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Patulous bilateral inguinal canals containing fat
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.
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31 Replies
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Hey Forest, how are you doing now? Are you feeling better?
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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?
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Thanks GI.
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@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.
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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
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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.
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quote Good intentions: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.
Good luck.
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
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quote 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
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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.
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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.
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[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.
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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?
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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.
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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.
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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.
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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.
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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.
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quote Forest: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.
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.
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