Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

[Good intentions]

I don’t know how big it was. I had a visible peaked bump, probably about one inch wide and 1/4 inch tall (guessing) when standing that disappeared when laying down. It was only a problem after intense physical activity. Not during, but after, like the day after a soccer game I would have pain while raking leaves in the yard. Occasionally things like a twisted testicle would occur. The pain and problems always resolved after a few days. I was aware of the issues with hernia repair and had decided to try to live with it and keep doing the things I wanted to do.

Eventually it was a choice of giving some things up or having surgery. I was leaning heavily toward Dr. Brown or Shouldice but then found the head of surgery at a big clinic who was part of a group that trained people in laparoscopy, who also had a very good referral from my friend who was a surgeon (in a different specialty) and had had his own hernia repaired years before. I found out afterward that he had had a Lichtenstein repair. I also found out later that my surgeon was still fine-tuning his implantation method from the year before but he never said what he was trying to fix. I also found out later that he had had a semi-professional soccer player as a patient before and the patient had ended up going to Florida to have his mesh problems worked out. Yet he still took a chance on me.

My experience has all of the hallmarks of what is wrong with hernia repair today. Surgeons mindlessly doing what they do, because it is what everyone else does, and they can’t admit mistakes. If my surgeon had been honest he would have discussed the problems that he had with the other soccer player with me before he accepted me as a patient. But he hid it from me and downplayed it later. Pretended that he didn’t know why the guy had problems. But he did know that there were problems with the repair that he did.

In the big scheme of things my big mistake was not trusting my own judgement, using what I had learned about hernia repair at the time. There was really no reason for me to believe that the surgeon I chose was any different from all of the other hernia repair surgeons. They are all learning from the same sources. People like Dr. Felix, traveling the world giving presentations about the 10 Golden Rules, and the Repair Guidelines that were sponsored by Bard and Ethicon years ago.

If I was starting over I would trust the most the surgeon that can clearly describe the pros and cons of each repair method. The ones that can only talk about “here’s what I do” are really just automatons.

Sorry for the diatribe. It really is a dangerous and difficult process. Good luck.

[David M]

Also Good Intentions, just how big was the direct hernia that you wish you would have watched? At what point do you think you would have eventually had it fixed?

[William Bryant]

Good Intentions, would you hold off surgery in my case… Largely asymptomatic and I do and carry less to try to keep it that way. I do find that frustrating as I used to carry a lot of stuff although never into weight lifting. But I can and have adjusted what I do to delay surgery.

How long should I put it off – do people think?

[Good intentions]

Here are a couple of things from Dr. Towfigh about imaging, linked below. You are in a risky spot, with your assumption that you might have a hernia. The edge of a slippery slope leading to hernia surgery. Inguinal hernia repair is not the same as umbilical repair. Don’t assume that good results for one means that you’ll have good results for the other.

Have you taken a long rest period since you first had the pain or have you continued doing your normal activities? When I had my direct hernia I could rest and recover to a pain-free condition, even to the level where I could go for training runs and do light workouts. I chose surgery in an attempt to get back to my high level of physical activity, playing soccer several times per week. I think that I would have been better off retiring soccer and just living healthily at a lower level of physical activity. Surgery is very risky.

Good luck. Be careful.

https://jamanetwork.com/journals/jamasurgery/fullarticle/1893806

Role of Imaging in the Diagnosis of Occult Hernias
Joseph Miller, MD, MS; Janice Cho, BA; Meina Joseph Michael, BS; Rola Saouaf, MD; Shirin Towfigh, MD
Author Affiliations Article Information
JAMA Surg. 2014;149(10):1077-1080. doi:10.1001/jamasurg.2014.484

https://youtu.be/jJcu8kHPkgA

[Swayze]

Dredging this thread back up because I am currently experiencing what I can best describe as ilioinguinal nerve pain (radiating to inner thigh, right testicle, scrotum – dull pain and discomfort on pubic bone constant) without any obvious bulging. There may be some very slight swelling on right side of pubic bone but I can’t differentiate between the fat pad on that area and any swelling.

Had a umbilical hernia repaired in 2015 by Dr. Goodyear (mesh) and while this pain is not the same – the feeling of heaviness in the general area is making me think this is the start of an inguinal hernia. With my umbilical hernia I could ‘push in’ the bulging but there does not really seem to be anything to push in in this case. I was lifting heavy bags of yard waste a few weeks ago that could have caused this. I visited the dr (Kaiser CA) this past week and they placed me on NSAID and are having me report back next week for possible MRI or CT if pain persists.

Is there a particular imaging technique that would be preferable for identifying an inguinal hernia (that is likely fat) that I should advocate for? I also saw on some threads that David Nguyen was the preferred doctor for Kaiser patients – but since he is referral only and I have no way of getting in touch (Kaiser is brutal in this regard) I figured I should try here first.

Thanks for any insight.

[drtowfigh]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

The canal fat or sure. If the cord lipoma is contiguous with that, then yes again.

[Chaunce123]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

Does a laparoscopic repair fix the canal fat or a cord lipoma?

[UhOh!]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

Thanks, will try and track it down. It was actually done in your neck of the woods at Westside Medical Imaging; before bothering to request the disk, do they generally produce good imaging? My only other experiences with medical imaging (aside from dental x-rays) have been at research universities, not private practice…

[drtowfigh]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

– Size of hernia does not determine need for repair
– Size of hernia helps determine best technique for repair
– All hernias increase in size and content over time. It’s unpredictable who and which type of hernia will grow faster.

UhOh,
CT 7 yrs ago may indeed show a hernia.

[UhOh!]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

Oh, and one more imaging-related question: If this was a congenital defect, would an abdominal CT I had done about seven years ago (kidney stone) show it? Don’t have the disk so would need to track it down, so I’m curious if it’s even of any diagnostic value.

[UhOh!]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

Thanks, this is helpful. My interests in knowing the “contents” and nature of the defect are twofold: Knowing the likelihood of it getting worse (increasing in size; going from fat-only to fat and bowel) as well as the likelihood of complications (too small to strangulate; just small enough to strangulate).

Per the original question in this thread, is there much difference in the prognosis for a minimally symptomatic hernia with a fat-only sac, fat seeping into the inguinal canal and a cord lipoma (if there really is a difference between these things)?

[Chaunce123]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

UhOh, this is based on personal experience, I am not not a doctor so take this info with that knowledge:

– I believe the advantage to knowing contents is mostly about surgical recommendations (timeline, mainly), and for diagnostics pertaining to the more unusual or ambiguous cases. Patient symptoms matter, as does the patient presentation. Most hernias of the groin are obvious, there is little ambiguity about them existing, and the precise contents are often irrelevant if the hernia is asymptomatic, minimally symptomatic, or the procedure is elective. It may impact a watch and wait vs repair recommendation, but if you’re going to have it repaired anyway it probably does not matter whether there’s fat or bowel in there. The sac contents are figured out definitively during surgery, either way, and as far as I know, the repair is usually the same too.

– Sometimes an Ultrasound can determine the size of a defect, and sometimes ultrasound can determine the contents as well

– CT and MRI can also sometimes determine what is contained within a hernia defect, because fat, inflammation, intestine, etc, look differently on imaging studies.

Both of those say “sometimes” because it may depend on who is reading and interpreting the radiology images. I personally have had mixed opinions about the exact same radiology, so the “sometimes” is pertinent to less-than-obvious cases.

Clear as mud, from a patient perspective anyway … right? :blink: 😆 😆 😆

[UhOh!]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

Sorry to dredge up an old thread, but I just started leafing through pages on this site after discovering it recently and it led me to a question about diagnosis: Is it possible to discern between tissue types involved through imaging, and is there any real advantage to doing this? The info in this thread suggests that there may be slight variations in the cause of symptoms, but not necessarily any difference in the outcome.

I understand, based on answers to my previous questions, that size of the hernia is often telling (the smallest inguinal hernias are usually composed of fat). But is there any way to definitively “take inventory” of the sac and, to that end, know just how large a hole/tear/weakness exists in the musculature and does that provide any useful information from a management/treatment perspective? Thanks.

[drtowfigh]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

If you have groin symptoms that are carefully evaluated and found to be consistent with a groin hernia AND you have tenderness in the are on exam with or without a bulge AND you have fat in the inguinsl canal, then that is a symptomatic inguinal hernia in my book.

I disagree that fat in the inguinal canal is normal and expected. I believe that is always a hernia. If you’re not symptomatic from it then that is an asymptomatic hernia and there is nothing to do about it. That’s all.

[Chaunce1234]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

It’s primarily based on symptoms, history of a bulge, goal of the patient, physical exam and sometimes imaging. And it is not a one size fits all answer. So the answer to your question is that there is commonly fat in the canal, there is often groin discomfort, and sometimes the two are related and sometimes not. That relationship is often very difficult to sort out. The fat however is not dangerous in terms f risk as it would be if there were intestines in the hernia. Hope this helps!

[JD]

An MRI, using the procedure described by Dr. Towfigh, should tell you if you have an inguinal hernia, even if it is occult. It did for me.

You could also consider a consultation with a Pelvic Floor Physical Therapist. I decided to hold off on surgical repair of my hernia, because pelvic floor PT is helping me manage the symptoms well. It looks like you are in CA, and there is a well-known PT clinic there. The founder has been a guest on Hernia Talk with Dr. Towfigh.
https://pelvicpainrehab.com/locations/

Best of luck.