[allj]

In my case, it seems removing the sutures would be the first thing to rule out

before doing anything more drastic. It probably isn’t an easy task after 12 years. Is this something you or other surgeons could/would do? Thanks so very much for helping.

[allj]

Thanks. Any idea where this is done regularly? I called Beth Israel Pain clinic in Boston – they said they do it but not regularly.

[allj]

Thanks NFG12 and Jgens and others. I just wish I didn’t have the mesh replaced with alloderm, an absorbable mesh that is no longer used for hernia repair and has limited strength.

[allj]

Dr. Towfigh – I really appreciate all the advice and warnings from you and others who have posted. The nerve cutting was the surgeon’s idea. After reading the posts I’m not going to agree to this. Part of my concern is that the mesh that was removed was replaced with alloderm. With all the negativity about this absorbable, I’m worried thinking I should have a stronger mesh implanted posteriorly (original is anterior) before I’m much older (I’m 73). I was told by other surgeons that I have a “watch and see” hernia. Is this too risky? Is my thinking flawed? I don’t know what to do. Thanks again

[allj]

No – what is it and have you had it done?

[allj]

Sounds scary. I have random nerve pain and was thinking the alloderm is absorbed and not very strong. I also get pain in the hernia area more frequently after exercises like riding a bike than I did a few years ago. Do you think it folly to have another implant posterior (the first was anterior) and reject the nerve cutting or is the whole thing folly? Also if I put off having a neurectomy can this be done anteriorly or can it only be done posteriorly? Thanks

[allj]

I am had an anterior mesh removal and alloderm replacement and inguinal neurectormy 12 yrs agi. New surgeon is going to put in a heart skin muscle from a pig covered with a plastic mesh. He wants to cut the inguinal higher and thinks the sensations that are being picked up are from the iliohypo nerve and wants to cut that up. If I understood him correctly he said the new mesh and skin will make it difficult if not impossible to do the ilihypo later if that is causing a problem. I’m 73 and can no longer do many things I used to even just a few yrs ago without more pain so was hoping to just get a posterior repair and not worry about herniation in the future as I age.

[allj]

Dr. Towfigh – The surgeon wants to re-cut the inguinal nerve higher up and the iliohypo at the same time. He said if it isn’t done during the lap procedure it will be buried in the mesh and difficult to impossible to do later. I wanted to be conservative and do a repair now and worry about the nerve issues later and only do it if I can’t tolerate the pain. If necessary, can the nerves successfully be done later? Thanks for your help.
Alan

[allj]

I found a reputable and skilled surgeon who is going to do an lap procedure on me. I already have an ilioinguinal neurectomy. He wants to cut the nerve higher and at the same time cut the iliohypo nerve. I am so reluctant to cut another nerve but he said this picks up a lot of the innervation when the ilioing is cut. Any thoughts on having the procedure done with the suggested neurectomies? Is there any benefit having a posterior vs anterior

neurectomy

?

I read that I could also develop abdominal wall laxity. Is this painful?

Thanks again! Alan

[allj]

Dr. Towfigh –

I’m not sure my question

about the long term efficacy of triple neurectomies was

answered. I only found one study regarding long term outcomes of triple neurectomy. It reported that “

The mean follow-up duration was 34.78 months. Return of pain was reported by 13 (68%) of 19 patients. Using a verbal numerical rating scale (0-10), pain was completely relieved in 27.8%, better in 38.9%, no better in 16.7%, and worse in 16.7% of patients.”

Is this due to the way the procedure was done or is this what I can expect?
Thanks Alan

Long-term outcome following ilioinguinal neurectomy for chronic pain. – PubMed – NCBI
https://www.ncbi.nlm.nih.gov
J Neurosurg. 2010 Apr;112(4):784-9. doi: 10.3171/2009.8.JNS09533.

[allj]

Thank you DrBrown. This info really helps. All I have to do now is find someone who will follow this plan.
Alan

[allj]

“One wrong turn just one wrong turn”. Thanks to everyone.
I will definitely contact the Dellon institute.

Dr. Towfigh your good advice is always appreciated.

I assumed the weakness I have is because I had an alloderm replacement and the mesh removed. I am currently talking to a skilled surgeon about doing a lap repair (since the other repairs were done openly) in hopes of strengthening the area. Does this make sense? (my thinking is that I’m 73 and if I get much older and the alloderm/collegen doesn’t hold I’ll be too old to operate on)

Good intentions – I had mesh removal and a single neurectomy of the inguinal nerve ~

12 yrs ago

. I have also kept active – mostly bike, exercising and hiking but when I’m not active for a short time I’m in slow agony – death by a 1000 cuts. Activity seemed to keep the nerve activity down and the area feels stronger but more recently exercising has aggravated the groin hernia repair area causing significant innervation elsewhere in the area and weakness. Even standing, I had little strength and walking reverberated pain in the area. The surgeon prescribed a steroid pack and nsaids and after 3 weeks I am starting to exercise again. He also suggested getting a triple neurectomy with Dr. Chen. After reading the helpful comments I realize this isn’t a fix-all and may be misery. I’m leery of doing it.
Thank you all – so glad and thankful there are people like you
Alan

[allj]

Wishful thinking. Thanks

[allj]

Thank you again. I downloaded the “International guidelines for groin hernia management” and am going through it. I now have a better knowledge base by which to assess my options. Alan

[allj]

Thank you for your help. I am definitely fearful of having another surgery esp with the information provided. I had pain from the beginning of post surgery and through the 3 yrs before having the mesh removed. I have a mesh implant on the other side and had some what I think were nerve issues that resolved after a year of so. I made an appt with Dr. Earle in MA. I hope I’m not “jumping from the frying pan to the fire”. Honestly, I don’t think I can emotionally survive this if it’s worse. Thanks again.

[allj]

The original mesh was prolene with a plug. The mesh was removed and an neurectomy performed after 3 yrs due to a trapped nerve and associated pain. Any recommendations on the best type of mesh to use in my situation is appreciated. Are the porcine mesh products absorbable like the alloderm. Should I stay away from all bio mesh? Thank you for offering your help. I’m so very appreciative.
Alan

[allj]

Thank you for responding,
It’s been a difficult 12 years. I haven’t had any faith in the few surgeons who evaluated me. They didn’t have any experience with alloderm replacement and said I had a slight hernia that needed watching. I noticed you use bio, hybrid and synthetic mesh. Is the bio and hybrid mesh you use absorbable? What would you recommend? I live in MA and would come out there but would prefer finding a qualified surgeon in my area. Do you have any recommendations? I’m so very thankful to you for your help.
Alan