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Recurrent incipient inguinal hernia following Shouldice repair
Hi! I will try to sum up my case and ask for your opinion guys.
In 2018, January I suffered an elusive ab injury while working out in the gym, doing heavy compound lifts. After the session I felt like my entire abdominal musculature somehow lost its symmetry and was sore. The next day the soreness localized to my right groin, which seemed to have become somewhat lax, it looked slightly more “out” than the left side if that makes sense. No typical hernia bulge though. I stopped going to the gym and got it checked by some doctors. 2 out of 3 doctors said it was an incipient indirect inguinal hernia, only palpable upon Valsalva and even then just slightly. In June 2018 it was repaired using Shouldice technique.
The 1st week of recovery was miserable, then it got a lot better. That weird assymetrical look to my groin never went away, but I didn’t give it much thought and carried on with life. Probably a month after surgery I was swimming and cycling, and soon was back doing bodyweight training.Five years later this January, I tried macebell training. For those who are not familiar, it is kind of like a mix between a kettlebell and a club, and you train in a very ballistic fashion with it. I realized after tge first session that it puts a lot of strain on your abs, since you have to resist a lot of rotational forces with your core. I used the tool for like 5 days when the old weird feelibg in my abs returned. I took a day off, and then tried a simole bodyweight routine with pull ups, push ups, lunges and stretches at the end. Next day I could hardly walk. My entire groin was extremely painful. I rested like 4-5 days, and then started doing PT type of stuff. Began to feel better. Tried to resume physical activity (light bodyweight exercises), symptoms started again.
This cycle was on repeat for 5 months. In the meantime I had many ultrasounds, an MRI, spoke to several surgeons. Only the last 3 ultrasounds showed a recurrence of a small 10-15 mm herniation in the scar of the previous Shouldice repair. Still had no visible or palpable hernia. One surgeon said he could do a TAPP laparoscopy with self-grip mesh and that would sort out my problem. Another (a seemingly lot more conservative and cautious) surgeon said he was reluctant to operate on a hernia that only shows up on ultrasound and advised me to wait. He also added if my symptoms continue he could perform an open lreperitoneal mesh repair with possible neurectomy, but he cannot guarantee success. Both these surgeons agreed my symptoms are somewhat analogous with an incipient/sports hernia. Currently I am at a loss of what to do. What are your thoughts?
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12 Replies
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@wirsz Sounds like you simply have a small recurrence after an otherwise successful Shouldice repair from 5 yrs ago.
Go back to the surgeon who recommended laparoscopic repair. Make sure they’ve done at least 250.
Best of luck.
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A consultation with Dr Conze, including him doing a dynamic ultrasound himself, cost in the region €400 a couple of years ago I think, if you just wanted to get his opinion initially.
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Hi Krisztian,
Dr Muschaweck and Dr Conze (who would be a clear preference of the two in my opinion, as I’ve covered in previous posts) are the most expensive hernia specialists in Germany from my research.
Dr Lorenz, Dr Wiese and Dr Koch, who are the other better known specialists in Germany, were all less than half the cost when I last looked into it a couple of years ago, though that may have changed.
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@wirsz
Sorry to hear about this recurrence. You may want to consult with one of the top tissue repair surgeons in Germany (Conze, Lorenz, etc.) to see if it makes sense at all to try to fix it with a revisional tissue repair. I’m guessing it wouldn’t be the best option, but I’m certainly no expert on that.
They used to repair Shouldice recurrences with another Shouldice at the Shouldice Hospital. They probably still do that, but I’m not sure. For what it’s worth, when I asked my surgeon over there what I should do in case of recurrence, he said that most likely laparoscopic mesh would be the best choice. They actually do open posterior mesh operations there in some rare cases for primary hernias with bad tissue quality. However, that wasn’t the technique he was suggesting if I recur. I wouldn’t necessarily draw any firm conclusions from that. Just wanted to share what I was told there.
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Did you get the Shouldice repair at the Shouldice Hospital?
Reading your account I got the impression of somebody that is not letting an injury heal completely before testing the injured area again. I have been that person myself with other types of injuries.
The other impression I get is of somebody who is really pushing their body to its limit. That might, in the end, be a choice that you have to make. Giving up the extreme exertion exercises in favor of living a healthy and comfortable life. I tried to get my high end performance back and ended up much worse off than where I would have been if I had just realized my high intensity life had run its course.
But those are just opinions. You might start by assuming that you do have a sportsman’s hernia (athletic pubalgia) and following the guidance for properly and completely healing before getting back in to training. Athletic pubalgia is basically an overuse injury, not a physical defect like a groin hernia.
Here is one very basic description of it. It’s a complex area of study like all groin pain problems.
https://orthoinfo.aaos.org/en/diseases–conditions/sports-hernia-athletic-pubalgia/
You can also search the terms I mentioned above in Google Scholar.
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=athletic+pubalgia&btnG=
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How can you be so close minded? Do you know my financial situation at all? Do you know anything about the private hospitals and surgeons in my country? Could you point my country on a map? 😀 You’re talking from your American high horse telling me to spend all the money I have on hernia surgery abroad, when there is a war next door to us and I can literally not know if I will need my funds to save my family and myself. You have zero idea Billy.
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What the hell are you talking about? I said we have good surgeons here, hernia specialists too, very good private hospitals. Why on earth would I spend all my savings when I can get surgery in PRIVATE CARE – in case you still don’t understand – here in my country with a SPECIALIST for cheaper, because EVERYTHING is cheaper here??!
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This reply was modified 9 months, 3 weeks ago by Krisztián Wirsz.
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This reply was modified 9 months, 3 weeks ago by
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Sorry I won’t go international for a hernia surgery. Tons of peoole had hernia surgeries around me, most of them on insurance for free and I don’t know one at the moment who is having problems. That consultation with travelling and accomodation would set me back 2K euros easily. You guys need to understand that is not realistic for us in Eastern Europe, plus we have excellent hospitals and surgeons here too, but prices are way lower. Besides, after a failed Shouldice I really doubt another open pure tissue repair is on the table.
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You don”t seem to understand how reality works. Some people in the world simply cannot spend 8-10 thousand euros on a procedure that can be done in his country by qualified surgeons for a fraction of that Western European price lol. What a recommendation, Jesus. Please don’t even bother to reply.
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I contacted Muschaweck’s clinic but the price is too steep for me. They said they have a package for foreigners for around 8K euros. I can get 3-5 laparosopic (which is more expensive) surgeries here in private care for that amount.
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It looked asymetrical before the surgery and ever since after too. My surgery was not done in the Shouldice Clinic, but in Europe in my country (Hungary) by a general surgeon. At the time I had no idea about surgical techniques so I just went with this guy who is a friend of my brother-in-law and trusted he knew what he was doing.
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I was pain free every time I tried to resume to physical activity, apart from perhaps the last couple of occasions. You are somewhat right with your assessment, even though the type of training I was doing in the last years was nowhere near extreme. On the other hand, I am perfectly fine if I won’t be able to pursue those training goals I had in the past, but as of now even simple PT type of things can aggravate my symptoms. As for what you wrote about Athletic Pubalgia, I highly doubt it could heal on its own even if I rested it for months.
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This reply was modified 9 months, 4 weeks ago by Krisztián Wirsz.
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This reply was modified 9 months, 4 weeks ago by
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