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Chronic Pain Following Ventral Hernia Repair
To make a (very) long story relatively short, I am a 31 yo female and I am 3 months post op from a ventral hernia repair and repair of my oblique muscles (torn/damaged during component separation June 2018). The hernias were repaired this time (I have had 7 operations in total, with 2 recurrences following component sep surgery) with mesh placed in the preperitoneal space. Recovery was fine, and I have not had a recurrence (usually I have recurrence quickly, so this is awesome). I do have this burning, stabbing lingering pain in one tiny small spot on the right side (my problem side historically) just lateral to where my umbilicus used to be. My surgeon tried a lidocaine injection, which provided zero relief. I am currently on gabapentin which provides about 80% relief. The pain is only present when those right side muscles are in use – for example, cough, sneeze, stretch, sit up from a supine position, etc. The pain can be isolated to an area about the size of a quarter. It feels muscular to me, like not very “deep”. Is this type of pain just part of the “deal”? Normal? Is there something I can push harder for treatment-wise? Thanks in advance for any advice 🙂
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7 Replies
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I recommend CT scan, since you have scar and mesh that can cause artifact with typical ultrasonography.
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This may be where your component separation occurred. Usually there isn’t pain associated with that unless the separation was made too deep and so you get a laxity in that region.
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Thank you both for your responses! I am currently in the waiting phase during this pandemic to receive ultrasound guided injections. @drtowfigh – brief anatomy question : in the area of my pain I can feel separation between my rectus muscles and a small soft area near where my oblique was sutured back in place. Is this normal/okay? I can’t feel any hernia due to the 32×34 cm piece of mesh under the muscles. Could this muscle separation be causing any of this pain or is it normal for some separation to occur as healing occurs? 6 months post op here. Thanks in advance – any input is genuinely appreciated!
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Can be suture pain. Local anesthetic needs to be targeted to the actual suture knot area. I use ultrasound guidance to help.
Also, can be ACNES, which is basically a nerve entrapment at that level. Nerve block should help if given exactly at the level of the anterior or posterior cutaneous nerve. Neurectomy can help if blocks don’t provide longterm help.
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@momof4 – I, too, am hopeful it will resolve. Until then, my surgeon has referred me to pain management for some more injections in hopes that fixes it. He thinks it is suture site pain/inflammation because of the location – very near the location he had to fully repair/reattach my oblique muscle that had been cut all the way through. However, to me, it fits all the textbook boxes of a nerve pain. The skin in the area of pain is also totally numb. I don’t know…just very frustrating. Oh well – I will just keep walking this road and being VERY thankful that for the first time in three years, I don’t have a hernia. Truly amazing!
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@lkdivers,
Since you are only three months out, hopefully this pain will resolve. I don’t think any long term pain from hernia repairs should be part of the deal or the new normal. Keep seeking advice and help. I’m hopeful there is a cure! Best wishes -
@drtowfigh – that makes sense, thank you. The side I’m having the pain on is the same side that all 3 layers were either cut through or cut too deep during component separation in June 2018 and the component separation totally failed – everything kind of ripped apart. I had two major recurrences after that before seeing a specialist (my mistake – I didn’t know). My last surgery in October 2019 was to repair that. Just left with pain on that side and it doesn’t feel quite right to me. Hoping that pain management can see something with ultrasound – or I might should ask for a CT?
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