Chronic pain

Hernia Discussion Forums Hernia Discussion Chronic pain

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    • #33384
      Chuck
      Participant

      One of the reasons i chose lap mesh surgery is because dr towfigh and dr voeller cited numerous studies showing that lap mesh resulted in the lowest rates of chronic pain. Sadly this was incredibly deceptive because it seems true without all the cutting. I saw some studies showing shouldice had 26 percent long term chronic pain risk…and several local surgeons told me they had seen patients with chronic pain issues from that clinic. In addition…i found several blogs of shouldice patients claiming pain three years later…also talked with several folks online who said they felt their shouldice every time they lifted their kids…now our friend watchful cites studies showing mesh has higher chronic pain…all i know is there doesnt seem to be any type of hernia surgery that doesnt carry a siginificant risk of chronic pain…havent heard any kang patients complain of it so i am just going to go with that. Dr tomas also contends there is little chronic pain with desarda…but Dr towfigh writes off the dessarda repairs as not well established…in all honestly folks wtf are we supposed to do…there are no good options…

    • #33386
      Watchful
      Participant

      There are no safe options – chronic pain is a risk with all approaches, and there are other risks as well. You basically have to pick your poison and take your chances if you really need to have surgery done. There are a lot of nerves, and a lot of sensitive tissues and structures in the groin area.

      If your case is a good fit for tissue repair, then I think that’s a better bet overall than mesh. Not all cases are a good fit, though, and it’s not necessarily easy to tell in advance.

      I don’t know how one should pick among Shouldice, Desarda, and Kang. I think the choice would really depend on the details of your case and anatomy, but there isn’t a way for a patient to get an answer for this. Among these techniques, I think Shouldice is a good fit for the largest variety of cases, but it’s likely “overkill” in some cases.

      I don’t think chronic pain is as widespread with Shouldice as you think, at least not severe chronic pain. That wouldn’t be consistent with what I observed while I was at the Shouldice Hospital. Some people were doing the “Shouldice shuffle”, but they were not in severe pain which would require sitting down or lying in bed. Many were walking, exercising, etc. like nothing happened. I wouldn’t have been able to tell that my roommate had surgery. It seemed to have no impact on him whatsoever, and he was in his late 60s. No one left on a wheelchair or with crutches. I don’t think these people that didn’t have severe pain after surgery will develop severe chronic pain. Unlike the case with mesh where the chronic pain issues may hit you later on, I think with tissue repair this starts shortly after surgery. If nothing really bad shows up in the first couple of days after surgery, you’re likely to be fine, although it’s not certain, of course.

      Chronic pain, including debilitating chronic pain, definitely happens with this procedure, but it’s not some common thing like you mentioned (not 26%), at least not at the Shouldice Hospital. It’s still a serious problem, though. Even if it’s just very few percent, it’s still too much.

      What’s the alternative, though? Mesh (including lap TEP) has chronic pain issues as well. Desarda and Kang are also open repairs, so the increased potential for nerve and tissue injury is still there. There’s less dissection and stitching with Kang than Shouldice, and the incision is smaller (at least if you have only direct or indirect rather than both). However, I don’t know the impact of the extra tension on pain. The benefit you get with Shouldice for all that extra dissection and stitching is that the load and tension are distributed over four layers. Does this mean more pain, or less pain, more recurrence, or less recurrence – who knows really. It is the most studied tissue repair technique, and it has the longest track record, and that should maybe count for something as well.

      I think Desarda is actually the most innovative and interesting tissue repair technique of recent times. However, I really don’t know how to assess it.

    • #33426
      William Bryant
      Participant

      Hello Watchful, has the pain subsided now? Or starting to?

      I’ve just read rave praise for Desarda technique repair.

    • #33448
      Watchful
      Participant

      Hello William,

      I get occasional pains which are certainly unpleasant and disturbing, but not excruciating. They tend to be triggered by certain activities and positions. For example, when crouching or sitting cross legged a lot, or slouching on a chair. I would call these pains moderate – not minor, but not severe either. They tend to go away on their own, or after stopping the activity, changing positions, or resting. I also have abnormal skin sensations in the area – numbness and paresthesia. I still have the hard healing ridge in the incision area, and it’s sensitive and painful when pressed. The healing ridge has decreased in size over time, but it’s a slow process.

    • #33449
      William Bryant
      Participant

      It sounds as though it’s going right way Watchful. I think I’ve read it takes a few weeks to months to settle down maybe a year even.
      But it’s improving and that’s good

    • #33489
      Jtk2
      Participant

      I had a right inguinal indirect tissue repair done by Yunis. Did a local and was woken up in the middle of surgery because I was moving. Pain while being stitched up was off the chart. Today, 4 months later, I am the proud owner of chronic pain. As a topper, some days it feels like the hernia is coming back. Yunis and his front office person Abigail were difficult to deal with, but I suffered through it, believing he was the best. If I need to redo, I would consider laparoscopic mesh, but definitely not with Yunis.

      • This reply was modified 1 week, 3 days ago by Jtk2.
      • #33493
        sensei_305
        Participant

        I am 3 weeks out from left inguinal mesh removal. Will have right side done in March. I feel much better on the inguinal are were mesh was. What is annoying is testicle pain. Its sensitive to touch and hurts pretty bad. In my case 95% of the mesh was taken out leaving a small piece floating because its close to Spermatic cord. To be fair, I have had testicle pain way before I had mesh surgery to fix the hernia so who knows..

    • #33491
      Watchful
      Participant

      Jtk2,

      Really sorry to hear that. Did you ask him where he was stitching when you felt this bad pain during surgery? Did he check if there was a nerve close to where he was stitching? It may give a clue about what might have happened, particularly if a nerve in that area is consistent with the chronic pain you’re experiencing. The pain may also be unrelated to that incident, of course.

      I was also thinking about what I would do in case of recurrence, and reached the same conclusion that lap mesh would probably be the least bad option if (God forbid) this happens.

      • #33499
        Jtk2
        Participant

        Yunis said he had to manipulate the spermatic cord and that could be causing the pain which may resolve or be permanent. My sense of things is that because Yunis does 6 surgeries on the days he operates, he’s not able to discuss specifics after the fact, because he probably doesn’t remember them. Additionally, even though I was told by staff to ask Yunis about choice of anesthesia day of, he was far to harried pre-op to talk about anything and simply responded that I should have asked my questions earlier. Staff did say, at my 3 month phone follow-up, if I was concerned about the hernia returning, I should get an ultrasound.

      • #33501
        Watchful
        Participant

        The spermatic cord is always manipulated in these open procedures (it needs to be retracted), so that doesn’t really tell you much…

        I hope the pain resolves. How frequent and severe is it? Where do you feel it, and what triggers it?

        His interaction with you sounds disappointing, and the results weren’t what they should have been. Almost all his reviews are very good even in recent times, so I’m surprised.

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