Pain after mesh repair

[drtowfigh]

Pain after mesh repair

Please share this site with your physicians and surgeons.

[groundfaller]

Pain after mesh repair

Wow, I really do appreciate both responses. I have been feeling very depressed with the prospect of no improvement but it is nice to hear that there may yet still be help. That matters a lot. Your website and these forums and your quick reply shows real dedication to this problem and I am very impressed. Thank you.

It sounds like finding a doctor with a special interest in hernia repairs who will perform an MRI is important. Considering the prevelance of hernia repairs, I assumed they would be more widespread but it is surprisingly difficult.

Again, thank you and I will definitely continue to use this site as a resource. Receiving direct responses and being able to understand what others are experiencing is so valuable.

Troy.

[drtowfigh]

Pain after mesh repair

Troy,
I suggest you see another surgeon. For a second opinion. I do not personally know of anyone in Utah. Go to the American Hernia Society website to find someone. If not, you may have to travel.

Pain 9 or more months after a hernia repair is often due to a new recurrence. It is often worse with increased activity or end of the day, better when lying flat. Nerve pain rarely starts so late unless it is related to impingement from a recurrence. I recommend MRI pelvis to assess the groin after a prior hernia repair. Ultrasound is often inaccurate as the mesh distorts the visible field. Also, the MRI is best performed with Valsalva (bear down) and dynamic images. Not all radiologic centers do this.
I hope this is helpful!

[drtowfigh]

Pain after mesh repair

Stacey,
Thanks for the update.
Re MRI for occult hernias:
– I don’t believe the situation is as sour for non-inguinal hernias. The reason is because the groin area is poorly evaluable with CT but the abdominal wall is pretty well seen. That said, all hernias are underreported in imaging. It’s not high on radiologists’ radar.
– Hernias from laparoscopic operations are very rare. I’ve also published on this. See the Bariatric Times article “to close or not to close port site hernias.”
– Upright MRIs are excellent alternatives to MRI with Valsalva. But open MRIs are not sensitive enough to show occult hernias.
– You can take your CD to any radiology group and ask for a second opinion or re-evaluation. You may have to pay cash for it.

[sngoldstein]

Pain after mesh repair

You need a good pain management person, or even better, a hernia surgeon who knows how to manage this problem. It is not uncommon. Many of these issues can be solved with a simple injection to destroy the offending nerve or possibly an operation to remove it. I don’t know anyone in Utah as I am in NY but the Lichtenstein Clinic in California specializes in this problem. Google them and see what they say.

[groundfaller]

Pain after mesh repair

Hello everyone and thank you Dr Towfigh for providing this forum.

I’m a 41yo male and I had a left inguinal, open repair done 9 months ago. I have never been truly pain free since the surgery although I have had periods of manageable, mild pain during that time. Unfortunately, I have had two incidents where the pain became much more disruptive in life and I am now very concerned. At the end of September, following a business trip, I came home to significant pain which left me in bed for several days and took nearly a full month to become manageable again. Then, again at the end of November I experienced the same significant pain and it is now six weeks later and it is not improving at this time. I cannot walk for more than 1/2 hour before I start to hurt. Lying down generally relieves the pain. I saw my surgeon yesterday and she arranged for some PT for me but finished the conversation saying, “this may be your new life.” I don’t go out anymore because of the pain and I struggle through work on a daily basis.

There was an ultrasound performed in Sept which showed nothing significant and the surgeon performed a physical exam yesterday with nothing remarkable noted. She doesn’t seem to be offering anything more. I need help with my next step. Where do people go when their surgeon is no longer helpful? Should I return to my general practitioner? Does anyone know of a doctor in Utah that specializes in post surgery pain like this? I am not resigned to a life of pain like this at 41. Before the surgery I would mtn bike and rock climb daily. Does anyone have advice on my next step? Anything would be appreciated.

Thanks,
Troy

[Stacey]

Pain after mesh repair

I wanted to update my personal experience with chronic disabling pelvic pain after bilateral ( not at the same time) laparoscopic mesh hernia repairs. Several months ago I had exploratory surgery in which a small lower abdominal wall hernia was found and repaired and in addition the mesh was essentially entirely removed from both groins. I still have pain and limitations but the pain is not constant and is far easier to manage and deal with.

in case someone else is suffering like I did and pain management injections don’t provide adequate relief I think it so important it is to be evaluated by a hernia specialist who treats patients with pain after hernia surgery. Hopefully, like Dr Towfigh and others, they will also have a better idea of what you’re going through and not minimize your complaints or the effect its having on your life .

I also have a question. I looked at the JAMA article @ imaging occult inguinal hernias. Do you think results would be similar for other occult or incisional hernias ? I always wondered because I’ve had so many laparoscopic procedures and worried that they only were looking for inguinal hernias on the studies. Also, have the upright MRI machines where you can sit or stand been used to look for occult hernia’s? And, is there anywhere you could suggest getting an MRI reread in the event something may have been missed?

Thank you Dr Towfigh for starting this site.

[drtowfigh]

Pain after mesh repair

Great question.
Interpreting an imaging study can be like looking at a work of art. It’s really an interpretation. However, if the symptoms are real, there are examination findings that are real, and the imaging does not support any of those, then it must be re-read or another imaging must be sought. I don’t think it’s fair to have patients suffer from pain.

[Stacey]

Pain after mesh repair

How do you know if your imaging is read properly?

[drtowfigh]

Pain after mesh repair

Imaging is a great road map.

It is also important that the radiologist/surgeon accurately read the imaging study and not misinterpret it. In our study, for very delicate situations such as yours, a study may be misinterpreted up to 75% of the time.

A repeat study is not indicated if one was done a year ago. It’s important that that one from a year ago be accurately and precisely interpreted.

[Stacey]

Pain after mesh repair

Hi,
I’m 55 and had a laparoscopic left femoral hernia repair with mesh 2 years ago and felt totally fine. Then one year agp I developed daily distention, generalized abdominal discomfort, persistent left pelvic discomfort and several episodes of vomiting. I felt better with lying down and worse as day went on especially if I ate. I was sure it was the hernia but an MRI of the pelvis (to evaluate fibroids) and CT scan did not reveal this. Eventually had laparoscopic mesh repair of a hernia in the other groin with no relief and robotic surgery to remove a large uterine fibroid. I thought this helped but then all of the symptoms returned and over time the pain became severe. I had a pelvic CT,more ultrasounds, GI studies, saw a gynecologist, urologist, 6 surgeons and was in the ER twice. I was thankfully sent to a pain specialist who did nerve injections which gave immediate relief of the pain but the symptoms returned. Taking low dose gabapentin ( all I can tolerate), tons of advil and doing physical therapy. Every aspect of my life has been effected.

I am pursuing surgical treatments. How does one decide between neurectomy or mesh removal with preservation of the nerves?
Dr Towfigh has mentioned that MRI of the pelvis is the best way to look for a recurrent groin hernia if there is mesh. Should that be repeated if it was last done 1 year ago? I also suspect I have small incisional hernias at some of the trocar sites especially @ the umbilicus where I have felt pain and small protrusions , but other areas concern me as well. What is the best way to look for them?
And is it necessary to do more imaging if the surgeon is going to be looking inside anyway?

Hoping to get some insight and really just hoping to get better.

[MikPop*3837]

ミスター王は、現在でも、〈ヤマゴモリ〉をおこなう

しかし、ゲーム〈ヤキュウ〉ならば、どのチームにも負けない自信があった。(トクガワ第一代将軍は、M・ヤキュウの考えの支持者だった。なぜなら、ゲーム〈ヤキュウ〉には刀が要らない。将軍は〈刀狩り〉をおこない、日本中の刀を江戸の城の奥に隠してしまいたかった。彼はまた、ゲーム〈ヤキュウ〉をSh冏un’s Game、すなわち、オイエリュー〈お家流〉と呼んだ。) 野心家のM・ヤキュウは、冷酷な現実家でもあった。弟の(訳注・?)ジューベー・ヤキュウが一六二六年から三七年まで、十一年間、行方不明になっていたのも、実は、〈ヤキュウ〉を普及させるべく、ニンジャとなって全国の大名を説得して歩いていたからだ。北九州のある藩でバッティング・コーチをつとめたさい、ジューベーは彼の命を狙《ねら》う男から死球を顔にぶつけられ、片《かた》眼《め》を失った。 このゲーム〈ヤキュウ〉は、われわれのベースボールと、同じ人数、同じルールでおこなわれる。同じルールのゲームが、海をへだてた米日の二国に、なぜ発生したかは、文化人類学者の考察すべき問題であろう。M・ヤキュウの野望に反対したのは、意外にも二代目将軍ヒデタダであった。ヒデタダは、〈ヤキュウ〉が嫌《きら》いである上に、M・ヤキュウの権力があまりにも大きくなるのを恐れたのである。ヒデタダの考える武士道は刀であり、M・ヤキュウの考える武士道は〈ヤキュウ〉であった。 ヒデタダが〈ヤキュウ〉を嫌ったのは、彼自身がいかに努力しても、〈ボールが見えてこない〉からだったといわれる。(武士道としての〈ヤキュウ〉において、これは重大なことであり、現代のミスター王やコージ・ヤマモトも、しばしば、〈ボールが見えない〉〈見えてきた〉を問題にする。武士道ヤキュウは、このような美的ストイシズムを土台にしており、初球から大振りをする〈ガイジン〉は白眼視される。たとえ、レジー・ジャクソンといえども。) M・ヤキュウはヒデタダを暗殺し、大坂に逃れて、城にたてこもった,tumi アウトレット。三代目将軍イエミツは父ヒデタダの仇《かたき》を討つために、軍隊をつれて、大坂城を包囲した。これが有名な関ヶ原の戦いである。冬の陣と夏の陣を過ぎて、城は九月に落ちた。Mも、ジューベーも死に、ヤキュウ一族は滅亡した。 しかし、ゲーム〈ヤキュウ〉は不滅であった,MCM バッグ 公式。M・ヤキュウのチームに入れて貰《もら》おうとして断られた天才バッター、ムサシ・ミヤモトは、自分でチームを作り、十六人の影武者を作った,シャネル バッグ 新作 2013。日本では、この弟子たちを〈十六ムサシ〉と呼ぶ。 ムサシは、OK牧場の決闘にも比すべき有名な〈ガンリュウジマの決闘〉において、長い刀の使い手であるコジロー・ササキと、バットで対決した。正確にいえば、ボートのオールを刀で削り、バットを作ったのである,カルティエ 指輪。二つの刀を同時に使うことで有名なムサシが、一生のクライマックスにおいて、あえてバットを使用したところに、ムサシのヤキュウ好きがうかがえる。決闘に勝ったのは、バットを両手で握ったムサシであった。(コジロー・ササキは即死したが、以後、ササキ家の者はヤキュウを学ぶようになった。ササキ家の子孫の一人は、いま、日本でもっとも人気のある〈プロ野球ニュース〉のキャスターである。) ヤキュウ一族はほろびたが、その精神を継ぐ弟子たちは大坂で〈隠れヤキュウ〉として生きた。将軍の眼をごまかすために、ヤギュウ一族と名を変え、フジイデラ(訳注・藤井寺か?)という寺に閉じこもって、研《けん》鑽《さん》を積んだ。関ヶ原の夏の陣から三百年後の一九四五年、将軍とトージョーをほろぼしたマッカーサー元帥は、日本占領政策の一つとして、ベースボールを日本に普及させようとした。このとき、三百年のベールを脱いで、ヤギュウ一族が登場したのである。 マッカーサーは、封建制度の臭《にお》いのする名を好まなかった。また、YAGYUは、アメリカ人にとって、発音がむずかしいので、司令部の一人が和英辞典を引いてみた。YAGYUは、〈A WILD OX; A BISON; A BUFFALO〉と記されていた。こうして、バッファローズという球団が、一九五〇年に誕生した。彼らは現在でも、フジイデラを本拠地にしている。 バッファローズの監督のニシモトは、日本で、〈古武士の風格〉と形容されるほどのサムライで、勝敗よりも、武士道を貫くこと、立派さ、フェアプレイを重んじる態度で知られる。ニシモトは〈敗《ま》けることによって立派になる〉武士道野球の後継者であり、アメリカ流の野球を身につけた広島東洋カープ(ドン・ブラッシンゲームがコーチをしていたことがある)に、昨七九年度のペナントを奪われた。しかし、バッファローズの野球が武士道そのものであることは間違いないのである。 武士道野球のこのような成り立ちをみれば、日本人の野球が、きわめて特殊であり、エキセントリックでさえあるのが了解されると思う。選手たちは、おのれの所属するチームへの献身を要求され、すすんで、それに従う。西武ライオンズのノムラ捕手は、どこへ行っても——たとえ料亭でも——〈私は一生、捕手で過します〉という誓いの言葉を紙に書きつづけている。(訳注・「生涯一捕手」という色紙であろう,CANON EOS 6D。)ホワイティング氏が、日本の選手たちのトレーニングを〈海兵隊の訓練〉と評したのは、当を得ている。 ミスター・ジャイアンツとか〈お祭り男〉と呼ばれたナガシマのようなスーパースターさえ、現役時代には、日本野球独特の神秘的な〈ヤマゴモリ〉をおこなった,Tory Burch 財布。ナガシマの〈ヤマゴモリ〉とは、山の中に入り、酒や煙草《たばこ》を絶ち、木の実を食べ、平安時代の偉大な思想家である頼山陽の書にしたしむことであった。シゲオ・ナガシマは頼山陽の『日本外史』をことのほか愛し、それゆえに、いまでは〈ミスター・サンヨー〉と呼ばれている。 ミスター王は、現在でも、〈ヤマゴモリ〉をおこなう。