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Recurrent Sportsman’s Hernia (Inguinal disruption)
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Sounds like you had an inguinal hernia, maybe direct type and/or a small indirect type , and it was repaired. Pain 5 years later is a hernia recurrence until proven otherwise. A sportsman’s hernia would not act like this. And you would need to be quite athletic to get such injuries.
If I were to see you, I would get a dynamic MRI or review your ultrasound. If the hernia has recurred, then an open repair with mesh or a redo of the mesh repair would be indicated.
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Here is a search page about treatment of athletic pubalgia, with fairly recent results. Opinions have changed over the years.
https://scholar.google.com/scholar?hl=en&scisbd=1&as_sdt=0%2C48&q=treatment+pubalgia&btnG=
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I don’t know if this will help you or not but Dr. Sheen seems to run counter to prevailing opinion on treatment of athletic pubalgia. Many surgeons say that they do not use or recommend mesh for its treatment. But there also seems to be some discussion about how to define the problem.
You are in an odd spot, since Dr. Sheen is a firm proponent of mesh. He publishes often about mesh implantations. You might consider getting away from the mesh repair experts and see what an open repair surgeon thinks.
Here is a fairly recent paper by Sheen et al trying to show the efficacy of the TEP mesh procedure compared to open repair.
https://academic.oup.com/bjs/article/106/7/837/6092871
Here is another paper describing an open repair method on young athletes. It has some good diagnostic methods based on where the pain is that might help you understand your condition.
https://kosovajournalofsurgery.net/wp-content/uploads/2023/03/D-Litwin-2-KJS7_merged.pdf
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Thanks for your reply. I dont know of a specific action that caused it (I did carry a heavy item but the pain only started a day or two later). Last time, it was basically any minimal activity that caused pain and extreme weakness and its the same now. I am not particularly sporty but I am an active person and it drives me crazy to have to basically rest the entire time (and have everyone tell me they cant see anything wrong with me
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Did the pain return suddenly after a specific action? Or more slowly, like days/weeks/months? Have you been very active over the five years or more sedentary?
Sportsman’s hernias (athletic pubalgia) pain usually happens during activity, not so much afterward. While running or sprinting, for example.
If the pain is the same as before it seems reasonable to suspect that the same nerves are being affected. Not sure how a surgeon would address that since mesh has already been implanted. Mesh is known to shrink over time, so one possibility is that the mesh moved far enough that the previous weakness has been exposed. It is also known to fold and bunch up as it shrinks.
I am not an expert or a surgeon or a doctor but a TAPP procedure to view the abdominal wall from behind, followed by adjustment and/or placement of new mesh seems possible. I can imagine a surgeon recommending that as a possibility.
Just some ideas. Good that you got five pain-free years though. Hopefully the next will last longer. Good luck.
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