ajm222
Forum Replies Created
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Thanks! Dr. Belyansky is the surgeon. He did my removal.
I’ve heard initial pain is higher (and of a different nature) than with robotic surgery, as you might expect. But I know a number of people that kind of preferred the discomfort of the open repair (tissue or otherwise) compared to lap/robotic. I personally hated the robotic surgeries because they made me feel terrible and like my whole torso was swollen for several days. I just felt incredibly uncomfortable.
I’ve also heard some folks say that after a few days post tissue repair, while they still had pain, it had improved a lot and they were up and about and in some cases even doing light lifting and walking several miles. I guess as with everything your mileage may vary.
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My understanding (and I’ve seen it reported in studies and journals and mentioned here by doctors) is that it takes about a year to achieve maximum strength after tissue damage of the sort involved in hernia surgery, but that within a couple or a few months the great majority of the strength is there. After a year there will often be remodeling of scar tissue and such that could indeed go on for multiple years.
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Thanks!
And I think I knew there were some
options when it came to absorbable sutures but didn’t realize there were so many. -
Definitely. And thanks. I think I’ve decided that if I go through with this surgery, and all goes well, I’m going to convert from running for exercise to brisk walking. And will take extra care whenever I do anything very strenuous. I’m almost 47 and after everything I‘ve been through I will just be thrilled if I am mostly pain free and hernia free. I’ve never needed to be extremely active, and just want to take care of myself in order to avoid any further complications in this area. So exercise is important but I think my running days may be over. Add back issues and plantar fasciitis, and I think it’s time for some changes. As long as I can mow the yard and rake leaves and walk a few miles, I think I’ll be happy. So absorbable may be fine. But again, I’ll check with my surgeon and get his thoughts just to be sure.
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some more discussion about the 2-layer repair and some other alternatives
https://herniatalk.com/forums/topic/desarda-vs-grischkan-s-two-layer-shouldice-etc-d15/
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Thanks for the feedback. I’ve done some reading today on the 2-layer method (which I think is very common amongst surgeons who do that repair outside of the actual Shouldice clinic), which came from some initial experimentation with 3 layers (because some patients just don’t have enough good tissue for so many layers). Ultimately it seems that it’s been determined that the primary strength comes from the first 2 layers, and the second two are largely redundant. Recurrence rates with a properly performed 2-layer repair are very similar to 4-layer repairs (at least according to one study). Which is why I think many surgeons who do a Shouldice will opt for the 2-layer repair, because it’s obviously easier but also a shorter operating time and more than sufficient in most cases. More evidence perhaps that Shouldice is a little more invasive than necessary and probably just a carrying on of tradition more than anything else.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2502350/
I also stumbled upon some research suggesting both absorbable and non-absorbable are fairly similar. The former perhaps increases the chance of recurrence very slightly but not by much. I’ll let my surgeon determine what’s best if a full repair is needed. I think at this point I just want to avoid mesh because of the prior issues I had with it resulting in removal. And permanent sutures lack most of the three dimensional negatives that come from mesh. My issues felt like they were caused by tightness from the large and inflexible surface area of the mesh. I think permanent sutures, while continuous, are more two dimensional and allow for much more flex. And with a 2-layer versus a 4-layer, probably much less plastic material. I don’t think my issues were directly related to the presence of the plastic itself so much.
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Thanks again, Dr. Towfigh. That all makes sense. And I know I have an issue based on the physical symptoms, so I wasn’t really putting any stock in the reading of the CT scan to begin with. And Dr. B did admit that there’s certainly a chance of hernia even if it wasn’t evident on the scan. He just wasn’t able to see it when I saw him in person on two separate occasions (maybe because of the long car ride and all the sitting) or detect it when he examined me while I coughed. The only thing he could detect was the lipoma, which I don’t think is causing the bulge. So it’s just sort of a weird situation where there’s a visible bulge some of the time that I would say is roughly ping ping ball sized, but at other times it’s not very prominent.
I asked his nurse if he would convert to the Shouldice if he got into the area and noticed it was worse than anticipated, and she said he definitely would. I will be sure to have the conversation with him on the day of surgery and let him know that I would like him to do so if the situation warrants, and I might also ask about the tightness of a Marcy-type repair and if that risks a future failure.
Dr. B for his part has said he hasn’t yet known anyone with an indirect hernia who had mesh removal done by him that recurred, for whatever that’s worth.
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I also think Dr. Kang has said,
“Furthermore, I cannot understand why the healthy floor of a Hesselbach triangle has to be opened and sutured again during surgery for indirect hernia, where the deep inguinal ring is enlarged. I am sure that the results of Kang repair have proven that this process is not necessary at all.” Suggesting perhaps in his mind something more akin to a Marcy could in fact be sufficient in the case of an indirect hernia. But maybe I’m misunderstanding his words. Just wondering if this could be a fair point of contention amongst surgeons. -
Thanks so much, Dr. Towfigh.
The actual CT says the following:
“There is no pelvic adenopathy. There is no soft tissue mass. There is no free air, or free fluid.
Reported postoperative changes status post prior right inguinal hernia repair. There is no residual or recurrent hernia. There is no adenopathy. Inguinal region is unremarkable. There is no lipoma. Vasectomy clips are seen.”
Would a surgeon be able to tell upon direct inspection during surgery if the area requires more work once he got into that space? I could always clarify if he’s planning on doing a Marcy but willing to convert to a Shouldice if the situation changes after he begins operating.
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The “tugging/ripping pains” would scare the heck out of me. I guess that doesn’t indicate that damage to the repair site is being done?
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Thanks, GI. It’s definitely internal. No issues or discomfort on the surface. It gives me kind of a squishy feeling inside, and I can actually kind of feel the fat or whatever that’s in that pocket moving around a little when I move. Unfortunately, while I imagine I will continue to improve in a number of other ways over time, in the same way I’ve improved over the last two years, I think that this particular issue, since it’s very similar to a true hernia, won’t get better, assuming it’s indeed a result of a laxity or whatever in the abdominal wall. Again, Dr. B did say there’s a chance that unlike a full hernia it won’t actually continue to grow and get worse. But I suspect over many years it’ll probably continue to get a little larger and more problematic, just based on what I’ve seen the last few months. Maybe there’s a point though where it’ll reach some sort of stability (if it hasn’t already).
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Very interesting. Thanks for sharing.
My initial thoughts, for whatever they are worth:
I have noticed recently that when I am focused on my issues, the pain and discomfort goes up significantly, to the point of sometimes being debilitating. When I relax about it, it almost vanishes. I will often get stressed about lingering issues and they will get worse and worse, and then I will make an appt with my surgeon and talk over surgical options, and my hope for the future increases with a game plan, and then the pain ‘magically’ goes down to almost nothing.
Point being, I do tend to believe in many cases there is a very cerebral component to the pain and discomfort. Recent science suggests this isn’t at all a new or fringe idea. Anyway, I am wondering if anticipatory anxiety, and being in a situation where you know almost TOO much, has had an impact on your level of pain. Some surgeons even suggest cognitive therapy or medication prior to surgery to improve outcomes.
I had an experience when younger where I had two surgeries. Didn’t feel like I healed from the first one. Then the second didn’t seem like it was healing either. Lots of issues. Freaked out, had a breakdown, got on an SSRI, and finally fully healed within a month. The meds were the difference maker. My brain just needed a break from the obsession. My mind had gotten stuck and physically I was healing but mentally I was not.
So I would recommend trying your best to do some positive visualization and relaxation tricks just to keep your spirits up, and just tell yourself daily you are going to heal up perfectly fine. Unless something bad happens that clearly needs medical intervention, give yourself lots of time to get better and try not to stress too much about it. It also just takes a long time for some folks to heal from surgery. As long as there are regular improvements from week to week, you should be good. The body is amazing with it’s ability to heal. But we can hamper this by focusing too much on it and thinking about the pain. That keeps the body from trimming those neurons and delays it from turning off the pain signals as you heal by reinforcing those pain pathways that really aren’t serving a purpose any longer.
Lastly, I wonder, physically, if having a hernia for that long may just mean it’s going to take you a bit longer to heal and feel back to normal. Most people get a hernia and have it repaired fairly quickly and don’t wait years or decades. And they don’t have a hernia while crossing from child to adult. No reason to think that would prevent you from healing, but it may explain some of the extra pain and healing time needed in your particular case. Usually after about a year most people find the vast majority of twinges and discomforts have finally stopped being noticeable. Ultimately sounds like you’re going to be just fine.
Just some thoughts. Thanks again for sharing this experience. Very interesting.
I am possibly having a procedure myself in February to remove a lipoma and tighten up the inguinal area because I have a small bulge after removal that is apparently technically not a full hernia but probably is some extra fatty tissue pressing on some weak areas that exist possibly because of the mesh removal. I think it may be the source of some lingering pains and discomfort and the plan is to do a more minor repair with some stitches (not a full Shouldice-type repair). Hoping it goes well. But I also have some concerns as I am obsessive and a hypochondriac and I know I am my own worst enemy when it comes to healing. I’d leave it alone but I feel it’s an issue and I am finally ready to deal with it after my last surgery two years ago.
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Dr. Belyansky often does prefer to see at least one scan before agreeing to removal. First go-round I did mail a CD. The last time (since I am considering another surgery to tighten things up and remove a lipoma) and since I live 2.5 hours away, I actually drove up and got the scan there in the morning and had an appt with him in the afternoon. Everything done at his hospital seems much cheaper than having it done anywhere else, too, including the actual surgery.
So yes, I am out of state but within driving distance. The first appt will often have him saying “I would caution against it unless you’re very serious about this or very bothered by it or disabled, because it’s a major and risky surgery. Let’s talk again in a few months.” And then the second appt he’ll usually say “Ok, I see you’re serious. I will remove it if you want.” And at that point they can get you on the schedule, which is usually a couple months. But I am guessing if you really push and tell him you’re going to get removal one way or another, with him or without him, he may immediately agree to do it.
Also, I went home the day of my surgery. I had removal done on only one side.
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i second chuck’s recommendation and all that he said about Belyansky. he did mine. he’s in Maryland. he’s done the removal for a couple of other folks on the forum as well, and lots of other people. his reputation and skill is indeed fantastic.
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“Evaluation should be multidisciplinary and should take place in specialized centres.”
I’m sure this’ll be easy for the estimated 80k people across the country potentially experiencing this issue (sarcasm)
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it’s a great question. i don’t understand myself.
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Met with Dr. B., and I think he now appreciates how much this is bothering me and that I am serious about another surgery, so he’s ordered a CT scan to get a better look. But he suspects the bulge is retroperitoneal fat making itself known, and that he could go in and get rid of the fatty tissue and stitch up the space and strengthen it a bit. Probably won’t solve all of my issues, but would reduce the bulge and the squishy feeling I’ve had lately, and could potentially help with some other things, while the chance of anything getting worse would be low. I always suspected I might need something done to strengthen that area after removal.
He said (and this is still where I and I assume others have a lot of confusion) it wouldn’t be like a full hernia repair, even though he would call it that on the report. He wouldn’t need to fully open the inguinal canal and do a big shouldice-type repair with all the stichtes and layers of tissue etc. etc. It sounded like maybe he’d just be dealing with the fat and then closing the opening to the internal inguinal ring, or something like that, with a small number of stitches? Perhaps that’s similar to one of the simpler types of repairs (Basssini, Marcy?). But we will see what the scan shows and go from there. I will ask him more questions next time.
I think I likely have some chronic discomfort that will potentially always be with me to some degree, but I would like it to get to where it’s mostly discomfort and not pain and soreness. I am wondering if some of the testicular tenderness/sensitivity is related to pressure from this fat/lipoma along with some of the other soreness. If the surgery is less involved than a big hernia operation, with low risk, it would seem worth it to me to give it a shot. And then I could also feel a little better about the strength of the area.
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Thanks, Dr. Twofigh. That’s interesting. As I said, it’s a bulge that’s been there since the removal. But seems to get larger with more intense activity and lots of standing. But Dr. Belyanksy didn’t detect a full hernia.
I still wonder if it’s unusual for a lipoma to grow back as I had one removed on that side when the mesh was initially placed in 2018 before the removal in ’21. And I wonder if the removal has made it easier for the fat in that space to push against weakened tissue and cause the bulge in the first place, if that’s what’s doing it. If so, I wonder if his suggestion to remove the lipoma if it’s bothering me and just use a couple of stitches to reinforce the area would finally shrink that spot down and strengthen that area better. I am also having continued soreness and testicular discomfort. Could be coming from the pressure from the lipoma I supposed.
Talking to him Tuesday and will get his thoughts.
Thanks again
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Perhaps. I’d still like to understand what this bulge truly is, though. It would seem a simple matter to be able to understand why there’s a bulge in that spot and what it is. But like everything hernia related, there are no simple and straightforward answers for something that’s supposed to be straightforward and simple.
The bulge itself seems unlikely to be caused by the lipoma. So perhaps it’s a result of damage to the area from removal, and fluid or blood or something is filling that spot and increasing the size upon heavy exertion. That spot was always a bit puffy after removal. Perhaps it’s an open space resulting from the surgery that’s prone to issues. After a year and a half though you would generally think the area would settle down. I know we all say here a lot that healing takes a long time. But tissue really should stabilize after less than a year. Maybe far less. But you would also think imaging would be in order to see what’s going on there. But my surgeon doesn’t seem to think it’s needed.
Dr. Belyansky and his staff have said don’t do surgery unless it’s a bother. But it’s definitely a bother. Unfortunately what I don’t know is if the discomfort is coming from the lipoma or the bulge or something completely unrelated. I just hate the idea of suffering needlessly if there’s an easy fix. Surgery to deal with the lipoma, as I mentioned before, is minor according to him. He said it would not be a true hernia repair where the whole inguinal canal is operated on and opened up. It would just be excising the lipoma and then a couple of permanent stitches. Might be worth doing it just to see if it helped, given the likelihood that a worsening of my condition would be unlikely with a minor open surgery, and maybe he’d see anything else going on in there out of the ordinary. But I still appreciate that any surgery has risk.
It seems to get biggest after these 4 mile runs I’ve been doing. Not as bad when I run less or rest. The other discomfort is there off and on regardless of activity – doesn’t seem to be a clear connection. Soemtimes heavy activity hurts, sometimes it helps. But you may be right that I am just going a tad too hard. But the bulge is still there and I’d just love to know what the heck it is.
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for sure, though part of me had managed to come to terms with things and was looking forward to having that area strengthened with a solid tissue repair. but any surgery is truly a big deal and i’d just much rather keep avoiding it if possible. and i certainly will be happy to not have to spend the money.
i had even asked him if perhaps my original hernia was even a real hernia and not just a lipoma, as i do remember my first operative report mentioning a cord lipoma being dealt with. he said who knows. but that report did also mention a true hernia i think, so hopefully all the surgeries weren’t for nothing. and though memory is short, i do feel like i definitely had a reducible and moderate sized bump.