Recurrent hernia after removal
08/13/2022 at 7:15 am #32161
So I’m suspecting, after a year and a half, that my hernia may have recurred after robotic mesh removal. I had what I was told was an indirect right side hernia in 2018 that was repaired with progrip mesh. Had mild to moderate pain and discomfort after repair that never went away. Had removal three years later (Feb ‘21).
I was examined last month by my removal surgeon (Belyansky) because of a soft lump that had been there since removal, and was judged not to have a recurrence, but I noticed a change this week and I think it finally broke through. No new pain or discomfort that wasn’t already there. I had a lump before but it was basically empty. Now it feels like it has reducible contents.
I have another appt with Belyansky to confirm and to ask questions and possibly schedule a tissue repair. I was always told an open tissue repair would be very feasible since that space hadn’t been disturbed. I’m just wondering if there is anything I should worry or be concerned about in the meantime. I really was hoping I’d make it longer or forever before recurrence and frankly surprised it came back so quick.
Is there a higher chance of strangulation in this case?
How quickly might this thing grow?
Are there any other things I should look out for under the circumstances?
Should I avoid any lifting and exercise until repaired?
What are the chances of a tissue repair holding in a low-BMI 46-year-old when performed by a reputable surgeon?
If I get the repair, should I stop running and just go easy for the remainder of my days, assuming it goes ok?
What would be the best type of tissue repair?
I don’t really have the means or desire to travel the world looking for the absolute best possible tissue repair despite knowing ideally I should do everything possible to make sure this is the very last surviving have on this hernia, and I have a good relationship and trust with Belyansky. He knows me and he knows anatomy. I considered Sbayi but that’s no longer an option.
08/13/2022 at 3:08 pm #32165Good intentionsParticipant
I don’t think that running increases the odds of getting a hernia. Certain types of lifting do though, I think. Using the Valsalva maneuver to lift more weight for example.
Since Dr. Belyansksy is primarily a laparoscopic mesh implanting surgeon you’ll want to find out what pure tissue method he uses and what his results are. He probably has a small number to work from though. You might ask him if he has a recommendation for a surgeon for a pure tissue repair. Who knows, he might be more confident in someone else’s skills in that area.
08/13/2022 at 3:27 pm #32168David MParticipant
I’m just researching myself, but I think that Dr Towfigh, in one of her recent videos….maybe the one on Watchful Waiting, discussed exercise with her guest. I think they both said that exercise was not generally a problem, though they did warn people off of squats and something else. I’d seek confirmation of what was said. I found that particular video to be a good one, btw, and posted a summary of the later half the other day.
I have what I think is a direct hernia. It’s about the size of a tennis ball now. If I’m wearing a truss, I feel no pain whatsoever when I do fast walking for exercise. The truss works, imo. In the morning when I wake up the hernia is reduced, but once I start walking around, I can feel slight discomfort. It doesn’t hurt much, but the feeling makes me distrust walking around without the truss. So, i would consider the idea of a truss when exercising.
In another one of her videos, Dr Towfigh has said that trusses have been shown to be safe and, I believe, not to make a hernia worse. At any rate, I think they have value based on my personal experience, but my hernia is fairly large. And I couldn’t say with regards to an indirect hernia.
What kind of tissue repair does Belyansky do? I would also ask him how many times he has performed the tissue repair and how many he has done in the last year. Whether he’s good or not, I think it’s important to have a doctor with strong and current experience.
08/13/2022 at 3:36 pm #32169
Thanks. I did ask, and he didn’t really have a lot of recommendations for tissue surgeons. While I know he’s great with the robot, I know he’s also an experienced abdominal wall reconstruction surgeon, and must do a fair amount of tissue repair even if it’s not always for inguinal hernias. while it’s probably mostly robotic, I’m sure he’s got plenty of experience with tissue and an excellent knowledge of all of the relevant anatomy. But I’ll definitely get details. When I go back up I’m going to get all the details as well on the method he uses for open inguinal repair, and if it’s also done under general.
I do remember surgeons saying running and walking and most exercises don’t really worsen the chances for a hernia or make an existing hernia worse, but I do wonder if after mesh removal basically anything could stress a very weak area like that. Perhaps after an adequate tissue repair it’ll been safe, though I think my running days are over. Will likely stick to walking or swimming or something.
I’ve had regular pain and soreness since removal and I’m wondering if finally getting another repair might help with that. I pray it doesn’t make things worse. Though at this point I’ve very little in the way of positive expectations.
08/13/2022 at 3:37 pm #32170
And another recurrence after this would be very bad. Would probably have to go back to mesh and just deal with it.
08/13/2022 at 5:07 pm #32171Good intentionsParticipant
It might be worthwhile to contact Dr. Ponsky. He showed good results for his laparoscopic pure tissue technique all the way up to patients aged 41 years. If you have weak tissue it’s going to affect any type of pure tissue repair.
08/13/2022 at 5:34 pm #32172
Thanks, will do.
08/14/2022 at 8:43 am #32180
FYI – I reached out to Dr Ponsky this morning and he immediately responded, saying he can’t do the procedure himself because he works at a children’s hospital, but he is going to look into finding someone nearby who he could help do the procedure, which I thought was interesting. He said it may work very well for me. Obviously I’d be super nervous about someone doing this exact procedure for the first time on me. Doesn’t seem like a great idea. But I’ll see what else he says. I also don’t know about going back in laparoscopically after mesh placement and removal. Seemed like an open tissue repair might be more ideal.
08/14/2022 at 9:33 pm #32188WatchfulParticipant
Interesting. Did he explain why he thought it would work very well in a 46 year old? Just treating the sac without treating the defect seems like begging for recurrence…
08/15/2022 at 10:10 am #32197
Hi didn’t say. And I don’t know enough about the procedure. But he got back to me again later and basically just copied Michael Rosen from the Cleveland Clinic on the email and suggested the two of us connect. Will see if he chimes in.
I need to verify this is definitely a recurrence, and the nature of it, and find out the size, and speak to several surgeons and see what they all suggest I do.
09/02/2022 at 11:45 am #32308
Quick update. Saw Belyanksy again. Seems it might have been a false alarm somehow. Felt what he thinks is perhaps a small lipoma maybe upon coughing but not like a full-on hernia, and something so minor he said don’t do anything unless it’s totally bothering me. And if he did need to do anything, it would only require a smaller incision and some stitching to deal with the lipoma and close and tighten things up, but not totally opening up and fixing the entire inguinal canal. And I don’t think any of my issues are coming from there. So a relief for now.
09/02/2022 at 12:58 pm #32310William BryantParticipant
Good news and must be a relief for you.
09/02/2022 at 2:23 pm #32311
for sure, though part of me had managed to come to terms with things and was looking forward to having that area strengthened with a solid tissue repair. but any surgery is truly a big deal and i’d just much rather keep avoiding it if possible. and i certainly will be happy to not have to spend the money.
i had even asked him if perhaps my original hernia was even a real hernia and not just a lipoma, as i do remember my first operative report mentioning a cord lipoma being dealt with. he said who knows. but that report did also mention a true hernia i think, so hopefully all the surgeries weren’t for nothing. and though memory is short, i do feel like i definitely had a reducible and moderate sized bump.
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