News Feed Discussions Simultaneous Appendectomy and Inguinal Hernia Repair

  • Simultaneous Appendectomy and Inguinal Hernia Repair

    Posted by TooMuchPain on November 16, 2017 at 1:33 pm

    I am a 38 y/o female. Just over 1 year ago I underwent emergency surgery for appendicitis and a small inguinal hernia repair was completed at the same time. Prior to this surgery, I had no history of RLQ pain.

    I had continued pain post surgically, around a 5 chronically, then, 4 months later underwent surgery for stump appendicitis.

    Since that surgery on 2/2017 I have had increasing RLQ pain where the mesh was implanted. The pain has become so severe that I can no longer work.

    Q1) I have been told by 2 separate surgeons in f/u that the original surgeon should have never completed both surgeries at the same time. But a 3rd surgeon said it is common. I don’t believe the pain was at all related to a hernia, but when I was in the ER and in that much pain, I didn’t really think that through. So my Question is- is this a common set of procedures to be completed at the same time?

    Q2) Surgeon used a large Bard 3dmax mesh which is approx 4″ x 6″, for a hernia that measured approx 2cm x 1.5cm. I was told that is standard for an inguinal hernia repair. It seems to be a bit overkill size-wise. Is this standars practice?

    Q3) I am in constant, severe pain in the area where my mesh was placed. I have difficulty sitting, walking and most excruciatingly, going from a sitting to standing position. 3 surgeons I have seen believe I need the mesh removed but do not feel qualified to complete the removal. 1 surgeon has suggested inguinal nerve ablation. Would is be beneficial to consider a nerve block prior to agreeing to ablation? I would think if benefits are seen from a block, then a reasonable expectation would be that the ablation could be effective long-term.

    Q4) I have recently started experiencing swelling in my hands and feet in addition to the abdominal swelling I’ve experienced for the past year. I am waiting to see my surgeon for f/u to pain management, but I have 1 more month to wait. Is this a symptom I should be contacting their office about, or is it just a complication of hernia mesh implantation?

    Thank you!

    TooMuchPain replied 6 years, 6 months ago 4 Members · 7 Replies
  • 7 Replies
  • TooMuchPain

    Member
    December 27, 2017 at 6:25 am

    Thank you for the responses! I am sorry I didn’t see them until now- I never received a notification of posts on the subscription!

    Drtowfigh- thank you for the very thoughtful and detailed response! I went in today for exploratory and the surgeon found that 2 of the tacks had unravelled and were most likely the source of my pain. They were literally stabbing me with every movement!

    I was very desperate and was willing to have the mesh removed and potentially nerves severed, if they hadnt found those tacks. I have been severely depressed due to the pain and pretty hopeless given my lack of options and I had already used up my 2nd opinions so insurance wasnt going to allow me to see someone new.

    I have had no real fevers. (Just hangs out at high 99 or low 100) so I was told repeatedly that there was likely no infection in the mesh. We will see if today’s procedure was successful. I’m praying the tacks were the pain source and that I dont have to dabble in mesh removal.

    Thanks for the insight about the appendectomy and mesh repair at the same time. I was told by 3 surgeons that it is not recommended (after the fact), but was having a difficult time finding any studies or information that would lead to indication of wrongdoing in that example.

    It has definitely been quite a year. Thank you all for your responses- I am hoping that this does the trick and I can resume my life once I heal from surgery!

    Chaunce1234- thank you so much for the response as well. Dr Chen’s stance was that my obesity was what caused the issue. But I never had hernia symptoms in the first place. They found a small hernia (under 2mm) and justified the appendectomy while they were fixing the hernia. But I am pretty sure (and so is my current and my stump appendectomy surgeon) that the appendix was the culprit to begin with- and pathology confirmed both chronic and acute appendicitis after the 1st surgery. So the hernia mesh was just overkill in this instance.

    My pain was like a stabbing tearing pain every time I sat or stood up. Standing was particularly agonizing. But so far, only a few hours post o.o- I don’t feel that pain any longer!

  • Chaunce1234

    Member
    November 27, 2017 at 1:26 am

    I’m sorry you’re going through this, chronic pain is very unpleasant. Have you been checked for a hernia recurrence? Did Dr Chen elaborate on the relationship between symptoms and your weight? Are you underweight or overweight? Do any particular activities or behaviors make your symptoms better or worse?

    A general comment if you, Jnomesh, or others have difficulty with eating, digestion, and nausea would be to try drinking a strong ginger tea or real ginger ale (the types where ginger particles are floating in the bottle, it is strong) before a meal and see if that helps.

    My opinion as a fellow patient, if you are already in the Los Angeles area you might want to make an appointment to see Dr Shirin Towfigh, who also happens to run these helpful forums and wrote the comment above, and get her to review your case. She is very knowledgable, I believe her number is (310) 358-5020

    Best of luck, and keep us updated on your case and progress.

  • drtowfigh

    Moderator
    November 18, 2017 at 5:05 pm

    Thanks for the post.

    Very interesting clinical situation. I have high hopes that you will reach a cure.

    – no, it is uncommon to have a hernia repair at the same time as an appendix operation. Usually, we do not like to mix the classifications of contaminated or dirty (ie appendicitis) surgery with clean (ie Hernia) surgery. The only time it would be considered routine would be if the hernia was involved with an appendix in it.

    – what type of laparoscopic repair was performed? TEP or TAPP? Just curious.

    – have you been evaluated for a possible low grade infection or contamination of the mesh? That can potentiallly cause some of the other vague symptoms you have. Were you ever started on antibiotics to see if your symptoms go away?

    – my two cents about mesh removal and nerve stuff: please don’t dabble in it. Do not mess with the nerves unless you can prove that they are the problem. Nerve block may be part of that workup. Did your hernia repair use tacks? If not, then there is no way The ilioinguinal nerve can be injured.

    – as for the mesh size. Tat is standard. It’s not overkill. Studies show that size is best for most patients and has been shown to have lowest recurrence rate.

  • TooMuchPain

    Member
    November 17, 2017 at 3:01 am

    Thanks for the suggestions of surgeons. I really appreciate the info!

    I didn’t like Chen. Very arrogant and very dismissive. I was shocked considering he is touted as an ‘expert’. If he didnt want to do it he shouldn’t have seen me as a 2nd opinion IMO.

    Thank you for sharing your experience. I am glad to hear you are healing, even if slowly. I look forward to the day when I can walk again…or dare I even hope to run again? And sitting without agony sounds pretty amazing too.

    I appreciate you taking the time to respond. This has been a very frustrating experience…I wish I had found this forum earlier! Ive been looking for something like this for months, but the internet is very sparse on these types of things for some ‘odd’ reason.

    Thank you again! Wishing quick healing for you!

  • Jnomesh

    Member
    November 17, 2017 at 1:26 am

    No problem. Since you had it put in lapro I would focus on dr. Ramshaw of dr. Belyanski or Towfigh for possible removal. Ramshaw I heard has a long waiting time so I would as I mentioned send your scans to dr. Belyanski. He is doing more and more removals. I have spoken to three people recently who are scheduled to have there mesh removed by him in the winter.
    the mesh caused so many issues for me (attached to the bladder, spermatic cord, colon and illiac artery and vein-in addition to being folded up inside. Two things that are gone is that I now urinate normally. I also don’t feel that heaviness in my abdomen and I don’t feel sick like I did anymore. For me I was amazed at how little pain there was in the actual mesh site post removal. I went back to work after 7 weeks.
    sitting for me before surgery was the hardest for me and still can be challenging in certain situations. Driving mostly OK couches and deep soft chairs can be bothersome. If I sit to long I can get some burning in the upper lateral thigh. Waking is fine and lying down is fine. Eating and digesting was very tough for me after surgery and although much better is still an issue for me. I eat smaller lighter meals and don’t have as strong of an appetite.
    I am grateful to be back at work and getting through the workdays with no issues and back to being out of bed and back with my family doing normal routines.
    ive heard from others that healing can take at least 6 months to a year or longer so I hope there will be a day where whatever still ailes me is gone or minimally bothersome.
    lastly I have heard mixed things regarding Chen. I would consider ruling him out for removal. I also heard he has a tendency to do nuerectemies as part of the mesh removal whether or not the nerves are cought in the mesh. I know Belyanski does everything possible to preserve these nerves as well as Ramshaw

  • TooMuchPain

    Member
    November 17, 2017 at 1:01 am

    Thanks for the response!

    I had it implanted using lap, so I definitely know I need a lap removal.

    I have been on nortriptylene, gabapentin, Percocet and cyclobenzaprene to try to manage the pain but it isn’t doing much to help at this point.

    I saw Dr. Chen at UCLA and he blamed everything on my weight- I weighed the same before the surgery and was an active runner. Now I can barely walk through the grocery store. It is horrific.

    I am sorry you had a similar experience! How are you now that the mesh is out?

    Thanks so much for the quick response and feedback- my fear has been that it folded over or that a tack wad placed improperly. But nobody will take me seriously. Ive had a MRI 2 CT scans and Ultrasound- all of them are ‘perfect’. It is getting frustrating and depressing. I can’t live the rest of my life like this. Heck, I don’t know If I could handle another 6 months!

  • Jnomesh

    Member
    November 16, 2017 at 3:46 pm

    Hi I am not a doctor but a patient of the same type of mesh you had implanted. This type of mesh has a tendency to fold up inside of you especially if there was no fixation used and it can attached to the groin nerves. Please get your operative report so you can see the details.
    I eventusll had to have my mesh removed. It is not an easy process and you have to choose one of the few surgeons out there who do this-warning there are only a handful and you mostl likely have to travel.
    here is my advice-you are going to want to do two things simultaneously: 1) rule out that the mesh has folded up inside of you. If it has in my opinion then it absolutely has to be removed especially given the amount of pain you are in. The surgeon who discovered my mesh was folded is dr. Igor Belyanski in MD you can google him. Get a cat scan and send him the scan in a CD and see what he has to say. 2 other top notched surgeons where I live in NYC said all was well when they reviewed my CT scan. They were wrong and truth is 99.9% of surgeons and radiologists just aren’t trained on what to look for.
    2) while you are doing this yes get a nerve block make sure the place you are going to uses ultra sound guided nerve blocks. Based on your description to them they rule out one of the 3 groin nerves. If you feel relief from these nerve blocks some people rx doing it a couple more of times and there pain can be lessened or eliminated if not then pulsed radio frequency Albation is the next step and it has been reported to have results that last up to a year and then can be repeated.
    make sure the clinic has expertise in these matters.
    if it is determined that the mesh has to come out please only go to the best don’t let a local surgeon do it.
    also how your mesh was implanted: laparoscopic or open is the way the mesh should come out of it comes to that point.
    dr. Belyanski removed mine. He specializes in removing it robotic assisted laparoscopically but can do open removals too. Dr, Bruce Ramshaw in TN is an expert and can do both but usually has a long waiting time
    there is dr. Towfigh who runs this forum who has expertise in removing mesh and a dr. Peterson who I believe only removed mesh openly.
    also there are drugs like gabapentin that help with this type of nerve pain. There are pros and cons to it but i know how it feels to be laid up in pain and I was willing to do anything and everything I could to get back to work.
    best of luck to a very trying and difficult situation you are in.

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