right laproscopic inguinal hernia surgery with numbness and pain on right leg

[Jnomesh]

Also on one of your points Wilfred yes they tend to use a large mesh. They did with me and like you I am a thin guy. Part of the rational is that with a large mesh put in laparoscopically can cover all three types of growing hernias-femoral, indirect and direct which all occurred in different areas but in the same overall space. So yes it’s common for a large mesh to be used.

[wilfred]

NFG12 Thanks for words of encouragement. Your explanation is great. I have started taking some oral steroid s to see if it helps. I shall give it a good few months before deciding on mesh removal. Thanks again.

[NFG12]

Mesh removal is like a 50/50 thing. Surgeons say this might help a lot, it might help a little, you might feel the same or you can be worse off but they say usually no one is worse just the same. Some surgeons choose to cut nerves because it will bring numbness over pain and people opt for the numbness over pain especially if nerves are involved already then the damage has already been done to them. Surgeons also say that if the mesh is removed the scar tissue that grows back can entrap nerves and cause pain. They cant really know whats going on until they get in and see though. Once mesh is put in the anatomy is altered. Each time you go back in the same area especially a fragile area like the groin it alters it each time, it is a very complex area. For me I could not go on anymore with it in, the pain would keep me up some nights so I had to get it out because things would of just got worst and worst and the whole situation gets very tiring. I felt like I was getting sick a lot,sinus stuff, also like UTI symptoms, burning pains and numbness. I had it removed after 19 months and had 1 nerve removed on each side. The tacks would have eroded like, they were going into my pubic bone. The surgeon explained that they never use tacks for reasons like chronic pain and he said they always cause problems and that each time your moving the tacks are tugging and say when you have sex and your bumping that area its like driving them in more and more. I felt a lot of symptoms go away like the sick feeling, the UTI feeling, and the pain decreased, and its good to know its out mentally but its not like your back to 100% like you were before mesh, once its in the area will never be the same. Surgeons will even want to put more in after taking it out even the ones people name on this forum. A surgeon told me that say if you repair the hernia after the mesh is removed from the inside and suture it that it never really holds for long anyways but never opt for another mesh replacement. Take care of it down the road or find someone to due a tissue repair open. Each time they go in that area it gets weaker and weaker. Just give it a little more time and keep yourself educated by looking stuff up yourself about removal and nerve stuff. This is tough for everyone that goes through it and I wouldn’t wish it on my worst enemy. Keep your head up and try your best! Best wishes to you!

[wilfred]

Hi everyone
I went to my GP to request for an MRI. I gave him a copy from Dr Towfig’s protocol for MRI. His initial request 2 weeks prior were denied by my insurance due to lack of proper reasoning for MRI need. Hopefully with his refiling for MRI with my insurance with the proper language it should be approved. I need some feedback on the following:
Out of desperation and with no help from my surgeon I went to the local urgent care to get some x-rays of my pelvic area to see what was going on. I was surprised to see on the x-ray that my surgeon has used 13 helical titanium tacks. The clinical notes says 3 were used to fixate the mesh. There was no mention in the report about the number of tacks used to close the peritoneum. The report only said the peritoneum was closed with tacks. So I counted on the x-ray and it turned out to be a total of 13. Is that not a lot of metal in my body ? Is this normal to use so many metallic tacks for a small hernia on a thin patient? To add more mystery he has used an extra large size 3Dmaxx mesh. My waist is only 32 inches and I am completely at loss. Also I am confused how those 10 helical tacks are going to stay in the peritoneum long term? Don’t they get loose while doing exercises or any other vigorous activity? I wish I could upload the X-ray on this forum for some expert to look into that.. On the x-ray some tacks look horizontal (shown as circle) whereas other are vertical showing the full helical form. Some look like anchored to bone whereas most of them look as simply floating ( I guess those used to close the peritoneum will show as floating in empty space on the X-ray. This is just my guess. What I am worried is if any one or more tack has come loose? How would you know if any tack has come loose? Will it show on X-ray or MRI? My symptoms of constant testicular pain and heavy feeling of pressure and pull is not going away. This combined with pain in the glutal muscle and in the leg all on the right side where the hernia was is driving me crazy. If any of the 13 tacks were to impinge on any nerve should I be getting moderate pain (the way I have it now) or excruciating pain? I would highly appreciate if anyone has any advise or know anything about the tacks. I just want to rule out that these tacks are not the reason for my symptoms. I just can’t rationalize how tacks can stay and not get dislodged specially those are used just to connect soft tissue. I am not only concerned about my current symptoms but also about my long term prognosis with these tacks. Please advise. Thanks

[wilfred]

Thanks Jnomesh and NFG12 for the reply. NFG12 how are you doing after your mesh removal? I am just too concerned that life should not become completely devastated after removal of mesh whenever I decide to do that. Even in best hands there is no guarantee of a complete pain free life or at least better than with mesh in your body. Knowing from the experiences of those who went through that procedure could be very helpful. Is your life better than before as far as pain is concerned? Please advice . Thanks again. Jnomesh I was surprised that you had no pain after mesh removal from the surgery. I hope and pray that coming months you would improve from this difficult ordeal. I just wish I should have waited more.

[NFG12]

Hey there Wilfred! Sorry to hear what you are going through. You are pretty early out still but I can tell you that I had the same experience as you right after I had hernia repair with mesh. I had numbness from the crease of my thigh to about 6 inches away from the knee. I told the surgeon and he said it will go away in 8 weeks and its normal not to worry about it. 3Dmaxxx was used and 2 huge tacks to fixate it. Funny thing is you aren’t even supposed to fixate it at all, how Bard puts it anyway the company that makes it. It has a tendancy to fold over due to its shape that is supposed to fit the inguinal canal but no 2 human bodys are the same nor 2 inguinal canals. I knew I had nerve damage off the bat and pain from the mesh but was told to just give it time. I wish I knew then what I know now because I would have never got it done for 2 fat containing hernias that were found on a Ct scan not causing any symptoms ever! I talked to a surgeon that said I have a hernia now but I am going to wait till it gives me real problems because hernia repair is risky and up to 40% of people that get the surgery get chronic pain from it, especially when mesh is used is such a high rate. Dr. Jacobs in New York is one of the best hernia specialists in the country and he has had a hernia for like 10 years but opts not to get surgery and that tells you something. I had a bilateral repair for hernias that were nothing and I could have waited years to get surgery but I was told that hernia surgery is nothing and just to get it done and over. I was 25 years old,5’11, 160 pounds in 2015 when I got it done and to use a heavyweight mesh in a slim person is insane! Mesh is like toxic to your body and it even says that it is not intended for implantation of the human body. For me I had numbness right afterwards that subsided a lil bit but never went away and pain that just got worst and worst over time. I got it explanted after it being in for 19 months and had to have 1 nerve cut on each side. This simple surgery as so many surgeons put it and the mesh, the gold standard as they say, changed my life around and put me and my family, fiancé, friends through so much. If you are having problems already they might go away and they might not, mine never did. The sooner you would get it removed the better chances you have. A tack could have went through a nerve, my explant surgeon said no one should ever use any tacks because they always cause pain. You can try nerve blocks to see what nerves are irritated. My mesh created a lot of scar tissue which can also contribute to pain and the scar tissue the mesh produces is what is the barrier not the mesh itself its the scar tissue it induces. Mesh causes inflammation, it shrinks, it moves, it can fold like mine did. Just keep your head up and try your best. Your pretty early out still so see if things start to improve a lil bit then go from there. Best of luck to you!

[Jnomesh]

First of all having mesh removal is a bogndeciokns with a lot of unknowns for you will feel afterwards it depends on a lot of moving parts. That being said I do believe if you have it done with one of the free experienced surgeons it can be removed safely.
sounds like you are having some nerve issues and those can die down with time or can be sometimes dealt with successfully with nerve blocks/pulses radio frequency ablation
if your pain is a around a 3 I’d probably say hold off in thinking about removal unless you just want it absolutely out and are worried maybe things can get worse.
once it is removed you’ll also have to deal with will there be a hernia is there and then how to repair it-which will probable have to be repaired open method if you want a tissue repair so it will be a double surgery wrapped into one.
if you’ve had the mesh in for a Couple of years there is a good chance the hernia defect maybe closed due to scar tissue.
in my opinion I had to get mine removed Bc I had debilitating symptoms that got slightly better but still were pretty bad and when I found out the mesh was folded I knew I had to get it out.
so how am I doing ? Mixed. I fall under what appears to be a very common response-I’m glad it is out but I’m not doing great. I know and can feel it is out-and I feel healthy again but I still have some issues-especially with digestion and sitting which can cause a pressure feeling and inflammation in the stomach and groin. As I am a little under 5 months out I’m hoping this gets better with time but I’m also worried maybe my hernias have recurred. Again my mesh was folded and I felt it grab and twist my muscles and really globally messed with my body.
i will tell you I felt very little to know pain in the actual groin post surgery which I was very surprised and happy about. I did have a lot of stomach swelling and had a harder time dealing g with that. I can walk around and move fine but for whatever reason sitting is still very uncomfortable.
lastly when you have large mesh inserted lapro it covers a large area in there. Mine had to be peeled off my bladddr and other structures. Hope this helps

[wilfred]

Thanks Jnomesh for the reply. Could you please tell me how are your symptoms after you had your mesh removed ? Did you symptoms improve, same or more after the mesh removal. Would you recommend mesh removal if done by good hands as mentioned in this forum? If my symptoms did not improve then I may get the mesh removed but worried that I should not be in worst situation than now. Thanks

[Jnomesh]

Dr. Belyanski said the 3D maxx is a heavier mesh and isn’t the best for thin people. Yes definitely get the tests-a cat scan may show better if maybe the tacs/screws got dislodged or are hitting a nerve (although it doesn’t sound like it) it could also just be inflammation. Unfortunately it can be such a myriad of things it’s dizzying. Praying with time it resolves itself but arm yourself with knowledge in the meantime. I went back to my original implanting surgeon 3 times over the course of a year Bc I would have these unbearable flare ups-and all 3 times all he did was check for a recurrence. So definitely seek out a specialist there are a few out there (Towfigh, Ramshaw and Belyanski )

[wilfred]

Thanks Jonomesh for the reply. I just don’t understand about my surgeon who boasted that he has done 3000 hernia surgery and I being thin would never have any complications. Finally he places an extra large mesh, places three titanium tacks and closes the Peritoneum with more tacks. This is what the report said. I watched Dr Shirin Towfigs’s presentation on u-tube in hernia society meeting which clearly said that non use of tacks can reduce the post op pain. I don’t have debilitating pain but this constant dull ache in groin and other area is just driving me nuts. Cannot concentrate in my work and don’t know what to do. I never had high blood pressure and now constantly I am having this high blood pressure because of being stressed out so much. I am thinking about getting an MRI and cat scan to see if it shows up something. I shall contact Dr Shirin Towfig after I have all my documents. At least we are lucky to have pioneer like her who can help remove the mesh if needed. There are people outside USA who do not have any access to any surgeon who can remove mesh. I hope I get better with time. I thought they had done lots of improvement in the mesh design since you had your surgery 6 years back. But who knows what improvement in design they did. Everyday I wake up and cannot turn back the clock. So frustrating.

[Jnomesh]

I really don’t want to worry you but wanted to chime in that I had the 3D maxx mesh implanted 6 years ago and had issues from day one. They weren’t debilitating but occasional flare ups were.
about 10 months ago I did experienced debilitating pain and after much exhausting journey found out that the mesh had folded. The only surgeon to see this on a cat scan was dr. Igor Belyanski in MD. I ended up having to have the mesh removed.
i have spoken with a good number of people on a mesh forum who also had the same 3d maxx mesh and are either in pain or had to have the mesh removed. For them to the mesh had folded over. Unfortunately this type of mesh Bc it is concave (this the 3D) it had a tendency to fold over. Not saying this is happening to you but just so you know that this particular mesh has a tendency to do that.
your local surgeon will most likely be of no help, they only check for recurrences and then it’s off ti pain management.
im sorry for the pain you are going through and I hope in time it will dicipate. I’m the meantime please layoff stressing the area-no lifting excecing etc. give the area time to heal and then go from there p

[wilfred]

Hi everyone,
i have posted earlier about my numbness and pain on my right leg from my butt down. I had only occasional pain on my right testicle and groin after the surgery which for most purposes I thought was a part of healing. But my main concern was my right leg numbness and burning at the butt down to the leg. Having found no help from the surgeon and having no improvement I went to a chiropractor 5 weeks after my surgery. He was little aggressive in manupulation of my gluteal muscles and legs. Since I saw the chiropractor it has been 3 weeks and I saw some improvement in my numbness but now my right testical pain which was intermittent is almost there all the time including light burning in the groin area. My right testicle feels like heavy or pressure or pulling kind of sensation. This was very intermittent after the surgery but now has become almost constant. I went to the surgeon last week as I was worried that the repair might have been damaged by chiropractor manupulation of my legs but he checked and said the repair looks fine and my symptoms should go away. When I take Motrin it reduces or goes away but comes back immediately if I don’t take Motrin. I was most concerned about the pain on my butt and now on my right testicle. Can it be that the manipulation by the chiropractor made the mesh to move? I am really concerned. My testicular pain is about 3 and sometime 4. My surgeon told me that I had a small hernia but he always uses extra large mesh to rule out reoccurrence. I looked into the surgical notes and it says he used XL3Dmax mesh. I am only 5 ft 7 inches tall and weigh only 148 lbs. I don’t see the rationale to put extra large mesh on a thin patient like me. Could this be the cause of my symptoms? I don’t know what else to do. Very depressed whether it will ever go away. Please advise me if I should go for an MRI or Catscsn? I don’t expect anything further from my surgeon as he can only verbally console me that it would go away. Please advice me.
Thanks

[ajm222]

quote wilfred:

Hi Ajm222
Thanks for the response. Bring a dentist myself I like reading journal articles. Are you from Virginia? I graduated from medical college of Virginia (VCU) dental school in Richmond. I still remember during the gross anatomy days while disecting cadaver the instructor showed us the inguinal canal and all the nerves in that area which I never paid much attention as I thought I should only concentrate in head and neck which is my area. But overall I do understand and know the basic anatomy of that area though never had to use in my practice. My surgeon called me today and told me that he never had anyone complained about the kind of symptoms I am having. But all those journal articles or even forums are full of these post op symptoms in the leg or groin. I explained to him clearly that my symptoms are mostly in the area where lateral cutaneous femoral nerve innervates. But in addition I am also having some symptoms at the calf muscles and sole of the foot. Anyway with great difficulty I managed to get an appointment for tomorrow with a neurologist for EMG and nerve conduction test. I was told it is ok to get physical therapy started which I am starting from Friday. I hope and pray that I am out of this saga of post op pain and numbness and can enjoy seeing my own patients and give them 100% of myself the way I used to.

Sent you a private message about RVA and dentistry 🙂 Good luck with the appointments, and hope things continue to improve. Maybe I’ll actually reach out to YOU if I have questions about articles I come across or the anatomy of the area in question! Will be interested to see your progress.

I am trying to plan an inguinal hernia repair (possibly bilateral) myself in the next month or two in town and obviously worried myself about possible complications. I personally know about five people who have had the surgery (all with mesh), including my grandfather decades ago. All but one suggest they recovered 100% (and the exception says he’s still satisfied) but several did have some issues. And oddly enough most said open repair was easier recovery than laparoscopic. Was thinking I’d go with robotic laparoscopic repair but I also know the cost will be ridiculous. I have insurance, but I am certain that would max out all of my deductibles, etc. Wondering if it’s worth it.

I don’t currently have a ton of issues with discomfort and pain, but it seems on the weekends when I am more active and standing a lot, I do have problems. And when I overexert myself or cough or sneeze, it’s uncomfortable. I have a small bump and could probably just wait, but it seems wise to just get it fixed sooner rather than later. I’ve basically come to terms with the fact that non-mesh repair is very hard to come by and almost never done here in the states. And all the surgeons have said they’d have mesh if it were them, and that non-mesh can have complications of it’s own and somewhat more likely to need repair at some point down the road. And any surgeon doing a non-mesh repair isn’t going to have a lot of experience doing it, unless I travel somewhere, which is cost prohibitive.

[wilfred]

Thanks Momof4 for the reply. I also feel some encouragement from others that it shall go away with time. But I wake up with very depressing feeling. Sone time I wonder why I didn’t fly to South Korea or to have it done by a handful of US surgeons who do without mesh or tacks. My burning pain has now changed to intermittent throbbing pain and that is what bothering me. Why did you go for mesh removal? Was there lots of complications with the mesh? Let us hope for the best.

[Momof4]

I am going to have to chime in on this topic. I had a large mesh removed 3 months ago and ever since that surgery I am having trouble with my lateral femoral cutaneous nerve on my right side. I never had any problems with it before the surgery. My skin is numb to the touch and I have tingling and burning pain that goes from the crease of my leg to just above my knee. I have had a nerve block by a pain management specialist, after mesh removal, and that didn’t help. I also had a re-exploration looking for nerve entrapment but that wasn’t the issue. The nerve may have been compressed in a tight repair and it has been loosened up. I also still have lots of inflammation and swelling that may be contributing to the problem. I am going back to pain management and perhaps a neurologist for help. It is the kind of pain that is hard to ignore, I feel it all the time. I am hoping it is something that will resolve with time. It gives me hope to hear that others have had the problem resolve over time. Wilfred, I hope you find resolution to your problem. I certainly know where you are coming from and it is not fun!!

[wilfred]

Hi Ajm222
Thanks for the response. Bring a dentist myself I like reading journal articles. Are you from Virginia? I graduated from medical college of Virginia (VCU) dental school in Richmond. I still remember during the gross anatomy days while disecting cadaver the instructor showed us the inguinal canal and all the nerves in that area which I never paid much attention as I thought I should only concentrate in head and neck which is my area. But overall I do understand and know the basic anatomy of that area though never had to use in my practice. My surgeon called me today and told me that he never had anyone complained about the kind of symptoms I am having. But all those journal articles or even forums are full of these post op symptoms in the leg or groin. I explained to him clearly that my symptoms are mostly in the area where lateral cutaneous femoral nerve innervates. But in addition I am also having some symptoms at the calf muscles and sole of the foot. Anyway with great difficulty I managed to get an appointment for tomorrow with a neurologist for EMG and nerve conduction test. I was told it is ok to get physical therapy started which I am starting from Friday. I hope and pray that I am out of this saga of post op pain and numbness and can enjoy seeing my own patients and give them 100% of myself the way I used to.

[ajm222]

Well, best of luck. And hopefully Dr. Procter can chime in again with some hopeful words. It can be tricky to review scholarly articles as a layperson and fully understand them without catastrophizing. I know many times I’ve read them and come to certain conclusions that were totally off-base because I didn’t fully comprehend the context or the lexicon. Not to say you read things wrong, but almost hoping that maybe you did 🙂 Regardless, I think over time many of these things tend to sort themselves out. Hopefully that happens in your case. In the meantime, probably good to follow the doctor’s advice and stay active and do moderate stretching and some walking/running or whatever you can. It could be nerve entrapment, but I am guessing it could be a dozen other things as well that have a great long-term prognosis. Again, I have several friends who have had inguinal hernia repair with mesh and almost all basically said they had lingering issues that took several months to completely resolve. For the most part they were fine shortly after surgery, but several had things that persisted for quite a while. All report they are 100% better today except for one person who has an occasional twinge once in a while. But even he says he’s satisfied with the surgery and would do it again.

Oh, and I believe I have read here that there are definitely ways to remedy a trapped nerve. So even if it’s that, and even if it doesn’t go away, you do have some recourse. Not to say it would be a simple matter, but a trapped nerve isn’t impossible to deal with. Really depends on the situation I think.

[wilfred]

Thanks ajm222 for the reply. I am still worried. As I read some scholarly journal articles saying that if the numbness happens immediately after surgery as in my case then it may not go away as compared to happening few days after surgery which shall go away as that is due to inflammatory response of the body. Once the inflammation stops the numbness goes away. It makes sense. If the nerve is trapped it shall never go away. But if it is due to inflammaory response it should settle down with time.I also read that this complication is more common in laproscopic and not that much in open procedure. Thanks for sharing words of some hope.

[ajm222]

I have a good friend who had lots of numbness after a second inguinal hernia surgery, and it took a couple of months for things to improve (i think this is unusual and his situation sounded worse – constant leg numbness). but it eventually went away completely. he was told this is not an uncommon complication and that usually resolves without issue.

[wilfred]

quote LeviProcter:

Still pretty early in the postoperative course. Need to give it at least 6-8 weeks.

B9781416054740000424_gr4.jpg

Gluteal nerve sensation is supplied by any nerves in the region of an MIS inguinal hernia repair.
See above link for skin sensation region based on the nerves at risk in an MIS inguinal:
– iliohypogastric
– ilioinguinal
– Genital branch of GFN
– Femoral branch of GFN
– Lateral femoral cutaneous nerve

The femoral nerve itself would be very difficult to in-advertantly injure. It’s difficult to even find and is often deep to psoas

Your symptoms don’t sound tack related.
Your symptoms seem to be pressure on some of the groin nerves (lateral fem cutaneous) related. If it occurs in a seated position it can be mesh pressing on the nerves but is relieve with moving. Your mesh is generating lots of inflammation as its intended at this time frame.

The gluteal down to the foot can imply lumbar nerve root impingement vs muscle spasm related issue.

Nerves are not sought typically to prevent injury. Tacks are avoided in the triangle of pain (where the nerves primarily are).
Fixation often not needed unless large direct hernia >= 3cm.
If fixation is used it’s based on anatomy and landmarks.
Stretching is fine.

Way too early to jump to conclusions.
Be active.
Give it 6-8 weeks before digging further.

Thanks Dr LeviProcter for replying. It makes lot of sense to wait and see as you rightly said the natural inflammatory process due to mesh will take some time to settle down. Thanks again.