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Hernia surgery and sexual dysfunction
I’m new to the forum so I apologize if this is something that’s already been discussed here in depth. I have a bilateral inguinal hernia. It’s going on four years now sense I was diagnosed and I’ve been putting off surgery primarily due to the horror stories that I keep coming across, in particular those involving sexual dysfunction. I’m hoping the doctors here can give me some helpful feedback regarding what surgical approach would be recommended for someone with these concerns. As I understand it (and I may very well be wrong), studies haven’t found a significant difference between the amount of post-op chronic pain and the type of procedure. Am I correct? But what about sexual function? I’m wondering if there is any type of procedure that has been shown to result in a lower number of sexual dysfunction complaints versus that found in other procedures.
What are your thoughts on the Kugel technique? I’ve been considering this because, based on my reading, it avoids those nerves and structures that can become adherent to scar tissue or entrapped in the mesh when its placed anteriorly. From what I understand, scar tissue on the the three sensory nerves can cause chronic pain or numbness which is often responsible for the sexual dysfunction complaints. So I’ve been considering Kugel for these reasons. But then I recently came across a study showing a higher complication rate with posterior approaches verses anterior ones, so now I’m not so sure.
What about open verses laparoscopic? On the one hand, I would have thought that open surgery would result in less nerve damage because the surgeon can physically see the nerves, vessels, and spermatic cord and take care that these aren’t compromised during the procedure or entrapped in the mesh. But on the other hand, the open surgery involves direct manipulation of these structures. Aren’t they physically moved out of the way during an open procedure? Doesn’t that alone pose a risk of damage or scar tissue? Which should be a greater concern?
And then there’s the question of mesh versus no-mesh. Has any significant difference been found between mesh/no-mesh and sexual function after the surgery? And if no-mesh is the better option, which is the most advisable procedure when considering sexual function? I know that no-mesh procedures are usually done openly. So the pro is no mesh to contribute to scar tissue, nerve injury, etc., but the con is that those structures that are important for sexual function are in the playing field of the surgery, which brings me right back to considering the Kugel repair as it avoids those structures.
As you can see, I’m overwhelmed in my options and I’m spinning. I’m not sure how much of what I said was accurate, but I’m hoping the doctors here can clear things up for me a bit and point me in the right direction. I’ve had a few consultations with doctors that specialize in one particular type of procedure. But I want to know, before getting the surgery, that I’m not being taylored for a specific type of procedure but rather, that a doctor has heard my concerns and a procedure is chosen in consideration of those concerns. I guess I feel that I haven’t yet gotten that kind of feedback, and I just don’t feel comfortable going through with surgery until I do. Any advice would be greatly appreciated!
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