Possible Recurrence after Shouldice Repair

[Bure96]

quote Chaunce1234:

Shouldice surgery performed at the Shouldice clinic has something like a 1% recurrence rate, I would not be overly concerned about recurrence if you had the procedure done in Toronto.

If recurrence has been ruled out, have you tried an extended course of NSAID (anti-inflammatory) to treat the symptoms? Or nerve blocks? Anything of that nature?

Frankly I am not having any significant pain or discomfort at this point that would warrant a nerve block or extended NSAID treatment. There are some days or weeks where I have some discomfort or pain, but it has not been long term and I am not overly restricted in what I am able to do on a daily basis. For instance, I have gotten back to playing ice hockey with little to no pain involved on most occasions. Weightlifting, tighter waistbands on my pants and sexual activity can cause soreness, but it’s not too bad.

One of my primary concerns was the raised area around the surgical site. When I look in the mirror, my right groin area bulges out and there is a significantly asymmetrical look compared with the left side. I’m not concerned too much with the appearance of it, but I wanted to find out what this could be, whether a recurrence, scar tissue, or something else. Dr. Chen did not believe it was a recurrence or scar tissue and felt that it was just a symptom of the stretching of the muscle involved in the Shouldice repair. He mentioned that because I am relatively thin (142 lbs at 5’7″), it’s probably more prominent than it would otherwise be.

I suppose all I can really do is try to limit things like lifting couches and refrigerators and make sure I’m using good form and not going too heavy when lifting weights.

[Chaunce1234]

Shouldice surgery performed at the Shouldice clinic has something like a 1% recurrence rate, I would not be overly concerned about recurrence if you had the procedure done in Toronto.

If recurrence has been ruled out, have you tried an extended course of NSAID (anti-inflammatory) to treat the symptoms? Or nerve blocks? Anything of that nature?

[Jnomesh]

Hey Bure96.
i would definitely seek another opinion in addition to chen’s. I’m not a doctor but I’m almost positive the shouldice hospital would refute what he has told you.
chen is very pro mesh and anti mesh and I’m sure inside he was gleaming that a pure tissue repair isn’t satisfactory to some one. Your comment that he said the problem with the shouldice repair is that “when” corrected to “if” kind of said it all.
i would definitely get a third opinion from dr. Brown. Something doesn’t seem right with Chen’s assession that you have bulging Bc you ab muscle are weak as a result of the shouldice technique.
i had a mesh repair go bad and the mesh had to be removed, you had a pure tissue repair and seems something is off-what I have learned from my ordeal is that when it comes to surgery and probably a lot of other things we just can take a surgeons word and have to really do our due-diligence: get a second or third or 4th opinion. Until you feel good about the surgeon and what they are telling you and also do some research on your own.
unfortunately the drawback of going to the shouldice hospital is that should you need to see them again it means that you have to travel.
because the repair is so specialized it may benefit you to return for a follow up.
i understand the worry that maybe they will push you off and not explore further.
final thought is that if you haven’t you should really get your operative report from the shouldice hospital as there may be some clues in the report-sometimes they may note some unusual things that can give insight to what may be bothering you .
hope this helps-if you can id try my best to see dr. Brown especially if the pain lingers.

[dog]

quote Jnomesh:

Consider dr. William brown in San Fran. He also specializes in non mesh repairs. It is also possible it is a Seroma-which is swelling donto fluid collecting where the hernia once was. It’s is usually soft and can be similar in appearance to a hernia

Shouldice repair is very complex..recovery is difficult … Dr. Chen correct about overstretching …..better alternative
Desarda M. P. method …..dr. William brown in San Fran..worth to visit..he is expert in this kind of situations

[Bure96]

Update: I had an appointment with Dr. Chen at UCLA here in Los Angeles a couple of weeks ago. He appeared rather fascinated with the Shouldice repair because he doesn’t see them very often, but he did seem quite familiar with the procedure. He asked me which surgeon performed my repair (Dr. Simmons) and he said he knew him. I actually heard him excitedly explaining the procedure to his interns after he examined me too.

Dr. Chen performed a manual evaluation of my repair and did not feel that there has been a recurrence. He explained that the large raised area near the original repair is not scar tissue, but rather just a symptom of the stretching of the abdominal wall that occurs to facilitate the Shouldice repair. He said that essentially they pull the already weak and thin layer of muscle even thinner to cover the hole where the hernia occurred. Thus, my insides are pushing against an even thinner layer of muscle and causing this bulge or raised area. By the time I had gotten to the appointment, the pain I had experienced for about 3 weeks around the time I made my initial post had mostly resolved. However, I’m having some pain again, possibly from all the poking around the doctor did during my visit. I have a good bit of nerve damage (numbness) in the area and there are instances of sharp pain when poking around the repair, but I can tolerate it.

Dr. Chen did not seem particularly fond of the Shouldice repair and even told me that “when the hernia recurs” (before correcting himself to “if the hernia recurs”), it will be at the site of this raised area. He advised me to refrain from lifting heavy objects or performing non-anatomical movements for pretty much forever. This will be difficult since I play ice hockey and try to stay in shape by lifting weights, but I will try to limit myself to lighter weights and higher reps.

Although I was happy to know that there has not yet been any recurrence of the hernia, I wasn’t exactly instilled with the utmost confidence moving forward. I’m a terrible worrier, so the fear that a recurrence could happen at any time will probably always bother me. I’m only 31 years old, so I’ll have to hope this repair lasts for quite some time. Dr. Chen noted that if a recurrence does happen, it will likely require laparoscopic repair with mesh.

[Chaunce1234]

quote Bure96:

I did have an ultrasound done back in September of last year (4 months after the surgery) and they did not detect a recurrence, but I was lying down and I don’t recall them asking me to cough or anything, so it’s possible they wouldn’t have caught anything. (The US was ordered by my urologists and was primarily to check out my other side, in which I’ve had periodic burning and aching sensations.)

I’m not a doctor, but I would say you might want to request another ultrasound of the impacted groin site. Specifically you’d want a dynamic ultrasound with valsava maneuver, which is basically you bearing down as if you were going to defecate. The idea behind that type of ultrasound is the following; it’s dynamic meaning a video is recorded of any possible movement/herniation of tissues, and the valsava maneuver can help appreciate a protrusion that may not otherwise show up by increasing intra-abdominal pressure. Sometimes these are done standing up as well so that you have gravity pulling things down further as well.

Anyway, ultrasound is fairly cheap with or without insurance, so it’d be unlikely to be too difficult to get insurance to approve it. If you have a primary care physician they should be able to order one for you as well.

In terms of doctors with specific Shouldice repair, the options may be limited in the USA. You will want to aim to find doctors that have experience with no-mesh traditional tissue repair, which was the standard for many decades until mesh was adopted as the one-product-fits-all approach, often that means older surgeons as the no-mesh repair is not commonly taught in most medical schools anymore, meaning unless a younger doctor has specific interest in learning the traditional tissue repair techniques they will not know them otherwise.

And as [USER=”2042″]Jnomesh[/USER] mentioned, Dr William Brown in Fremont CA is another good resource.

Good luck and keep us updated on your case.

[Jnomesh]

Consider dr. William brown in San Fran. He also specializes in non mesh repairs. It is also possible it is a Seroma-which is swelling donto fluid collecting where the hernia once was. It’s is usually soft and can be similar in appearance to a hernia

[Bure96]

Thank you for your reply. I am a 31-year old male. The pain I am having is mostly dull and aching, but can be sharp during certain movements, particularly getting up from a prone or reclined position. It comes and goes, but has been more consistent in the past 2-3 weeks. Lately, I’ve needed to unbutton my pants or wear something with a looser waistband to reduce pressure on the hernia area, which is something I had to do quite often before my surgery. It also seems to be a little worse when I am full. The pain sometimes radiates, with occasional sharpness, down into my testicle. The lump is slightly higher than the incision scar itself.

I did have an ultrasound done back in September of last year (4 months after the surgery) and they did not detect a recurrence, but I was lying down and I don’t recall them asking me to cough or anything, so it’s possible they wouldn’t have caught anything. (The US was ordered by my urologists and was primarily to check out my other side, in which I’ve had periodic burning and aching sensations.)

I contacted Dr. Towfigh’s office, but unfortunately it does not appear she accepts my insurance. I’m waiting to hear back from Dr. Chen’s office. There are a couple of other doctors in the area that I have also reached out to–there is a Dr. Leslie Memsic who has pretty good reviews and appears to have a good amount of experience with hernias.

[Chaunce1234]

What is the pain like? Is it dull and diffused? Vague? Pressure? Burning? Sharp? Electric? Constant or only with activity? Isolated to the area of incision or is it broadly dispersed throughout the groin? Out of curiosity, are you a male or female? How old are you?

Have you seen a doctor yet about the lump? It’s possible it’s scar tissue, it’s also possible it’s recurrence. A fairly easy way to find out if you have a recurrence is to get an ultrasound done with valsava, they’re usually pretty accurate for diagnostics.

Shouldice definitely works on recurrence so I wouldn’t worry about that in terms of returning to them, it’s fairly unlikely you’d even have the same surgeon since they are apparently randomly assigned.

In the LA area, the following hernia specialists could be a good start:

– Dr Shirin Towfigh (who runs these forums) is in LA

– Dr David Chen at UCLA

In Philadelphia, Dr William Meyers or Dr Alexander Poor could be good resources, they typically work with pro athletes.

As for insurance, you’d have to reach out directly to clinics and ask the front desk staff.

Good luck and keep us updated on your case.

[Krisztián Wirsz]

Hi! I have similar problem to yours (pseudo-recurrence 5 years after Shouldice) with pain following exertion as the most prominent symptom. I have been to 5 different surgeons and even asked dr Towfigh and I got 5 different answers. No surgery, laparoscopy, open surgery (Lichtenstein) with triple neurectomy, only neurectomy, etc. I am confused as hell and pretty dissapointed in medical science and/or these surgeons for not being able to arrive to a mutual conclusion. How are you coping wuth your problem and did you need surgery eventually?