Patulous bilateral inguinal canals containing fat
07/17/2019 at 11:27 am #11858
In January, I was diagnosed via CT that I had small bilateral hernia(s), and a small umbilical hernia. At the time, they were asymptomatic.
Doctors just told me not to lift anything heavy and left it at that.
I recently started noticing aching, burning pain about where my right inguinal hernia is and discomfort to my spermatic cord. Went to the ER last weekend, got another CT scan. The CT scan said I had “Patulous bilateral inguinal canals containing fat” and a distended bladder. I have been getting the bladder situation addressed as the dr thought that could be putting pressure on the hernia and that the fat filled inguinal canals putting pressure on the spermatic cord. The drs said they could feel the hernia palpitations when checked, but currently all fat filled. They concurred on seeing a hernia specialist.
I have an appointment with a hernia surgeon tomorrow. However, in the meantime, the discomfort has been increasing. The office says it is often 1-2 weeks from consult to surgery. Hoping I can make it that long.
My questions are 1) what does “Patulous bilateral inguinal canals containing fat” mean?, and 2) with this aching, burning feeling, and discomfort to spermatic cord, about how much time might I have before this hernia really takes a bad turn?
A number of people I know have hernias protruding and no pain. 3) However, wondering why I do? Is that because the fascia is being stretched, and until there is a “breakthrough” it will increasingly become painful? And once the breakthrough occurs, the pain subsides unless you get a capture/strangulation issue, then it is intense pain?
I am trying to do minimal movement in the meantime, but would also like to know anything I can do to prevent this getting worse until surgery.
Any advice is appreciated.
07/17/2019 at 4:48 pm #19214
The pain indicates that the material, “fat” or omentum, has already pushed through, or created, an opening. The “fat” in the canal indicates that “breakthrough” has already occurred.
The odds of intestine strangulation are low, especially if there is no intestine in the canals now. The odds of chronic pain from mesh are about one in six. Don’t get in a hurry to get this new problem behind you. Use the numbers and data available to make the right decision for the rest of your life. Mesh problems can not be “fixed”, only modified to less painful problems. Even if you schedule a procedure to get on the books continue to do research, and change your mind if you don’t feel right about it. There is very little accountability for problems with hernia repair. You will have very little recourse if you have problems. Get it right the first time.
Be very careful when listening at your consultations. Don’t get persuaded by confident words if they can’t be verified. Don’t confuse the number of implantations they’ve done with expertise in understanding how to minimize your risk of chronic pain. If your surgeon can only talk about how many operations they’ve performed but not about the long-term success rate of those procedures find a different surgeon. All surgeons should know how their work lasts, over many years. Lack of knowledge does not mean success. Mesh repair is easy and simple for the surgeon but the consequences can be huge and difficult for you. Experience in mesh implantation is not the same as hernia repair expertise.
07/17/2019 at 5:47 pm #19215
Thank you Good Intentions–I will definitely take that to heart and keep getting the data. Hard to find good public data amongst all surgeons–just the number of hernia surgeries performed is hard to find. Not sure how many is “optimal,” let alone long term success. And as I understand, it can get tricky because those who take “easy” procedures pad their stats, while those taking hard cases may have their stats negatively influencing, despite having greater skill or experience. So while I can get the data on the surgeon I am about to go to, it will be hard to compare unless I can make appointments with a number of surgeons to get their stats.
So the pain is essentially pressure, not breaking through fascia or other material?
07/19/2019 at 10:24 pm #19246DrBrownParticipant
Have the prostate evaluated. A distended bladder usually indicates that you are not emptying the bladder well. This will make the hernias worse.
Try to lose weight before having the hernia repaired.
Be sure to ask lots questions.
Bill Brown MD
07/19/2019 at 11:42 pm #19247
Dr Brown, thank you. Yes, I am not badly overweight, but I can definitely lose some weight. Yes, the distended bladder is being caused (most likely) by an enlarged prostrate. It wasn’t until an ER visit in which they had me do an emptying exam that I people started paying attention (yep, retaining 700 ml of urine…and otherwise that is the only symptom I had for the usually enlarged prostate questions). The urologist is addressing this now with a catheter (to decompress), and alfuzosin. Unfortunately, it took an ER visit to get some attention on the bladder–4 other drs saw it on an earlier CT scan and said asked me limited questions about it…not too happy about that. I did see a hernia specialist yesterday. He does robotic, laporascopic surgery–seemed to believe my situation will be relatively easy–all three are small. I am feeling more confident after seeing him. I definitely appreciate this website. Urologist said my issue now won’t pose a problem for surgery. The hernia surgeon said, worst case is that we may need to recathaterize you. 2 weeks till surgery.
07/20/2019 at 5:46 pm #19252drtowfighKeymaster
Fix the prostate problem first. You should reach a state where you are not straining to empty your bladder and not straining to improve the stream of your urine.
Then, if your hernias remain symptomatic, consider repair. The CT findings and your symptoms are basically that of a traditional inguinal hernia. Nothing nefarious. Risk of incarceration while watchfully waiting is low—0.18% per year.
And please do exercise and move around. Minimal movement is not necessary nor is it helpful.
07/23/2019 at 12:04 am #19274
Thanks Dr Towfigh,
Your comments give me confidence.
The moving around and exercise makes me nervous with the aching/burning going on…but trying to remain active.
I think we have the prostrate under control now with the alfuzosin and will do another bladder check next week. I think I am good for surgery in a couple weeks, with a final check next week.
Thanks so much.
07/25/2019 at 9:28 pm #19292
While I am waiting for surgery, I periodically get increased aches/burning. My surgeon told me if that happens to lay down and gently massage the area…does not seem to be working thus far. I take it that I have increased fat pressure on a nerve. Anyone have any other ideas to alleviate the pain?
07/26/2019 at 2:28 am #19298quote Forest:
I can not emphasize enough, here or in my past posts, about how everybody is fooled by the comforting words. First from the device makers to the surgeons, then from the surgeons to the patients.
Your surgeon is going to implant one or two large pieces of mesh in to your abdomen. Probably two, they always find a defect on the other side, The pain you feel now will be nothing compared to the hopelessness you’ll feel if you have mesh problems. There are many stories on this forum from very healthy athletic people who had mesh problem. You have other problems in addition to mesh problems. No offense, but you are not “healthy” so your issues will probably be even worse. Talk to your urologist about how they will have to deal with the mesh if you need a prostate operation. They will have to cut through it or go around it, and your hernia surgeon is probably going to use the largest piece possible.
Do not assume that all of the surgeons talk to each other and are working together, discussing your situation, to help you. They don’t and they aren’t. They are all “specialists” in today’s world and only do what they specialize in, with very little consideration for their fellow surgeons or for your future problem.
I wish I had positive words for you but you are on the path that many people of the forum have been on. You can read through the Topics and find some of their stories from start to today, and the similarities will scare you. Comforting words from the surgeon (easy, I’ve done many, International Guidelines), pulling the trigger to get mesh implantation, regretting it. Be careful.
07/26/2019 at 5:20 am #19305Arkj93Participant
I’d have to agree with Good intentions here as I was one of the ones fooled by the optimistic words of my surgeon. I had my mesh implanted over a year ago and started have problems almost right away, mostly nerve issues. I plan to have my mesh removed but for anyone considering a hernia operation I would strongly suggest finding a surgeon who can perform a pure tissue repair. Most hernias are manageable and you are not doing any harm by just waiting and doing some research first. I often think to myself if I could go back to when I had my hernia and before I got the mesh I would. Sure the mesh might reduce the chance of recurrence but for people with chronic pain due to the mesh it can be devastating.
07/26/2019 at 9:41 pm #19314JnomeshParticipant
Get a second opinion by seeing a non mesh surgeon.
07/27/2019 at 10:57 am #19318
The surgeon is planning to use a hybrid mesh–disappearing, with some small kevlar weaved into it. I cannot find anything more online about this type of mesh. All my research indicates that the surgeon’s skill is the most important part of the hernia surgery, and there is no way to truly find out how good the surgeon is…only indicators by # of surgeries performed and other doctors recommendations. My umbilical is small and will be sutured. I just don’t see how suturing the inguinals would be better. Sutures tend to fail more than mesh. I do get that a small percentage do have complications…it is a risk. Waiting until it becomes an emergency means I don’t get to choose my surgeon…
07/27/2019 at 3:24 pm #19322quote Forest:
Why would he need an experimental mesh if today’s products are perfected and your problem is simple?
The issue is chronic pain, not recurrence. Your research has misled you, it is biased. Chronic pain is the main problem with mesh repairs.
Good luck. Please stay in touch over the coming years.
07/27/2019 at 6:41 pm #19324
The more broad-based discussions are where you can find the truth about the situation. The surgeons just “don’t know” the levels of chronic pain that they are creating. They are becoming more like mechanics or automatons, just following the installation instructions and moving the patient along. It really is a travesty and part of a bigger problem with medical care, worldwide.
08/06/2019 at 1:24 am #19437
Just had my surgery today. Everything going well thus far. Did not realize that peeing after the surgery was such a big deal. Guess the inflammation and the effects of the pain killer can cause the bladder to retain. Fortunately they did not have to catheratize me as I was able to finally go after enough of the fentanyl wore off. Otherwise feels like I had a brutal lower ab workout. Getting up and sitting down very uncomfortable. Walking around like an old decrepit man. However, I think all is progressing nicely so far. Only concern right now is that I haven’t had a bowel movement since early yesterday. Uncomfortable, but I know that is not unusual with all the opiods and surgery. Taking fiber and stool softener, and drinking a pretty good amount. I find it odd that my pain is really only in the vicinity of the inguinal hernias, and not at the umbilical or where they inserted the laparascopic equipment–I barely notice those.
08/06/2019 at 2:45 am #19439
Good luck Forest. I hope that you’ll stay in touch with the forum, good, bad or mixed results.
It would be very interesting, and potentially helpful to many, if you could supply the fine details of your procedure and the material used. Even some background from your surgeon on his past results.
08/06/2019 at 10:38 am #19442
Will do–I’ll get the technical details/post-op report, most likely at my 2 weeks follow-up. I will continue to note progress in the meantime.
08/08/2019 at 2:19 pm #19450
Day 4 update. Hope this is not TMI, but I think people should be aware because I think it can get overlooked–I’ve had surgeries before, but never had this happen. Was pretty constipated on Day 3–took all day to have a bowel movement. I had been taking Docusate Sodium 2x daily, along with Miralax and metamucil. Just couldn’t go. Began the day by stopping oxy. Drank half a bottle of magnesium citrate (per nurse’s direction), waiting 3.5 hours. Felt movement, but nothing happened. Drank other half of bottle, after 1.5 hours, felt movement/cramps–some very aggressive, but still couldn’t go. Did an enema, waited 30 minutes, still lots of aggressive bowels trying to move, but no defecation. After about 3 hours, finally had a bowel movement, and cleared me out.
Have been feeling better since. I think it might have been useful if I had perhaps started stool softeners the day prior to surgery because I think my stool basically got stuck because I drank no water after midnight and did not have my usual morning coffee (for which I normally have a bowel movement in the morning). Then the effects of surgery, anesthesia, and no drinking water for essentially 15 hours, then narcotics really got me plugged and everything I ate afterwards, while soft, just couldn’t budge the previous days food.
I think I am faring pretty well so far. Getting out of bed really hard. Sitting and getting up from chair getting easier. Still walking slow.
09/18/2019 at 12:22 am #19815
So I am 6 weeks out from surgery. For my bilateral hernias I had 2 , 12x15cm Synecr Pre Rect Mesh by WL Gore &p Associates Inc implanted. I also had an inflames right femoral lymph node that was removed, biopsed, and came out negative. The 3-0 barbed absorbable suture was used. The umbilical was sutured using 2-0 PDS sutures (whatever that all means. I still had the right inguinal pain for a month after the surgery (ached). It went away. Then I had a urolift procedure done on the prostate a week ago, and now that inguinal pain is back. Dr said that that inflamed lymph node may have been caused by hernia rubbing, but otherwise could not be sure what caused it, but since it was negative, hewas not too concerned. Said if I have the pain at the 3 month post-op point to come back. The weird thing is that the aching pain I had before the surgery is exactly the same as what I am feeling now. Just hoping it goes away again and that maybe the urolift procedure got it irritated again.
BTW, lots of people on here, like me, have that dull, burning, aching, soreness pain—-what exactly causes that pain?
09/21/2019 at 4:45 pm #19854drtowfighKeymaster
[USER=”2932″]Forest[/USER] Thanks for posting so diligently
you had Synecor hybrid mesh placed. It’s a good product. It’s not considered standard of care and so long term outcomes are clear from it. But the buzz about it is positive so far. Have not seen or heard of significant complications.
The achiness will go.
09/23/2019 at 1:08 am #19870
Good luck Forest, After the absorbale portion is absorbed you”ll have a common polymer fiber-based mesh. The same long-term odds as everyone else I think. Short-term might look better but long-term, there’s no reason to expect a difference.
09/23/2019 at 1:08 am #19871
09/23/2019 at 1:09 am #19872
09/23/2019 at 2:38 am #19874
Thanks Dr Twofigh, that is reassuring…which is something I get from this site. Good Intentions, I appreciate your diligence and dedication to this, and hate that you had poor results. I am glad you are making people aware, so that people go in with eyes wide open. It’s interesting that arguably the most common surgery has so many options and outcomes.
09/23/2019 at 11:08 am #19878saroParticipantquote Good intentions:
the mesh in question was semi absorbable. but absorbable shirts? what references do we have? as far as I know, the absorbable meshes must keep exceeding a time of eight months / a year to allow time for the tissues to collagen, or in any case close the wall. It is a relatively short time in our lives, but a very long time for the organism,I also read the question on another post
09/24/2019 at 8:26 am #19886saroParticipantquote Good intentions:
hello Good intentions. I have your ideas about the mesh, but I’m not as ‘expert’ lyke you. I am instinctively averse to any foreign body. I don’t know what scares me the most, having to choose between an operation without a mesh with a permanent suture or a collagen and suture absorbable in a year. Good question
03/19/2020 at 8:25 am #22246
I am now about 8 months post surgery. I still have discomfort on my right side about where I had it priorto surgery. The left side and umbilical are rarely noticed, I have gained some weight due to lack of normal exercise whiLle this heals up. I am also feel tighter and less flexible than previously. Not sure if weight gain is causing the tightness/discomfort. It’s not bad, but sometimes uncomfortable. Wondering if this will get better with exercise, weight loss, and stretching.
03/19/2020 at 10:52 pm #22247AlephyParticipant
Start with slow exercises focusing on form and feeling and check how it feels before through and after…it is interesting that depending on the procedure and or surgeon you are advised on exercise differently. Personally I would say there must be movement always! Slow intensity exercise can keep you fit and keep the body memory of movement. My 2 cents
03/20/2020 at 11:53 am #22254
@Forest According to Gore’s literature, the PTFE mesh should be fully surrounded by vascularized tissue and the absorbable portion of the mesh should be gone, absorbed by the body. There will be some shrinkage, because all of the mesh products do that.
The PTFE mesh used in this product is fairly new for Gore. Their old products were based on their Goretex technology, stretched/expanded material with microporosity. A smooth film with very tiny holes, essentially. Your mesh is a knitted mesh, just like the polypropylene and polyester products, but made from polytetrafluoroethylene, PTFE. Same product as the old meshes just made from a different polymer.
Start a log or diary. Keep track of what you do that makes you feel better and what makes you feel worse. At eight months out the mesh should be close to as strong as it will get. There’s no point in waiting. Good luck.
03/23/2020 at 7:46 am #22268
03/26/2020 at 4:48 pm #22300
So GI, up until about a couple weeks ago, there really wasn’t much discomfort or an issue. Over the last couple weeks, the discomfort seems to have increased, seemingly out of the blue. It is exacerbated by sitting straight up in a chair with good posture. Of course, with coronavirus, getting an appointment right now is not really an option to get it assessed. So odd—I figured once I hit the 6 month point, and had no issues, I would be good. Wondering if some good exercising and/or yoga will help. Wondering might this be scar tissue or what? Don’t know if anyone here may have insight or experienced this. Or is this all weight gain related~20 lbs?
07/14/2020 at 4:42 pm #27321AlexanderParticipant
Hey Forest, how are you doing now? Are you feeling better?
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