Help w/ post-hernia pain questions 5 weeks after surgery

[DrBrown]

Dear Kevin P
The scrotal fullness could be blood, Swelling of the spermatic cord, or scar. All these usually improve with time. An ultrasound is simple test that should be diagnostic.
If you were not having nerve pain before surgery, then I am not sure why the nerve was cut. Also simple cautery of the nerve can lead to neuroma. If the nerve has to be cut, then the nerve should be ligated with a fine surgery and buried into a local muscles.
I agree that if you had a direct hernia, you would not have required any dissection of the spermatic cord.
I you would like to post your operative report, I would be please to review it with you.
Regards.
Bill Brown MD

[Good intentions]

Here’s the site for the PHS. It’s a lot of mesh.

https://www.ethicon.com/na/products/hernia-mesh-and-fixation/hernia-mesh/prolene-polypropylene-hernia-system

[Good intentions]

quote kevin b:

Hey everyone.

I’m 40 years old — 5’8″, 185 lbs. Decent/average shape (at least I was a month ago).

5 weeks ago (2/19/19) I had open hernia surgery on the right side. Surgeon found the following:

• Torn oblique and torn transversalis.
• Entrapped Iliohypogastric Nerve.
• Small direct inguinal hernia

He then repaired it by:

• Removal of section of iliohypogastric. Cauterized ends.
• Repaired the hernia (small bulge of spermatic cord) with medium prolene mesh
• Sutured up the muscles.

I had a lot of post-surgical complications:

Dr. Brown responded to your other post and might have more comments since you’ve added more detail. Are you reciting from memory or notes, or from copies of the surgery notes? I’m not sure that what you described is self-consistent. A direct hernia is a projection of material in to the inguinal canal from the side, not through the spermatic cord. But you mentioned a swelling of the spermatic cord, which implies a lipoma or an indirect hernia. If my understanding is correct. You could have both, of course.

Also, Prolene mesh is used in many different forms, from small patches, to complex two patch systems, connected together. The Prolene Hernia System. It would help to know what was used.

And, Dr. Brown probably has more experience in fixing ruptured muscles since he works on many professional athletes. Suturing them back together and getting them to work correctly are not the same thing, I expect.

As far as “stuff” in the scrotum by the testicles, I also had that experience. It resolved over time. I assume that it was some sort of tissue damage, possibly from the tying back of the penis during surgery.

Good luck. If you don’t have copies of your surgical notes you should get them.

[USER=”2580″]DrBrown[/USER]

[Jnomesh]

I would absolutely go back to your surgeon to hear what he or she says but be prepared to probably be not satisfied. There is a good chance he or she will say give it more time. This isn’t entirely inappropriate advice as a lot of people’s bodies heal over time. There is always a chance your surgeon will have some helpful insight but
be prepared to be pushed away for now. A urologist would be helpful to maybe rule out a hydrocele on the testicle. A MRI OR CAT SCAN can hopefully shed light on what that other bump is.
If you still have have pain down the line and don’t get better Your surgeon will probably order a cat scan or MRI anyways to rule out a hernia recurrence but most likely it will come back normal.
The next step will be that the surgeon will either say the pain has nothing to do with the repair or he or she will try some nerve blocks and if that doesn’t work it’s off to pain management.
What I would do is try on focusing on resting and getting better-at the same time I would request my operative report (this can be done through the surgeon or definitely through the hospital)
if you aren’t significantly better by 3-6 months I would see exactly what type of mesh was used and do some research on it as well as study the operstive report and see if there were any unusual circumstances regarding your surgery
i would also if not better by the 3-6 month mark see out one do the top hernia specialists who have experience with mesh issues.
Be prepared to travel to see one of them in that there are very few. There is a list of them in this forum. There have been very good reports by patients on dr. Igor Belyanski, dr. Sherwin Towfigh, dr. Billings and others.
if you are in significant pain after 3-6 months with no gradual improvement and no answer in what that other bump is you will need to take action.
Note: I am not a doctor. Maybe some of the other surgeons will respond.