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    Posted by Maximus on December 1, 2015 at 2:43 am

    I just had a question to see if anyone was familiar with.

    I am a 27 year old male who had surgery almost 3 years ago at the Shouldice hospital in Canada. I had surgery on a recurrent R inguinal hernia(first repair was laparoscopic with mesh that was a direct hernia, recurred within a month and was found to be indirect recurrence at Shouldice) and also 2 epigastric hernia repairs at Shouldice on the same admission.

    I have had bloating and digestive issues ever since the laprascopic repair. Have you ever heard of this occurring Dr. Towfigh? Digestive enzymes seem to help, but I had no issues prior and have tried to eliminate certain foods to no avail. I also have what I can only describe as a small fixed lump not visible above the skin near my incision site in both my groin and above my belly button. They are both there when I lay down and do not hurt at all unless I palpate them a lot. I do a lot of weightlifting and they do not bother me and all and I do not get pain at the site except for the occasional tugging sensation, but this is few and far between. I had Shouldice check them out and they said whatever it was is very small and had no cough impulse and their best guess is a piece of fat in between the sutures or scar tissue. Several doctors felt them and said they did not feel it to be a recurrence. I did not know if scar tissue could be felt like this. I know your not examining me yourself, but I did not know if you have stumbled upon this in your practice. Thanks for your time.

    Maximus replied 8 years, 2 months ago 2 Members · 2 Replies
  • 2 Replies
  • drtowfigh

    December 12, 2015 at 8:11 pm


    Hi there and thanks for the posts. Both are excellent scenarios.

    – You should look into getting a Gastroenterologist to evaluate you for SIBO (small intestine bacterial overgrowth). After surgery, if antibiotics were given to you (e.g., for your laparoscopic surgery, even one dose of antibiotic will do), it is possible that this caused an imbalance in the bacteria in your intestines, and thus you now have SIBO. The classic symptoms are bloating, especially worse with eating, and no change in diet works, but probiotics may have a small improvement. A hydrogen breath test is the study to diagnose this. A specific type of antibiotic and diet will help treat this.

    – Ultrasound and CT scans may be negative for small inguinal hernias or small recurrences in the groin. However, they are excellent tools for evaluation of epigastric hernias. If there is not hernia, then usually that is a true finding, unless the study was misinterpreted. Perhaps you have a suture reaction, such as to the knot in the suture(s) placed, and that is the cause of the bump under the skin. That is easily treated with either time (allow months), or local exploration, even in the surgeon’s office.

  • Maximus

    December 4, 2015 at 4:12 pm


    I also had a followup question. I had an ultrasound and ct using valsava. Both came back negative. I know based on reading your literature that this is not the best for groin hernias, but would this show a recurrent epigastric hernia? No mesh was used. Like I said, the fixed lump is very small and feels the same lying down or standing up and doing physical activities. Actually it feels a bit smaller when doing physical activities. I don’t know if its incarcerated or maybe not even a hernia at all. I didn’t know how good ct and ultrasound were for detecting something like that.

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