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Inguinal hernia recurrence
Inguinal hernia recurrence 🙁
In 1976, when I was 22, I had a bilateral inguinal hernia repair. The surgeon used the standard open repair technique, with no mesh. I never experienced any problems other than some occasional pain or tightness.
About 2 years ago, when I turned 60, my right side started hurting after standing or walking for longer than 30 minutes or so. I was referred to local surgeon who examined me and concluded both sides had recurred and I underwent a bilateral hernia laparoscopic mesh repair. The recovery was slower than I expected, but I did a lot of walking and followed all of the surgeon’s orders. However, the right side never felt right after the surgery and always hurt more than the left. The surgeon explained that the right side had been an indirect hernia and left side had been a direct hernia.
Over time I started to feel very good and no significant pain until March of this year, I was working in the yard and the right side started hurting very badly and would not stop. I went to the emergency room and they found nothing after x-rays and a physical exam. I returned to my surgeon the following week and he thinks my right side has recurred and possibly the mesh has moved or folded over. He said my left side was fine. He also told me it was not urgent and if I experience pain I should just put my feet up until it stops. He told me he could operate, but this time it would have to be an open repair and there was a higher probability of a recurrence since the right side had been repaired twice before. He also told me he would cut some nerves to reduce my pain level. I have decided to wait and research for alternatives and consult with experts such as those on this forum.On most days, I have pain and it feels like something moves into the hernia area after I am standing or walking. When this happens I can squat down or sit down and then it feels like something moves back in place, so to speak, and the pain and discomfort stops. I really do not have a bulge, but the area below my original hernia operation scar seems to become very tight until I relive it by sitting down, etc. If I do a lot of physical activity, it will become very painful and I will have to lay town for about 30 minutes or so.
With all that said, I am wondering what to do. My first thought is to see a doctor who specializes in hernia repair. I live in Northwest Arkansas, so there are no local hernia clinics near my location.
I would appreciate any suggestions or recommendations.
Thank you
John -
14 Replies
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I went back to the beginning of the forum to get a sampling of hernia repair stories and came across this one that is interesting. A bilateral pure tissue repair lasted 38 years. From about age 22 to age 60. He had a recurrence and got some mesh repairs. By the evidence he did have a recurrence. But a 38 year run is pretty good.
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Inguinal hernia recurrence
So excited that you got the care you needed.
Please keep spreading the word about our HerniaTalk discussion board.
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Inguinal hernia recurrence
It has been 3 weeks since my hernia repair. Doing well, but there is still some swelling above the incision. Very little pain, except for sensitivity of the incision area.
At my two week follow-up with the surgeon last week, he explained what he found and the reason for the recurrence, as explained in the op report as I have paraphrased here:
It appeared that the mesh (from the previous repair) had retracted somewhat superiorly or slid up to open a 1.5 cm window, thus forming the recurrent hernia.
He repaired the defect using a PHS medium prosthesis.
After the new mesh was installed, he noted how the ilioinguinal nerve emerged from the muscle and was somewhat tented around the mesh inferolaterally. He transected the nerve because of the potential for neuropathy.I am taking it easy, just going on short walks each day and not lifting anything even slightly heavy (less than 10 pounds). The more I move around and walk, it seems to feel better. However, at 62 years old, I feel that I am recovering slowly as I get tired later in the day, so it is going to take a while to fully recover. I am in no hurry and I am enjoying being able to go on walks, shopping, etc. without the painful hernia pushing out previous to the surgery.
I did so much research prior to having this recurrence repaired. I consulted with several recognized experts around the country, but only after finding Hernia Talk, did I gain enough information to go back ask my surgeon detailed questions and gain enough confidence to let him do the repair.
Thanks again to the doctors on this site!
I will keep everyone posted as I progress . -
Inguinal hernia recurrence
Excellent!
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Inguinal hernia recurrence
Back home after surgery this morning
Not much pain and I am moving around, walking okay
However, I am taking it easy.
My surgeon told us the repair went well.
I plan to post my op report after I go to my follow up visit next week.John
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Inguinal hernia recurrence
Great news!
If you are happy with your outcome after surgery, please share your surgeon’s name and location so others nearby can have similar success.
Please also share HerniaTalk with your surgeon and invite him to join us.
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Inguinal hernia recurrence
I went back to my original surgeon and we discussed my situation in great detail. I explained all of the information I learned in this forum and from other doctors I consulted with over the last few months. He was able to answer all of the my questions and I feel confident in his abilities. He plans to perform an open anterior mesh repair. My surgery is scheduled for Oct 15th.
He also shared the risks concerning the repair of a recurrent hernia. I am hoping all goes well.
I will keep the forum updated as things progress after the surgery.John
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Inguinal hernia recurrence
Would love to hear an update.
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Inguinal hernia recurrence
Thank you very much Dr Towfigh. I have a much greater understanding of my condition now and where to seek further help. 🙂
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Inguinal hernia recurrence
Definitely would use mesh for a recurrence. That is pretty much the gold standard.
When repairing a hernia in open fashion after a recurrence from a laparoscopic repair, you are basically performing an anterior repair after failure of a posterior repair. That is the standard approach and what is recommended for most patients. Therefore, an open anterior mesh repair should be chosen. Mesh repairs with the plug and patch or the Prolene Hernia System involve a posterior dissection as part of the anterior approach and that can be tricky. I would not recommend complicating the situation in that manner. A simple anterior onlay mesh repair (Ã la Lichtenstein technique) is probably your best and safest bet.
Once again, it is your surgeon’s discretion. A lot of the decision making is based on the type of recurrence, what is happening with the laparoscopic mesh, what your body habitus is and other risk factors.
Check the AHS website for surgeons skilled in revisional surgery in Arkansas and nearby. There are plenty that you can tap into I’m sure. http://Www.americanherniasociety.org. Tennessee is a great next door state for hernia specialists.
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Inguinal hernia recurrence
Thank you Dr. Towfigh.
If I elect to have the open repair, my surgeon mentioned using mesh or maybe a plug and patch. I have read about issues with plug and patch. Do you recommend a particular type of mesh, etc. ?
I am also wondering about going to clinic which specializes in hernia repairs, such as yours. I live in Arkansas, but I am willing to travel. I am going back to my surgeon in a couple of weeks, I have many questions for him. However, if I do not feel comfortable with his answers, I am ready to make the decision to travel for this surgery.
What are you thoughts on traveling for this surgery, is there the potential for follow up care issues, etc.?Thank you
John -
Inguinal hernia recurrence
Pain after laparoscopic hernia repair can be due to a hernia recurrence and/or the mesh interacting with the contents trying to recur and push their way through the recurrence. Your surgeon is correct: most commonly, the most lateral edge of the mesh folds in, partially exposing the indirect inguinal hernia. It seems, based on your symptoms of pain with activity and relief with sitting and certain maneuvers, that these hernia contents are moving in and out through the area of the recurrence.
Once the open and laparoscopic hernia options have both been performed, then it is up to the discretion of the surgeon and the specific situation at hand whether the next hernia repair should be performed open vs laparoscopically. If your first repair was performed with mesh, then perhaps redoing it would be risky, with risk of spermatic cord and nerve injury. This is because the mesh is already stuck to these contents. However, if there is no mesh anteriorly, it is my opinion that revisional surgery is less risky in the open repair. You may have to have nerves cut. That is your surgeons discretion. Not all surgeons do that for every revision. It is done to reduce risk of postoperative nerve injury and pain.
I recommend imaging such as MRI pelvis to view the mesh repair, see if the mesh has shifted or is folded or balled up, and confirm recurrence. If the mesh itself is not the major issue, then open repair is safe and effective, and mesh should be implanted. Revisional laparoscopic repair is performed safely by only few surgeons who are laparoscopically experienced. If that route is chosen, make sure the surgeon performs these regularly.
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Inguinal hernia recurrence
Sounds like a recurrence, and sounds like pain is from the hernia. An open approach probably wouldn’t be the best, but you would have to find an experienced laparoscopic surgeon to look in with a scope. You can find surgeons interested in hernia repair at the Americas Hernia Society website. Whether or not they do lap repair in this situation is unknown, but you could always ask. You are right to look in to it a bit more Hope this helps!
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@good-intentions but it seems the “gold standard” or most profitable is taking the easy route and putting mesh. Would be awesome if more surgeons learned tissue repairs and left it up to the patient to decide what kind of repair they want done and explain the pros and cons. Id take a 38 year tissue repair over mesh anyday.
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