Testicle/Spermatic Cord Pain Post-Shouldice

[Good intentions]

At this point, so early after surgery, there’s probably nothing that can be done. It’s too soon.

Many surgeons have “modified” the Shouldice procedure. Some even implant mesh and call what they did a modified Shouldice procedure. There are two-layer and four-layer Shouldice procedures. Not the same thing.

It would be interesting to learn what your surgeon actually did and why they call it a Shouldice-type procedure.

Good luck.

[NJS85]

Update 5 weeks post Op –

Feeling more or less “normal”. The inguinal canal pain is mostly gone. I did have a period where I was having some pubic bone pain on the left side, but that has also seemed to go away. The only thing that still remains is some tightness, extending from the upper corner of the incision outward to the hip bone, mostly on the left side. I have been massaging it and stretching, and that seems to help. The grind area from the incisions down and hip bone to hip bone it’s still numb.

Below are the operative notes from the surgeon:

Left side and right side were the same:

“The left side abdomen was prepped and draped in sterile fashion. Patient was placed under general intravascular anesthesia. We began by making a 5 cm incision 2 cm inferior medial to the ASIS to the pubic tubercle, parallel to the inguinal ligament. Patient was then placed in Trendelenburg position to reduce intra-abdominal pressure and facilitate repair.

Dissection was then carried out through the subcutaneous fat to the external bleak fascia and superficial ring. Local anesthesia was injected prior to opening the canal. Care was taken to identify injury to the ilioinguinal and iliohypogastric nerve. We then injected internal oblique muscle superior to the canal to provide anesthesia for the internal oblique and peritoneum use later in the reconstruction.

The spermatic cord was then isolated by a longitudinal anterior opening in the cremasteric muscle fibers at the midpoint of the canal extending medially to the pubic tubercle, creating 2 flaps of muscle medial and lateral to the cord. This maneuver allows a complete examination of the posterior floor, particular the medial aspect. The larger lateral cremasteric flap, which includes the genital branch was infiltrated with local anesthetic this is the internal ring.

The posterior wall of the inguinal canal was then examined for a direct hernia then open beginning at the internal ring and parallel to the external oblique muscle fibers using a combination of electrocautery and Metzenbaum scissors. Care was taken not to injure the inferior epigastric vessels found medial to the internal ring. The lateral flap was approximately 1 cm and was able to reach the edge of the rectus sheath and the first layer of the repair. Redundant transversalis fascia of the direct hernia was excised.

A continuous repair of the 2-0 polypropylene suture was used in reconstruction. It is a 4 layer tissue reconstruction using 2 separate sutures. A continuous technique distributes the strength of the repair evenly and was performed without tension.

The first 2 layers represent an overlap reconstruction. We began by medially anchoring the over the pubic tubercle, leaving a sufficient and to tie the running suture after the second layer. The inferior lateral flap of the transversalis fascia sutures to the lateral edge of the rectus abdominis muscle sheath by reaching underneath the superior medial myofascial flap conjoined tendon. The reconstruction then moved laterally to the aponeurosis of the transversus abdominis myofascial flap and the edge of the internal oblique muscle flap. The lateral extent of this layer we defined the internal ring which includes the superior stump of the of the cremasteric muscle. This buttresses the internal ring and helps prevent the and indirect recurrence. The suture was then reversed to begin the second layer. The superior flap of the transversalis fascia muscle flap was then sutured to the shelving portion of the inguinal ligament then tied to the pubic tubercle. The periosteum was not included in any bites as this can result in painful osteitis.

Next, we create a 2 layered imbrication to provide enforcement for a repair. Using a 2-0 Prolene suture a layer was begun superior and slightly lateral to the deep ring, anchoring the suture to the internal oblique myofascial layer. The inferior flap of the external bleak fascia, millimeters above the prior and parallel to the inguinal ligament, was tacked to the edge of the internal bleak fascia and transversus muscle. At the pubic tubercle the direction was reversed for the fourth layer and taken back to the internal ring and affixed. The inguinal canal was reconstructed by approximating the remaining external oblique fascia with 2-0 Vicryl and returning the cord to its anatomical position.

Scarpa’s fascia was closed using 3-year-old Vicryl in interrupted fashion. Skin was closed using 4 Monocryl sterile dressings were placed on wound. Patient was brought to recovery in stable condition.”

[miner]

I was still swollen at two weeks. Id wait a bit longer before getting worked up to much.

[NJS85]

A few other details I forgot to mention:

– Pain is a dull ache, sometimes feels like a slight pulling or pinching depending my movements.

– Sitting or lying down makes the discomfort go away immediately

– No pain during or after ejaculation