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Possible recurrent hernia?
Back in 2004 Dr. Parviz Amid (since retired) at the Lichtenstein Hernia Institute repaired my left inguinal hernia using the open anterior Lichtenstein method with mesh (When he opened me up he actually found multiple hernias). I have gone 11 years with no problems until about a week ago. Then this problem occurred out of the blue. I cannot think of anything I did that caused it.
For about 5-6 days I have had a feeling in my left groin area like their is intermittent pressure pushing outward from inside. Comes and goes. Other times it feels like something is rubbing or stretching (when I pull my briefs away from my skin the symptoms are relieved). Sometimes the feelings go away. Usually when I am walking. I really don’t have pain. For the first couple days I was sore when I pressed on a specific point in my groin but since then I really have no real pain. Just the symptoms described above. I also DO NOT have a visible bulge. In fact, both sides of my groin area feel and look the same. I have lost about 10 pounds over the last 2 months as I started eating more healthy (cutting out all the junk food). Could this have an effect? I am not overweight. I am 5’8″ and weigh 163 lbs (down from 174 lbs). I was wondering if I could have a recurrence or whether this could just be scar tissue from weight loss.
I am concerned that without the visible bulge it will be very difficult to diagnose my condition.
It is my understanding to fix a recurrent hernia and avoid scar tissue from the original open anterior Lichenstein mesh repair, a posterior laparoscopic mesh repair would be required.
If I do need a recurrent hernia repair, I would be looking for an experienced laparoscopic hernia surgeon LA/Orange County who has done over 750 laparoscopic posterior hernia repairs with mesh. I checked the AHS site but they do not clarify who is experienced in laparoscopic procedures.
What do you think of my symptoms? Is this typical of a recurrentce? Would one of the doctors on this forum be able to recommend someone with this experience in the LA / OC area?
Which method do you recommend – TEP or TAPP?
Regards,
Steve Bachman
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6 Replies
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Possible recurrent hernia?
A single view of an ultrasound is not very helpful. Ultrasounds are dynamic so the entire video of what was performed is more informative.
That said, this ultrasound shows two layers of mesh in the plane of view. The mesh layers are both flat. There is no air bubble. The question is: what type of mesh was implanted? If a single mesh, then the mesh is folded, with hematoma in between. If it was a two layer mesh, such as the Prolene Hernia System, then this may be a normal image.
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Possible recurrent hernia?
I had a bi lateral hernia operation in June 2013 which was a source of GREAT PAIN.
This image was taken November 25, 2013
I had conflicting ideas from the ultra sound technician and doctors.
Doctors said they did not know how to read an ultra sound and ignored the images & report.
One doctor said it was just an air bubble?
Standing would cause great pain and felt like an hard boiled egg in my groin. Laying down the pain was reduced.
The mesh was replaced June 2015, I can stand now. Some pain sitting.
The surgeon said the mesh had curled after the operation. The next day he said all was installed correctly???? He did not want to talk any more on the subject, and ignored his comments from the day before, that the mesh had curled . I an still waiting for the other side to be redone.
Are there an medical doctors that can give medical terms of what the Ultra sound shows.
I see a tear.
No doctors, or hospitals mentioned in the posting. -
Possible recurrent hernia?
Hi there
Any updates on how you’re doing? -
Possible recurrent hernia?
Redo surgeon again in the open fashion is not recommended. This would result in higher recurrence and higher risk of nerve and spermatic cord damage, due to reoperation in a scarred field.
The imaging with bear down views will help confirm the diagnosis of recurrence.
Adding stitches will not help. A new repair needs to be done. Synthetic mesh works by causing inflammation and having muscle thereby grow into it. The stitches are secondary. So restitching alone does not help -
Possible recurrent hernia?
Is it possible that a couple sutures could have come undone on the edge of the original mesh repair? Perhaps this would explain why there is no apparent bulge, yet I sometimes get the sensation of a bulge. Would this show up on a US, CAT Scan, or MRI? If this is the case would recurrent open be done to add in a few stitches? My greatest fear is nerve damage from operating through scar tissue. However, the operation will be done by a hernia specialists.
Regards,
Steve Bachman
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Possible recurrent hernia?
You are correct on all accounts.
First you should seek consultation with a surgeon that is familiar with revisional hernia surgery. Their ability to get an accurate history and exam is key in your diagnosis. They know what to ask and what to feel for.
A CT scan with valsalva or MRI pelvis with valsalva will help diagnose your recurrence, especially if there is no palpable bulge.
In LA, I am happy to see you. Also, Dr David Chen at UCLA. I also recommend Dr Namir Katkhouda at USC or Dr Edward Phillips at Cedars-Sinai. In the OC, I recommend Dr Mercedeh Baghai in Torrance.
Please let them know you were referred via HerniaTalk.
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