Laparoscopic neurectomy and Internal /external obliques

[Unknown Member]

[USER=”935″]drtowfigh[/USER] how can laparoscopic neurectomy take place in the preperitoneal space? Can it be performed both retro and pre peritoneal ? From my research laproscopic neurectomy is performed primarily via retro peritoneal space…isn’t pre peritoneal neurectomy an open excision with a blade?

[Unknown Member]

quote Jnomesh:

I find it very interesting and logical and maybe the surgeons can weigh in but you mentioned your repair, removal, neurectomies and subsequent repair were on the left side. The left side is where the colon is and obviously where a lot of the feces accumulates before going to the bathroom.
It seems obvious to me that left sided hernias and repairs can have more of a association with bowel issues and any other intestinal issues because of the anatomy.
It seems this should automatically clue in the medical professionals when someone has left sided inguinal hernias and repairs that these type of issues can be related. I know the surgeons may disagree with me in this one but when you have the mesh implanted laparoscopically there is even more potential for these type of Oreo lens should something g go wrong with the mesh
I’ve had both a right and left sided inguinal hernias and repairs and they were worlds apart in how I felt. The right hernia caused very few symptoms. And the reality the same.
However, my left hernia which went undiagnosed for a year and a half cussed all sorts of issues including constipation.
After left sided repair with laparoscopic mesh which ended up balling up I had all sorts of pain and issues including my bowels not working the way they should and a lot pressure in that area

Yes, I completely agree, I just dont know what to do at this point, another mesh removal seems like my only option but thats more trauma to my body with no guarantee that a non mesh repair can be done

[Jnomesh]

I find it very interesting and logical and maybe the surgeons can weigh in but you mentioned your repair, removal, neurectomies and subsequent repair were on the left side. The left side is where the colon is and obviously where a lot of the feces accumulates before going to the bathroom.
It seems obvious to me that left sided hernias and repairs can have more of a association with bowel issues and any other intestinal issues because of the anatomy.
It seems this should automatically clue in the medical professionals when someone has left sided inguinal hernias and repairs that these type of issues can be related. I know the surgeons may disagree with me in this one but when you have the mesh implanted laparoscopically there is even more potential for these type of Oreo lens should something g go wrong with the mesh
I’ve had both a right and left sided inguinal hernias and repairs and they were worlds apart in how I felt. The right hernia caused very few symptoms. And the reality the same.
However, my left hernia which went undiagnosed for a year and a half cussed all sorts of issues including constipation.
After left sided repair with laparoscopic mesh which ended up balling up I had all sorts of pain and issues including my bowels not working the way they should and a lot pressure in that area

[Unknown Member]

quote drtowfigh:

I disagree with the last statement—the laparoscopic mesh can be injected, as Dr Brown noted.

Numbness is to be expected from the neurectomy. Laparoscopic neurectomy has different outcomes depending on how far back the nerves are cut. I have Shy’d away from this procedure except in radical situations for the very details provided by Dr Brown.

shall I assume this was secondary to a prior hernia repair?

In march I went for Removal of my open mesh…surgeon removed the open mesh…did neurectomies and insert a progrip mesh in laparoscopically.

My surgery report says the following.

Laparoscopic identification and neurectomy of the left genital branch of the genitofemoral nerve in the preperitoneal space

Laparoscopic identification and neurectomy of the left autonomic paravasal nerve fibers in the preperitoneal space

identification and neurectomy of the left ilioinguinal nerve with proximal intramuscular reimpantation

in the notes too it says the following

The genital nerve was identiefied over the psoas with genital and femoral trunk. The genital branch was taken proximally and distally

The iliohypogastric nerve was not identified in this plane and had likely been sacrificed

The ilioinguinal nerve was seen ending into this mesh at the proximal end. This was traced back to its origin from where it exited from the internal oblique. This was ligated with a 2-0 Vicryl suture and then buried into the belly of the internal oblique muscle to prevent perineural scarring.

I beleive this severe constipation and impairment of my pelvic floor muscles is causing numbness and dysfuntion across my whole body

.recently though I took a fleet enema and it made me go a lot…it released alot of internal pressure and my whole body opened up and I was feeling sensation across my whole body..it even made it easier to walk and just move around..made me feel great mentally too…going to the restroom and passing gas seem to help open up sensation and strength across my body but its been a struggle to go to the restroom..both bowel movement and going pee..passing gas is nearly impossible for me…only in certain positions i might be able to pass gas….. i also get really bloated even when I eat small amounts of food. I really dont feel good at all..cant sleep good at all…I just feel sick…I dont know if its this severe constipation or this tension in my groin from the mesh or a combination of both but something is really messing up my insides…

[drtowfigh]

I disagree with the last statement—the laparoscopic mesh can be injected, as Dr Brown noted.

Numbness is to be expected from the neurectomy. Laparoscopic neurectomy has different outcomes depending on how far back the nerves are cut. I have Shy’d away from this procedure except in radical situations for the very details provided by Dr Brown.

shall I assume this was secondary to a prior hernia repair?

[Unknown Member]

quote DrBrown:

[USER=”3027″]Julian[/USER]
To determine if your pain is coming from the mesh, ask your surgeon to inject the mesh with a local anesthetic. If you feel better for a few hours that would be strong evidence that the mesh is the source of your pain.
Regards.
Bill Brown MD

will an injection still work if the mesh is put in laparoscopically ?
when I got an injection awhile back in the groin from my pain management and reported back to my surgeon..he said the mesh is too far into the body for a needle to reach..

[DrBrown]

[USER=”3027″]Julian[/USER]
To determine if your pain is coming from the mesh, ask your surgeon to inject the mesh with a local anesthetic. If you feel better for a few hours that would be strong evidence that the mesh is the source of your pain.
Regards.
Bill Brown MD

[Unknown Member]

quote DrBrown:

[USER=”3027″]Julian[/USER]
I would advise you to see your surgeon and ask him/her to evaluate your current problems to put together a treatment plan.
Regards.
Bill Brown MD

Dr. Brown

is it possible that this progrip mesh is shrinking/ contracting which is pulling my groin together just enough to cause problems.. Because when I pull my groin to the sides (left to the left and right to the right) it opens up my hips puts less pressure on my back and just opens up my pelvic floor and everything feels better..walking feels better..legs arent as heavy…..going to restroom is easier

[DrBrown]

[USER=”3027″]Julian[/USER]
I would advise you to see your surgeon and ask him/her to evaluate your current problems to put together a treatment plan.
Regards.
Bill Brown MD

[Unknown Member]

[USER=”3027″]Julian[/USER] I don’t understand why your surgeon performed a laparoscopic triple neurectomy when he performed an open removal … seems pretty abrasive and totally experimental…

[Unknown Member]

quote DrBrown:

[USER=”3027″]Julian[/USER]
During a laparoscopic neurectomy, the nerves are cut at a location where the nerves have both motor and sensory components. This will denervate oblique muscles and cause the abdominal wall to get weak. You may lose some support of the spine causing back pain.
An abdominal binder may help support the abdominal muscles and back. Work with a PT to try to get as much strength as you can.
Regards.
Bill Brown MD

I was told it was all sensory…now I cant walk right..use the restroom..pelvic floor is shot….can’t feel my genitals …life is bad….but it’s all sensory right

[DrBrown]

[USER=”3027″]Julian[/USER]
During a laparoscopic neurectomy, the nerves are cut at a location where the nerves have both motor and sensory components. This will denervate oblique muscles and cause the abdominal wall to get weak. You may lose some support of the spine causing back pain.
An abdominal binder may help support the abdominal muscles and back. Work with a PT to try to get as much strength as you can.
Regards.
Bill Brown MD

[Good intentions]

Sorry Julian, I thought that Dr. Brown would have some thoughts on how the nerves affect the muscles around them. He often recommends injections to determine which nerves are affected and is known for working on athletes. Maybe he missed my notification.

[USER=”3027″]Julian[/USER]

[USER=”2580″]DrBrown[/USER]

[Unknown Member]

quote Good intentions:

[USER=”2580″]DrBrown[/USER]

Got Unapproved, this might be a double

What does that mean ?

[Good intentions]

[USER=”2580″]DrBrown[/USER]

Got Unapproved, this might be a double

[Good intentions]

Dr. Brown seems to understand the nerve functions and anatomy better than most.. [USER=”2580″]DrBrown[/USER]