Chaunce1234
Forum Replies Created
-
I believe the Desarda repair by Dr Robert Tomas is done with absorbable stitches, I am not sure if other doctors go that route. You’d have to ask directly
Where are you located? Perhaps a no-mesh hernia surgeon is located near you that you could consult with.
-
quote zenacity:Hi – Just wanted to update everyone. Thanks for all of your input. So I had another surgery 3 weeks ago. This was a laparoscopic exploratory surgery to get in there and determine the root cause. Basically they went in to my abdomen by making 3 additional incisions on the right side. This was to allow the camera and tools to be inserted. Once they got in there, they had to cut away part of my omentum and remove a bunch of scar tissue. After they removed the scar tissue, they found a small area of calcium deposit which seemed to cause an abscess to form. They removed the calcium deposit as well as the abscess and the infected tissue. Then they sewed me all back up. I am still healing from the surgery and now I have more pain on the new incision sites. They tell me that this was the problem and I should heal up soon. I’ll let you know how it goes!
This is great information. Thanks for the follow-up on your case, let us know how you feel as healing progresses! Best of luck!
-
quote Pwuenstel:[USER=”1916″]Chaunce1234[/USER] yes, I need to find someone who specializes… no doubt. i am located in Pittsburgh PA.
I responded with a large response to everyone, and it was flagged as well. Was wondering if anyone had a steroid injection around the mesh, and if it relieved any discomfort?
There are certainly people that have had positive experiences with nerve blocks / steroid injections to target the area of pain, so that is absolutely something worth trying out.
As for hernia experts with significant experience managing complications of hernia surgery, including chronic pain, mesh removal, etc, here are some starting points:
– Dr Igor Belyansky in Annapolis Maryland
– Dr Brian Jacobs in NYC, New York
– Dr Shirin Towfigh in Los Angeles, California
– Dr David Chen at UCLA California
– Dr Bruce Ramshaw in Tennessee
– Dr Jonathan Yunis in Sarasota Florida
Dr Belyansky is very well regarded and several people on these forums have had good experiences with him managing complex situations, mesh removal, etc, he may be your closest best option, and at the very least would be a good resource to reach out to and start a dialog with.
Another possibility is Dr William Meyers at Vincera Institute in Philadelphia PA, though I am not sure if they do mesh removal. Typically Vincera Institute focuses on athletes and related pain issues but it could be a worthwhile resource to contact as well.
There are certainly other options available too, those are just a few off the top of my head. Hopefully some other forum users will chime in with some additional options near to you.
Best of luck and keep us updated on your case and decision making.
-
quote acausal23:I have read that one shouldn’t use serrapeptase – an enzyme that takes away scar tissue, and combats inflammation, if you have had hernia repair done with mesh. This is because scar tissue they said is what the mesh depends on to work. I don’t fully understand. Does anyone know anything about this?
I don’t know much of anything about serrapeptase so I can’t offer much commentary about that specifically.
But as for mesh in hernia repair, my understanding is that mesh relies on the bodies scar tissue that grows through it forming a lattice of sorts that basically keeps the mesh in place to maintain the repair, at least that is my understanding of how mesh is supposed to work. I am not a doctor however, so a surgeon may offer a better explanation.
I am not sure if taking an anti-inflammatory matters much in that process, I know it’s fairly routine for patients to be given NSAID after surgery though.
-
Is it painful or causing any symptoms?
If it’s purely visual and also slowly shrinking, I would not be particularly concerned. Give it more time. Your surgeon is probably pretty skilled if they were able to fix a hernia without mesh through laparoscopy.
As for what the ER doc told you, I’ve also read similar suggestions that strangulated fat is often of no concern since it’s fat and isn’t going to do anything except plug the hole, though I think the exception to that is in the groin where inguinal/femoral hernias containing fat can be very painful.
Anyway, keep us updated on your progress.
-
I had a more detailed reply but it was flagged for some reason.
Anyway: I’m sorry you are dealing with this. I would strongly recommend seeing an expert hernia surgeon who has experience managing complications of hernia repair. It is a sub-specialty of its own.
Where are you located? Perhaps someone can offer a few options near to you. You may need to travel, however.
-
quote Good intentions:Dr. Peter Billing of Eviva is also a good resource. He will respond to a well written description also and will remove mesh. He is the one that removed my mesh, he is in Shoreline WA.
https://www.evivamd.com/about-eviva/…eter-s-billing
Interesting, this is great feedback and good data to have about another doctor. Thank you.
Do you happen to know if Dr Peter Billing performs inguinal hernia repair without mesh as well? If so I will add him to a list of surgeons able to do no-mesh repairs.
-
Adding additional names just in case this could be helpful to any patient. Here is a list of US-based hernia surgeons who are apparently able to perform no-mesh hernia repair in the USA, though the technique may not always be the Shouldice method. Inquire directly with each doctor to confirm independently, and to see if that type of procedure is applicable to your specific case:
– Dr Shirin Towfigh in Los Angeles, California
– Dr David Chen in Los Angeles, California
– Dr Edward Phillips in Los Angeles, California
– Dr Robert Burns in Newport Beach, California
– Dr William Brown in Fremont, California
– Dr Paul Dally in Vancouver, Washington
– Dr Robert Martindale in Portland, Oregon
– Dr Michael Mastrangelo in Bend, Oregon
– Dr Kevin Petersen in Las Vegas, Nevada
– Dr John Etlinger in San Antonio, Texas
– Dr Zafar Parvez in Gallup, New Mexico
– Dr Samer Sbayi in Long Island, New York
– Dr Michael Reinhorn in Newton Massachussets
– Dr Igor Belyansky in Annapolis Maryland
– Dr William Meyers in Philadelphia, Pennsylvania
– Dr David Grischkan in Cleveland, Ohio
– Dr Paul Szotek in Indianapolis, Indiana
– Dr Bruce Ramshaw in Knoxville, Tennessee
– Dr Jonathan Yunis in Sarasota, Florida
– Dr Robert Tomas in Fort Meyers, Florida
Please add other names of doctors if you know of any.
-
I am sorry you are going through this.
Where are you located? Perhaps someone can recommend a doctor located near you that can help your case. You will want to seek out an expert with specific experience managing pain related complications of hernia surgery, as it is really its own sub-specialty of medicine.
Do you know the type of mesh used in the first surgery? Did the second laparoscopic surgery also use a mesh?
Out of curiosity, have you tried any pain management treatments? Nerve block injections? Physical therapy? Extended prescription strength anti-inflammatory course? Other medications? Medical marijuana? Alpha lipoic acid? You’d of course want to talk with a doctor before going any of these routes. Speaking with a well-regarded pain clinic can be very helpful as well.
If you’ve had some success with nerve block injections before, cryoablation of the nerves may be something worth looking into as well. They basically freeze the nerve to try and interrupt the pain signal, but the nerve itself is not cut.
I’m not a doctor but as a fellow patient I would recommend caution before any extreme surgeries like orchiectomy, or even before a nerve removal procedure. Severing of a nerve, a testicle, or even a limb or appendage is not guaranteed to stop pain – phantom limb pain is an obvious example of this where people who lose a limb often report feeling pain in the limb that no longer exists.
Also, keep in mind that pain can radiate, so you may be feeling it in the testicle but the “problem” may be higher up somewhere along the nerve, or along the spermatic cord, even in your abdomen. Perhaps a better approach is to first try and figure out if something else is causing that pain – a bad hernia repair, a new hernia recurrence, a failed mesh, an incompatible mesh, excess scar tissue, entrapped nerve, etc – and try to deal with that and see if it helps.
Good luck and keep us updated on your case and decision making.
-
Just out of curiosity, does your hernia hurt? How were you diagnosed? Do you have a bulge or just physical symptons?
Where are you located? Perhaps someone can recommend some regional options near you for a non-mesh repair.
As for absorbable sutures, that is much more rare as far as I know, but I think Desarda repairs in Florida by Dr Robert Tomas are done with absorbable stitches. Other surgeons may use them as well, maybe by request, you’d probably need to inquire directly and ask.
A partial list of surgeons in the USA who are able/willing to perform a no-mesh hernia repair using a traditional suture technique (various types of repairs, ask for clarification) include the following doctors:
– Dr Shirin Towfigh in Los Angeles, California
– Dr David Chen in Los Angeles, California
– Dr Edward Phillips in Los Angeles, California
– Dr Robert Burns in Newport Beach, California
– Dr William Brown in Fremont, California
– Dr Paul Dally in Vancouver, Washington
– Dr Robert Martindale in Portland, Oregon
– Dr Michael Mastrangelo in Bend, Oregon
– Dr Kevin Petersen in Las Vegas, Nevada
– Dr John Etlinger in San Antonio, Texas
– Dr Zafar Parvez in Gallup, New Mexico
– Dr Samer Sbayi in Long Island, New York
– Dr Michael Reinhorn in Newton Massachussets
– Dr Igor Belyansky in Annapolis Maryland
– Dr William Meyers in Philadelphia, Pennsylvania
– Dr David Grischkan in Cleveland, Ohio
– Dr Paul Szotek in Indianapolis, Indiana
– Dr Bruce Ramshaw in Knoxville, Tennessee
– Dr Jonathan Yunis in Sarasota, Florida
– Dr Robert Tomas in Fort Meyers, Florida
– Shouldice Hospital in Toronto Canada (just in case you’re near the border)
There are quite likely to be other surgeons with significant no-mesh hernia repair experience. If anyone happens to know of any other surgeons then feel free to add them to the list, or offer any input.
Good luck and keep us updated on your case, progress, and decision making.
-
I’m sorry you’re going through this.
Did a surgeon look for hernias when they were using the laparoscope to deal with the endometriosis? If they recorded the procedure or took pictures, that may be worth reviewing, as it’s possible existing imagery could be useful.
Have you had an ultrasound with valsava done? That can be a helpful (and cheap) test to check for hernias of the groin.
The east coast has a lot of great hernia and pelvic doctors, so you’re pretty fortunate to be near some of the best resources out there.
– Dr Brian Jacob in NYC is very well regarded and would be worth consulting for hernias.
– Dr Igor Belyansky in Annapolis MD is also very well regarded for hernias.
Another option would be to check out the pelvic/core/hernia center at Vincera Institute in Philadelphia PA with Dr William Meyers. They have a variety of protocols to rule in and out various painful conditions impacting the groin, pelvis, hip, lower abdomen, etc.
There are certainly other options out there too, this is just a handful of ideas to get you started.
Best of luck and keep us updated on your case and decision making.
-
Have you been checked for hernia recurrence? It may be unlikely, but it’s always a possibility and that’s often the first thing that will be checked for.
It may be worth returning to the hernia surgeon and seeing what their experience is with treating and managing post-op pain. It’s always possible there’s an irritated nerve or scar tissue is irritating something too. Sometimes nerve block injections and NSAID (anti-inflammatory) courses can be helpful.
Anyway, best of luck and keep us updated on your case.
-
I’m sorry you’re going through this.
quote msp651:Is it possible to definitively rule out a hernia without surgery?That is difficult to say conclusively, but some imaging studies can be pretty accurate at diagnosing a groin hernia without surgery. The most reliable methods appear to be the following:
– dynamic ultrasound with valsava of the impacted groin (sometimes standing up so that weight / gravity works in your favor as well)
– dynamic MRI with valsava – Dr Towfigh has done research on this particular approach which you can find some here: https://www.researchgate.net/publication/264989952_Role_of_Imaging_in_the_Diagnosis_of_Occult_Hernias I believe Dr Towfigh also has a specific MRI protocol for this purpose, which you may be able to get by emailing her office directly.
Good luck and keep us updated on your case.
-
I’ve had a few posts get flagged as spam. Unfortunately spammers tend to blanket forums with garbage posts, which can make it difficult for legitimate posts to come through.
-
Just wanted to offer an update on two other potential surgeons performing sports hernia surgery / athletic pubalgia in the USA. Both surgeons appear to be based out of GWU in Washington DC
– Dr Fredrick Brody at GWU in Washington DC
– Dr Robert A Grossman (GWU in DC as well? Unable to confirm)
This information is from the following video presented by Dr Grossman at a SAGES conference:
https://www.youtube.com/watch?v=pL_8t-YXYFU
Be aware that is a medical video showing a surgery, so not everyone may be comfortable watching it.
-
Just wanted to offer an update on two other potential surgeons performing sports hernia surgery / athletic pupalgia in the USA. Both surgeons appear to be based out of GWU in Washinton DC
– Dr Fredrick Brody at GWU in Washington DC
– Dr Robert A Grossman (GWU in DC as well? Unable to confirm)
This information is from the following video presented by Dr Grossman at a SAGES conference:
https://www.youtube.com/watch?v=pL_8t-YXYFU
Note that is a medical video of an actual surgery, so not everyone will want to watch it.
-
quote Julliac:Chaunce,
Thank you for your reply. I was never checked out by anyone at Shouldice post surgery to clarify. Toronto is a 4 hour flight away from me in Alberta. I talked to 3 surgeons over the phone shortly after my injury to discuss what I was experiencing (3 months after my surgery). Its now 2 years post surgery and I still ache. I just had an ultrasound to find a femoral “reoccurance” (they deem it a reoccurance because you are 15 times more likely to get a femoral hernia after sutured inguinal repair due to upward traction). The two doctors I saw here in Alberta said that ultrasounds are quite unreliable for diagnosing small femoral hernias.
Anyways, I never did ache during the first 3 months (other than the first 2 weeks of course). I have not tried anything to manage pain. I avoid heavy lifting as I’m terrified to hurt myself again. Nerve pain is no joke. But I miss my strength/body and realize now that I am allowing this fear to dictate my activity. Yes I ache to varying degrees (mild to moderate) but it’s not debilitating/severe. You’ve given me a lot to think about or try. I hate the thought of medication, that would be a last resort for me. I guess I should check with physio and massage and see if that could help. Thanks a million for the reply. Your knowledge is truly appreciated.Jill
Interesting, thanks for the clarification, I was under the impression you had already a physical exam post-surgery by a hernia surgeon. If you have not done so by a hernia surgeon, that would probably be a good idea.
Was your recent ultrasound done with valsava? Essentially you take a big breath and then bear down as if you are trying to defecate while they are scanning the impacted groin region, it’s a little awkward but it can be very effective at showing small hernias. If you didn’t have that type of groin ultrasound done, you may want to specifically request it.
I can very much understand your hesitancy to take any medication, but keep in mind an NSAID course is temporary and usually well tolerated. The aim is for an extended course of a strong NSAID, typically a prescription level anti-inflammatory, taken daily for a month or two straight. Only do this under a doctors guidance and assuming your general health can accommodate NSAID usage. The idea behind this is to consistently reduce any regional inflammation, which is often related to the pain.
Nerve block injections to target the site / nerve branches involved in the pain are also temporary and worth a consideration. These can be very effective for some people who have constant pain or an irritated nerve. Often it’s not just a numbing agent but sometimes a steroid / anti-inflammatory agent as well. If the first one is fairly effective, the shots are often repeated a handful of times every week or every other week, particularly if pain notably diminishes with each block.
Finally, groin / abdominal / pelvic / hip rehab with targeted physical therapy / massage, aimed at rebuilding muscle strength and flexibility while loosening scar tissue, is certainly a valid consideration. If you happen to follow pro-sports, you will find that just about every professional athlete who has groin surgery (for a hernia or another groin injury) seems to go through extensive rehab protocols aimed at improving flexibility and movement in the groin post-surgery.
Anyway, I’m not a doctor so be sure to review all of this with your own physician to create a plan of action. Best of luck and keep us updated on how you proceed and any progress.
-
Just out of curiosity, how old are you? And are you athletic? Overweight or physically fit? Was there any event that occurred with the onset of pain?
Was your ultrasound specifically looking for a groin hernia? It should be scanning the inguinal region / inguinal and femoral canal. It should also have you perform a “valsava maneuver” (basically you bearing down as if you were trying hard to defecate) as that can basically push the hernia through a hole and make it easier to see on an ultrasound. Typically this is with a dynamic ultrasound, meaning a little video is captured of any movement in the region. You need to make sure you had a groin ultrasound with valsava specifically looking for hernias, if you did not have the valsava maneuver it is less likely to be effective, sometimes patients are told to stand up during this process too because gravity can help as well.
Rarely, an MRI with valsava is necessary to show a small hernia. Dr Towfigh (who runs these forums) has done research on that topic.
Anyway, if you are athletic, it is possible you have a groin strain or pull, or even something like a “sports hernia” which is sort of an all-encompassing term that includes a variety of groin conditions that usually feature; a torn or detached muscle or tendon in the groin / pubic area, always with pain. More appropriate terms for these conditions include; athletic pubalgia, inguinal disruption, osteitis pubis, adductor tears or strains, etc.
It certainly wouldn’t be a bad idea to see an expert hernia surgeon who is able to accurately diagnose a groin hernia. Smaller hernias can be notoriously difficult to diagnose and many primary care doctors and even surgeons are not aware of them, let alone how to diagnose or find them. If you’d like to share your general location perhaps you are located near an expert hernia surgeon.
Good luck and keep us updated on your case.
-
Ultrasound is usually fairly accurate to show a hernia or not, so if you had an ultrasound done on the impacted groin and it came back negative, and you had three different surgeons review your case, then you can probably assume you do not have another hernia.
I’m not a doctor, but it is certainly possible that you have some lingering nerve irritation, scar tissue, or some other remnant pain issue that can be a side effect of surgery. The groin is highly innervated with wildly complex anatomy, and hernia surgery is diving right into that very delicate area.
Have you done anything to treat the symptoms? Nerve blocks? Extended strong NSAID course (if your doctor approves / health permitting)? Any other anti-inflammatory efforts? Targeted physical therapy? Mayofascial release? Targeted massage to break up the scar tissue? Heat and ice? All of those may be worth exploring, as many people report improvements.
You might also want to find exercises for recovering after a sports hernia surgery because the injury and surgery area is very similar (inguinal / groin) and so are the rehabbing exercises to rebuild strength, loosen scar tissue, and regain mobility. You sound like you’re fairly active so you’re probably familiar with the concepts of this already. For example, I found this on YouTube but there are many others: https://www.youtube.com/watch?v=p3I0mKxuQGU
Other things that can potentially help with nerve type-pain over time include: alpha lipoic acid taken daily, vitamin C taken daily, medical marijuana, and engaging in mentally engaging and/or challenging tasks (complex math, learning a foreign language, puzzles, playing music, creating art, etc). Endurance sports can also be very beneficial but that can obviously be challenging or impossible if you’re in pain.
It sounds like you’ve had a fairly thorough workup, which is good to rule in/out other potential issues, and Shouldice is pretty much the gold standard for optimal hernia repair so that combined with the various surgeons checking you out I would imagine the chances are pretty good that you don’t have a recurrence.
With all that said, of course it’s always possible (but perhaps less likely?) that there is a recurrence or a new hernia that is being missed. Dr Towfigh has done some research on this topic and has an MRI protocol, usually a high resolution MRI with valsava, to try and appreciate the rare ‘hidden hernia’ that can be difficult to diagnose despite causing pain. Here is her paper on that topic: https://jamanetwork.com/journals/jamasurgery/fullarticle/1893806 and https://www.researchgate.net/publication/264989952_Role_of_Imaging_in_the_Diagnosis_of_Occult_Hernias
Good luck and keep us updated on your case and progress.
-
[USER=”2457″]Jim82[/USER] Thanks for the status update, glad to hear you are doing well 3 months out.
Do you mind sharing the name of the surgeon you had, and any other details you may have about them or their experience? Other patients may find it potentially helpful to know.