal, as well as have this new left-sided issue confirmed. I assume following that I’ll go under the knife at some point.
I suppose my question to the group is this – have any of you with a hernia on one side of, say, the inguinal canal, experienced pain on the other side – particularly in scar tissue from a previous repair?
For any surgeons who might be reading, does that even sound feasible?
If people are okay, I might share my ultrasounds when I get them done next week.
Thanks everyone 🙂 Rob
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