Exploratory surgery

[dh305]

Just to follow-up @drbrown and @drtowfigh I met with my original surgeon today and now he’s ordered an abdominal ultrasound. Valvasa? Any suggestions on prep or what to ask of the technician so that I get the most out of it? Thanks for the encouragement!

[dh305]

Thanks to all for your insights. I am going to push for imaging. Thanks @drtowfigh

[Alephy]

I agree and I in fact did…I still think it’s better not to be too open at times based on my experience especially when seeking a second opinion

[drtowfigh]

Then perhaps you should change doctors. It’s your privilege to be treated by someone with whom you’re comfortable. Doctors are real people and so they have a wide variety of personalities and attitudes just like any other person. If you find a doctor that you don’t like or trust, then change doctors. There is no reason to suffer.

[Alephy]

And if you tell the surgeon you read this or that on a forum with doctors they might get angry and dismissal 😡

[drtowfigh]

In my opinion, Imaging is a must to help figure out why patients have pain after hernia repair. Examination cannot determine if there is a folding of the mesh, a fluid collection, bladder involvement, etc. To surgically explore without a plan of action, in my opinion and experience, is not a good idea.

Get a third opinion.

[dh305]

Thanks @drbrown I am seeing my first surgeon on Monday and will inquire about this. Thanks for your insights

[DrBrown]

@dh305
Your surgeons are correct that you probably do not have a recurrent hernia. But the most common cause of problems after mesh are scarring or damage to the local nerves. Neither or those problems will show up on imaging tests. So I use diagnostic injections. First I would inject the mesh. If you did not get better then I would block the local nerves.
Most surgeons do not know how to inject the mesh, so it will probably be difficult to ask them to do the procedure.
Regards.
Bill Brown MD

[dh305]

@drbrown both my original surgeon, and second opinion surgeon, are not inclined to order imaging for me. They both say the same thing: by doing a physical exam they feel everything is intact, and that imaging will not help them figure out why I am getting the soreness and stiffness that I feel when I am more active.
With regard to injections, they say that since my discomfort is more regional, and nothing acute, that an injection will not help.

Can I, as the patient, insist on these things? I tried to be respectful as I can with the surgeons, and don’t want to overstep.

[dh305]

Thank you @drbrown

[DrBrown]

@dh305
Consider a diagnostic injection. Inject the mesh with a local anesthetic. If you feel better that would be evidence that the mesh is the source of the pain.
Also, consider a nerve block. The nerves are often involved.
A standing ultrasound with Valsalva would help determine if you have a recurrent hernia.
Regards.
Bill Brown MD

[dh305]

Thanks @good-intentions

[Good intentions]

It is very common to “take a look” at the other side during a laparoscopic unilateral hernia repair. Apparently you can see a hernia, via both TAPP and TEP, if one is present.

On the other hand, once the mesh is in place and has been “incorporated” things tend to look just fine by the TAPP approach, apparently. Even when folded. My surgeon wrote in his operative report that everything looked normal, from inside the abdomen, but when he started removing the mesh he found that one side was folded and the other side had slipped downward. If he had just been “exploring” and trusted what he saw nothing would have been found, I assume. The decision to remove the mesh was made before the surgery.

I recommend talking to a surgeon who has a history of removing mesh. They will have heard the symptoms beforehand and seen the results of the removal. They’ll have the knowledge to draw a correlation, and assume cause and effect. A new surgeon will be looking for obvious physical signs.

• This reply was modified 4 years, 2 months ago by  Good intentions.