Post surgical pain

[Daniel]

Hello,

Apologies for non-hernia but somewhat related question – this board is informed, active and has both patients and doctors – a gem of forum.

A little over 1 year ago I performed a bi-lateral microscopic varicocelectomy which has had no anatomical or other surgical issues but has left me with constant groin pain on both sides. The surgery was done with delivery – many small metal surgical clips were used for vein ligation and larger surgical clips were used on cremasteric muscle fibers to also treat underlying vasculature (lost cremasteric muscle function as a result). In efforts to identify the cause of pain: multiple ultra-sounds, CT scans and MRI (imaging limited due to metal clips) – no evidence of hernia / varicocele recurrence, there is good blood flow present and nothing irregular anatomically. The pain is most acute and localized to the size of a quarter within the inguinal canal and correlated to the placement of the surgical clips (vs. surgical incision or scrotum). Been working through conservative treatment: nerve blocks (both ilio-inguinal and genitofemoral), pelvic PT and pain medications (Gabapentin and Celebrex) with limited and temporary relief. Any physical activities which activate the core causes an increase / flare up which takes weeks of bedrest and medications to reduce.

I used to be an active individual, now I manage my days around minimizing the pain. Any others in similar situation and/or doctors who can offer guidance on next steps to help resolve (if at all).

Many thanks
Daniel

[Good intentions]

I don’t have any suggestions Daniel. Just wonder if staple/clip removal is possible or has been suggested. Since the cremaster muscle is actually a muscle that moves and slides against surrounding tissue in the inguinal canal it seems to make sense that a metal clip would cause problems after activity.

And, if you’ve seen Watchful’s Shouldice thread you’ve seen that cremaster function after Shouldice is a big topic. Have you noticed if the scrotum is able or unable to lift the testicles? Maybe you could comment in his Topic. Good luck.

Here is is:

Where would you go for Shouldice surgery?

[Daniel]

Thanks Good intentions. Cremasteric function is gone.

Opinions from professionals are varied – Agreement: re-surgery in the area carries risk of more pain and testicle atrophy due to difficulty of scar tissue and anatomy changes – Disagreement: pain source a result of surgical clips (commonly used – although a real and recurring issue with hernia repair), neurectomy vs. preservation of nerve (s).

[Good intentions]

In the Shouldice repair the cremasteric muscle is completely removed from the spermatic cord. Any surgeon who does a Shouldice repair should be able to examine the cord and muscle and remove any staples if appropriate, without major concern, I would think. Maybe that’s why you came to a hernia repair site.

I would find a good hernia repair expert who understands the Shouldice repair. If you browse through the forum posts you’ll find several comments about surgeons who do not have a good understanding of the anatomy of the inguinal region.

There are thousands of surgeons out there who will try to help you, many just for the challenge of something new, but many who will not actually have the expertise to do so. Be careful.

[William Bryant]

Maybe David has given us another reason here for Shouldice to cut/resect the cremaster.

It would tie in with what I read about some surgeons cutting cremaster to avoid testicke retraction into inguinal canal causing a failure of the tissue repair.

In the circumstances maybe cutting cremaster is lesser of the risks if dangling testicle isn’t paunful and retracted is.

Good luck to David in resolving it anyway as I have spent a weekends with rsi computing pain and pain definitely gets you down.

[William Bryant]

I’ve replied in wrong thread – sorry everyone

[Daniel]

Thanks Good intentions – I came to this sight because of professionals familiarity with the anatomy – nerve, spermatic cord and inguinal canal areas.

Not many doctors willing to perform surgery – only a handful which have had much experience with dealing in complications.

[Good intentions]

Dr. Krpata might be worth consulting with. I’ll post some links.

https://my.clevelandclinic.org/podcasts/butts-and-guts/chronic-groin-pain-clinic

Case Report Illustrates Chronic Groin Pain Clinic’s Comprehensive Approach

[Good intentions]

A couple more.

https://www.generalsurgerynews.com/In-the-News/Article/08-2019/Experts-Describe-Unique-Approaches-to-Groin-Pain-After-Hernia-Repair/55620

[Author]

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