Should I have a hernia re-done?

[MSJR]

I’ve been doing some research on hernia repair and came across your work/research, which is very impressive. I’m a 36 year old male that had an inguinal hernia repair using the “open” method with mesh in 2000. A general surgeon at NY Hospital did the repair. Although the repair has seemed to hold up, I have had intermittent pain/discomfort over the years, especially when I play certain sports or workout in the gym. Certain abdominal exercises feel like a knife is stuck in me! Once the area gets inflamed, I generally ease off from a lot of physical activity and it calms down in a week or two. But no matter what I do (yoga, acupuncture etc) I can’t seem to completely remove the discomfort. On a scale of 1-10, I’d say it’s normally a 1 but can go to a 5-6 depending on what I do. But I’m always aware of it, which is annoying. I also think I have a small one on my left side, as I occasionally get intermittent pain there as well but it’s not too bad.

I’ve been reluctant to have someone go back in the and redo the first hernia but wanted to get your perspective on this. I lead a very active lifestyle (lift weights, martial arts, tennis swimming etc) and I don’t want to have to limit myself at all. Do you think the pain/discomfort I feel is normal? Is it worth opening me up again to try to remove this issue from my life? Any and all opinions are welcome.

Many thanks in advance!

[sngoldstein]

Should I have a hernia re-done?

I am a hernia surgeon in the Albany area. There’s no point in redoing your hernia if there is not a recurrence. You may benefit from a nerve ablation. Yes, you probably have a hernia on the other side.

[groundfaller]

Should I have a hernia re-done?

Is the answer really that simple…nerve ablation? What do the other doctors on here have to say. I have been dealing with chronic pain for a year now since my surgery and it is almost impossible to get a doctor to talk to me about it. If it were so simple as ablation, wouldn’t they be more willing to discuss this? Where is the research?

[drtowfigh]

Should I have a hernia re-done?

I agree with Dr Goldstein.

Details of your pain, where it is, the quality of it, etc, and a physical exam will help determine why you have the pain.
If the pain comes and goes with certain activities and has been doing so since surgery, it is possible that a stitch or a scar tissue or the mesh may be tugging on a nerve with those specific movements. Local nerve blocks may be diagnostic and possibly therapeutic. Your surgeon or a knowledgable skilled pain management physician can help start that work up. Often redo surgery is not necessary. At times surgical nerve transection may be necessary.
If you had no pain until recently, then a hernia recurrence should be considered. If it is not felt on examination, then imaging via dynamic MRI with Valsalva should help.

[MSJR]

Should I have a hernia re-done?

Thanks for the reply!

So assuming I do have a hernia on the other side that needs a repair, would you suggest a laposcopic repair so that the surgeon could inspect the other side for these possible issues you mentioned? Can anything be done surgically to alleviate the pain/rubbing/discomfort without re-doing the surgery?

Is there any risk to having nerve ablation done?

Thanks in advance!

[sngoldstein]

Should I have a hernia re-done?

The first step is to have someone who knows what they are doing do a diagnostic block with local anesthetic and see if that relieves your symptoms. If that is successful, then a permanent ablation should work. Other than failure and numbness, there shouldn’t be any issues. As far as the other side goes, a laparoscopic repair should have a lower incidence of acute pain, but it is more important to get the operation that your surgeon is most comfortable with.

[drtowfigh]

Should I have a hernia re-done?

A. I don’t recommend that you mix two procedures together. Deal with the acute problem of your pain first. Once you are pain free, then deal with the elective asymptomatic hernia. And let the surgeon choose the technique.
B. If it’s a nerve issue and nerve blocks alone are not helpful, surgery can help. If it’s a pure nerve issue and you have no pain from anything else, then yes the nerve can be surgically addressed without disrupting the repair.

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