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Soliciting advice, and maybe input from Dr. Towfigh
So many of you know I had progrip mesh placed on one side robotically in 2018 for an indirect hernia (and a lipoma removed at the same time), and then had that mesh removed by Dr. Belyansky in 2021 after three years of constant discomfort and pain.
Since the removal I have been quite active and generally doing well, but there has been lingering pain and discomfort that increases and fades in intensity for no real discernable reason. At times that pain and discomfort rivals what I dealt with before the mesh was removed. There have been improvements in terms of the frequency of discomfort along with the tightness I had with the mesh, though.
While no new hernia has been detected, I have been dealing with a modest bulge that sticks out on the removal side that seems to have gotten larger in the last few months. I was examined again by Dr. Belyansky and even had a CT scan because I was certain the hernia returned because it looked and felt just like that area did before my first mesh surgery. His diagnosis was that this was not a true hernia but there was perhaps some retroperitoneal fat pushing on that spot along with another lipoma, and maybe the removal weakened the area enough to allow for this bulge. The CT didn’t show an obvious hernia either.
I asked if surgery could correct this bulge and whatever is causing it and he said that he could do another surgery but it wouldn’t be a full Shouldice type repair where the whole inguinal canal is opened up as that didn’t seem necessary. He would instead remove the lipoma and just use some stitches to tighten the area basically (and use absorbable stitches if I wished). But he said if it were him he would just leave it alone if it wasn’t bothering me because it’s such a minor thing. He also said that it might not get any larger, unless I gained weight. I pointed out that one of the reasons I came back to see him was because it was in fact bothering my quite a bit in terms of discomfort and pain.
I am wondering if perhaps fixing this area might improve the discomfort and occasional pain, and make the area feel stronger. When I go on longer runs (3-4 miles), the bulge gets bigger, and it is more sore. Every surgery has risks, but I’ve always thought that some day I might need another surgery to strengthen this area. I know another patient that felt better after getting an open repair after removal, even though he technically hadn’t reherniated. This would also be an open repair on mostly virgin tissue given that my other surgeries were lap. That said, the spermatic cord is once again involved given the lipoma, and I guess there is always risk of testicular pain or complications (though his assistant advised this was low risk for chronic pain).
Complicating this is that for the last few weeks the usual pain and discomfort subsided considerably, and almost vanished for the first time in years. It has come back a little this week but not in a major way. I am almost convinced at this point that any pain I have had is possibly even mostly psychological – I’ve wondered if scheduling a surgery was enough to put my mind at ease last month. Anyway, I don’t want to jump right back into the fire, but I also suspect one day sooner or later I will want this fixed in some fashion.
So I am just unsure what to do and looking for some feedback. More importantly I STILL don’t quite understand how there would be a bulge here if there was no ‘true hernia’ present. The whole anatomy of this area is just so confusing. I am also trying to asses the true risk. Given that it sounds like a fairly minor surgery compared to a full open hernia repair, and given that it will be done by an excellent surgeon, in virgin space, and giving him an opportunity of directly observing whatever is going on, it would seem the risk would be fairly low for permanent damage or complications. On top of that, they said that it would be further insurance against future direct and indirect hernias on that side. And I’m still young-ish at 46 and this could pay dividends when I am much older given some of the damage likely caused by removal and lack of any reinforcement besides scar tissue from that surgery. It also may alleviate some of the soreness I experience as I am thinking this pressure from whatever is causing this bulge could be what’s responsible for some of the discomfort.
Any thoughts?
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