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New Onset Neuralgia- 5 months post-op
Hey all,
I’m 5 months post-op from a bilateral inguinal repair w/ mesh. It was performed at UVA Health System in Charlottesville, and was robotic-assist, but I’m unsure of whether it was a TAPP or TEP approach. Based on the analogy my surgeon gave me at my 3 week follow-up, it sounded like TAPP. On my right side, I have a 15 cm Progrip mesh that was placed as a precaution due to hernia-like pain, but no developed hernia yet. On the left, they implanted 5.9×3.9 cm.
At this point, my right side has given me no trouble for my recovery. However, my left side has consistently been painful. About two months ago, after returning to cardio and work (Firefighter), I began to experience more pain, but I chalked it up to breaking up scar tissue. After 5-6 days of pain, as well as the sensation of the mesh rubbing, my pain calmed down. flash forward to last week, and while lifting an especially heavy patient in a low squat, I felt….something. It wasn’t painful, but it was almost a “whoosh” at the site of my implant. 2-3 days later, I developed left-sided testicular pain at what feels like the base of my perineum. I’m no stranger to testicular pain at this point, so I tried to work it off with NSAIDs and rest, but as of today, the pain’s gotten worse–just a constant and dull ache around my spermatic cord. NSAIDs help, but the pain returns. Also, the pain is gone after a night’s sleep.
At this point, I’m hitting my limit here a bit with it’s severity, and I’m scheduling a visit with my surgeon tomorrow, as well as possibly heading to my PCP. In this case, what should my line of questioning be? Obviously I’m concerned about recurrence due to lifting, but I’ve also been lifting patients since 6 weeks post-op with little issues. I know pain is normal, and my body has done some wild stuff with sensations for the last 5 months, but I was hoping to be toward the home stretch on post-op pain at this point. Should I request imaging? Explore nerve blocks? Do I bother with my PCP? The most logical cases as I run down what it could be are recurrence, scar tissue breaking up, and something to do with the mesh affecting the genitofemoral nerve. . Anyway, I appreciate any insight. And as for my operative record, I requested that about an hour ago, so I should hopefully have it tomorrow. Thanks!
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8 Replies
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Great!
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Update: Cautiously optimistic here, but I think [USER=”935″]drtowfigh[/USER] is right with the scar tissue. The pain has definitely subsided from where it was, and I just have the occasional twinge now where the mesh was implanted. I’ve been focusing on stretching with extension, and it has helped considerably. I’ll still keep the appointment just to touch base with my surgeon, but the anxiety has eased. We had a pretty active day at work yesterday with lifting and some dynamic movements, and no major pain afterward.
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Sounds like a robotic TAPP repair. This is a standard procedure and the Progrip mesh has good results.
this far out from surgery, you may be feeling a tugging or a pulling from the mesh. The mesh scars down and can shrink. The only nerves at risk from this are the genitofemoral nerves and those associated with the vas deferens that go to the testicle.
I would start with imaging. That will confirm the placement of the mesh. In the meantime, gentle stretching and hip extension may help
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Got off the phone with the office RN. She thought this definitely warranted a visit, but could’t get scheduled until 12/23. I pulled up my operative report, and from what I can tell, it didn’t seem like there were any preventative neurectomies or adverse events during.
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quote Good intentions:Here are a couple of articles about wound healing that might help understanding of how things can change over months and years.
Notice that the new collagen/tissue formed during healing is weaker than “normal” tissue. So the inelastic mesh fibers are surrounded by weak and inelastic collagen. It’s not surprising that things tear and get strained months and years after the implantation, if a person considers the fundamental properties of the materials involved, the collagen and the mesh fibers, and applies some scientific and technical principles.
Anyway, you should be in the “remodeling” phase, which can last a year or more, apparently. Each tear or strain needs to reheal, which will probably cause more shrinkage, and might induce more strains or tears. Hopefully hings will level out for you at a place that works for you.
This is just my understanding, I’m not a doctor. Good luck.
Thanks for those resources. I’ll give them a read today. Luckily, there’s a few others at work that’ve had mesh repairs, so they’re a good sounding board to know where I’m at. Their collective opinion has been that it’s likely scar tissue involvement.
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Here are a couple of articles about wound healing that might help understanding of how things can change over months and years.
Notice that the new collagen/tissue formed during healing is weaker than “normal” tissue. So the inelastic mesh fibers are surrounded by weak and inelastic collagen. It’s not surprising that things tear and get strained months and years after the implantation, if a person considers the fundamental properties of the materials involved, the collagen and the mesh fibers, and applies some scientific and technical principles.
Anyway, you should be in the “remodeling” phase, which can last a year or more, apparently. Each tear or strain needs to reheal, which will probably cause more shrinkage, and might induce more strains or tears. Hopefully hings will level out for you at a place that works for you.
This is just my understanding, I’m not a doctor. Good luck.
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Hey Dr. Brown, thanks for the response. I contacted the clinic today, and am awaiting a call back from the office nurse to discuss the pain, as well as the next step. I’ll let you know what she says. Thanks for the input though–after a solid 18 hours of NSAIDs, the pain is a little better today.
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[USER=”2964″]Nacly[/USER]
Dear Nacly.
If the pain is in the scrotum, then that often indicates irritation of the ilioinguinal nerve.
If the pain is in the testicle, then that indicates that the genital nerve or the spermatic cord is involved.
A spermatic cord block or an ilioinguinal nerve block can be very beneficial.
What did your surgeon advise?
Regards.
Bill Brown MD
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