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Spigelian Hernia, Constipation, questions for surgery
35f, lower right side abdominal pain, 2 fingertips down and to the right of belly button. 5’2″ 115 pounds, normal to low blood pressure, previously very fit
I have a probable small spigelian hernia that appears on ultrasound with valsava but did not appear on MRI or CT scan. The symptoms started after intercourse following a rest period post IVF egg retrieval and have been worsening over 7 months. At first, it was a tightness only but with severe constipation that started concurrently. After several months, it became more painful and pain radiates through the hip most commonly and lower back at times. The pain would be much more severe with running or working out. It hurts the most prior to BMs and is somewhat relieved with rest and a liquid diet. The pain is always there and does not resolve except for a handful of days where I didn’t really feel it.
Previous imaging:
Pelvic MRI with contrast
Pelvic CT with contrast
Two trans vaginal ultraounds with no significant findings
Abdominal ultrasound with potential spigelian herniaI had two GI doctors prescribe increasing amounts of Miralax and all kinds of IBS drugs (which I didn’t take because the symptoms didn’t match IBS). I did end up taking a lot of Miralax and did two full “cleanouts”, the first with two bottles and the second prior to a colonoscopy. So we’ve ruled out constipation as the source of the pain. The MRI showed accumulation of stool on the right side colon and in the cecum.
I have a surgery coming up with a general surgeon. He shared that he didn’t think this hernia could cause the constipation I’m experiencing. We plan to do a laparoscopic no mesh repair (because I hope to still get pregnant) in a few weeks. I was wondering:
1) What is the risk that the hernia will not be seen? I find very little literature on the Spigelian hernia and this topic but I’ve read this a few times anecdotally. Going in and seeing nothing would be a terrible outcome.
2) Could a small spigelian hernia still cause constipation symptoms?
3) The surgery will be a robotic laparoscopy to repair whatever is found, without mesh. Any concerns with this approach for a spigelian hernia from the experts?
4) If the surgeon has never operated on a Spigelian hernia, should I be concerned? Are there specialized skills for this type of hernia or it’s pretty much the same? He has good patient reviews and seemed very competent
5) Are there any special recovery or rehabilitation considerations for Spigelian hernias with this type of repair? The advice seems to be pretty general, and I’m wondering what the recovery timeline looks like. For example, what amount of exercise would I be able to do after 3-4 weeks?Thanks for your thoughts!
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1 Reply
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Hello Ash, in afraid I dont know enough about that hernia, but you could search this forum using Spigelian.
Dr Towfigh will be best to answer I’d think but she does post regularly as surgeons tend to have loads to do! But she may have some answers for you when she does
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