[Bure96]

I haven’t called Shouldice about it. Now my cough has subsided, I’m going to just wait and see how it feels. It has felt slightly better over the past couple days. Hopefully that’s a good sign.

[Bure96]

I can’t tell whether the bulge has gotten bigger or changed shape or if I’m just over analyzing it. I wasn’t in the habit of looking at it very frequently. Mostly it is just sore and I get sharp twinges of pain with certain movements. I think I just need to have a surgeon check it out.

I’m not limited to PA. I’m willing to travel for the right doctor. Would love some suggestions.

As for my post’s formatting, I have no idea what happened. I did not copy anything from anywhere else. I just typed it up in the text box. I’ll edit it to clean it up.

[Bure96]

quote dog:

drkang Very good point! But it will work just if doctor totally specializes in tissue repair. Here is what happened with one person

The person did repair with Good old school doctor … first time Desarda…second time Shouldice

It was more of a Shouldice type repair. it was a tiny hernia so he put two stitches in it. Here is the thing, Sometimes people have more weaknesses than one in the abdominal wall. In theory, the surgeon notices that as he is doing the surgery and repairs both at the same time. But in my case Dr. ..didn’t (at least that is what I am being told). After the second surgery Dr. …. said the first surgery looked great and was holding fine and his fix seems to be fine now too. But I can’t actually verify any of this as I am asleep as it is all being done. So if there was an issue with the original Desarda repair and he fixed it I would have no way of knowing that was the case. That said, I did some research and there are cases of two weaknesses in the abdominal wall in slightly different locations in some individuals so Dr. …story is certainly possible. The bottom line is that either the Shouldice or Desarda repairs require more expertise than mesh repairs and more expertise than most surgeons have. So there just isn’t a whole lot of choices if you want to go that route. And as you know, if you do have issues with either of those repairs, there is a fall back. With mesh not so much. Good luck. Overall I wish I had not had to go through it twice. The second time it was a lot easier as it was just so much less painful. And so far so good. I
–

If the surgeon found additional weaknesses or repaired a ruptured previous repair, that should all be in the surgical report. You can request a copy of this report from the surgeon.

[Bure96]

quote Chaunce1234:

I believe it is standard for the Shouldice repair to cut the entire cresmasteric muscle, which presumably removes its functionality and reflex even if the nerve is intact. One might think if it was a problem then Shouldice would have addressed it, but they may have something specific to their method that avoids that.

I think I recall reading at one point that at Shouldice they ‘pin’ the remainder of the cremaster muscle up so that a testicle does not dangle too far, but a surgeon who performs the procedure would be a much better resource to discuss this, and whether it may relate to neurectomy?

I had a my repair done at Shouldice and my testicles still shrink up when I’m cold and hang loose when I’m hot. I honestly haven’t noticed much, if any, difference in that regard.

[Bure96]

quote Chaunce1234:

Shouldice surgery performed at the Shouldice clinic has something like a 1% recurrence rate, I would not be overly concerned about recurrence if you had the procedure done in Toronto.

If recurrence has been ruled out, have you tried an extended course of NSAID (anti-inflammatory) to treat the symptoms? Or nerve blocks? Anything of that nature?

Frankly I am not having any significant pain or discomfort at this point that would warrant a nerve block or extended NSAID treatment. There are some days or weeks where I have some discomfort or pain, but it has not been long term and I am not overly restricted in what I am able to do on a daily basis. For instance, I have gotten back to playing ice hockey with little to no pain involved on most occasions. Weightlifting, tighter waistbands on my pants and sexual activity can cause soreness, but it’s not too bad.

One of my primary concerns was the raised area around the surgical site. When I look in the mirror, my right groin area bulges out and there is a significantly asymmetrical look compared with the left side. I’m not concerned too much with the appearance of it, but I wanted to find out what this could be, whether a recurrence, scar tissue, or something else. Dr. Chen did not believe it was a recurrence or scar tissue and felt that it was just a symptom of the stretching of the muscle involved in the Shouldice repair. He mentioned that because I am relatively thin (142 lbs at 5’7″), it’s probably more prominent than it would otherwise be.

I suppose all I can really do is try to limit things like lifting couches and refrigerators and make sure I’m using good form and not going too heavy when lifting weights.

[Bure96]

Update: I had an appointment with Dr. Chen at UCLA here in Los Angeles a couple of weeks ago. He appeared rather fascinated with the Shouldice repair because he doesn’t see them very often, but he did seem quite familiar with the procedure. He asked me which surgeon performed my repair (Dr. Simmons) and he said he knew him. I actually heard him excitedly explaining the procedure to his interns after he examined me too.

Dr. Chen performed a manual evaluation of my repair and did not feel that there has been a recurrence. He explained that the large raised area near the original repair is not scar tissue, but rather just a symptom of the stretching of the abdominal wall that occurs to facilitate the Shouldice repair. He said that essentially they pull the already weak and thin layer of muscle even thinner to cover the hole where the hernia occurred. Thus, my insides are pushing against an even thinner layer of muscle and causing this bulge or raised area. By the time I had gotten to the appointment, the pain I had experienced for about 3 weeks around the time I made my initial post had mostly resolved. However, I’m having some pain again, possibly from all the poking around the doctor did during my visit. I have a good bit of nerve damage (numbness) in the area and there are instances of sharp pain when poking around the repair, but I can tolerate it.

Dr. Chen did not seem particularly fond of the Shouldice repair and even told me that “when the hernia recurs” (before correcting himself to “if the hernia recurs”), it will be at the site of this raised area. He advised me to refrain from lifting heavy objects or performing non-anatomical movements for pretty much forever. This will be difficult since I play ice hockey and try to stay in shape by lifting weights, but I will try to limit myself to lighter weights and higher reps.

Although I was happy to know that there has not yet been any recurrence of the hernia, I wasn’t exactly instilled with the utmost confidence moving forward. I’m a terrible worrier, so the fear that a recurrence could happen at any time will probably always bother me. I’m only 31 years old, so I’ll have to hope this repair lasts for quite some time. Dr. Chen noted that if a recurrence does happen, it will likely require laparoscopic repair with mesh.

[Bure96]

Thank you for your reply. I am a 31-year old male. The pain I am having is mostly dull and aching, but can be sharp during certain movements, particularly getting up from a prone or reclined position. It comes and goes, but has been more consistent in the past 2-3 weeks. Lately, I’ve needed to unbutton my pants or wear something with a looser waistband to reduce pressure on the hernia area, which is something I had to do quite often before my surgery. It also seems to be a little worse when I am full. The pain sometimes radiates, with occasional sharpness, down into my testicle. The lump is slightly higher than the incision scar itself.

I did have an ultrasound done back in September of last year (4 months after the surgery) and they did not detect a recurrence, but I was lying down and I don’t recall them asking me to cough or anything, so it’s possible they wouldn’t have caught anything. (The US was ordered by my urologists and was primarily to check out my other side, in which I’ve had periodic burning and aching sensations.)

I contacted Dr. Towfigh’s office, but unfortunately it does not appear she accepts my insurance. I’m waiting to hear back from Dr. Chen’s office. There are a couple of other doctors in the area that I have also reached out to–there is a Dr. Leslie Memsic who has pretty good reviews and appears to have a good amount of experience with hernias.