Chaunce1234
Forum Replies Created
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quote Jeremy B:Chaunce1234, Thank you for posting about Dr Todd Ponsky. I talk with him tomorrow morning about entering his trial.
I really hope that I’m a good candidate for the procedure: https://www.youtube.com/watch?v=nsIHTlfhrM4
I just hope that I have an indirect hernia as it seems a less invasive repair can be utilized.What type is more commonly seen in a fit healthy middle aged male? Direct or Indirect hernia?
[USER=”2329″]Jeremy B[/USER] That’s very interesting and exciting, please keep us updated on your conversation with Dr Ponsky and if you will be a part of that trial! Would you need to travel to see him? Be sure to ask the doctor about what his plan(s) would be if a direct hernia is found instead of an indirect, as that would apparently require a different procedure.
I am not a doctor, but from my understanding the indirect hernia is more common simply because many people are just born with it, yet it often doesn’t become a problem until later in life (if ever). The direct hernia is supposedly acquired through some sort of injury or cause, though I have also read that isn’t always the case. Both can occur to anyone at any age as far as I know. Personally I know athletic people in good physical shape and of all ages who have had both types of hernias, as well as sports hernias, so I am not sure either of the conditions only impact one age group or another.
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This story is puzzling but I am not a doctor so it may be more puzzling to laymen like myself than those in the medical world. Nonetheless I would echo [USER=”2029″]Good intentions[/USER] advice to get medical records, imaging records, diagnostic records, etc so that you can get a better understanding of what was going on, and so that you can get a better idea of how to move forward particularly if you still have problematic symptoms.
I suppose it’s entirely possible they did an exploratory surgery but found nothing?
Just out of curiosity, where exactly is your incision scar? Is it on your lower left abdomen? Personally when I hear “belly” I think of “belly button” area.
Good luck and keep us updated on your case.
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Dr Ulrike Muschaweck is typically based in Munich Germany but performs surgeries in the UK as well, she is very well known in pro-athlete communities for managing “sports hernia” / inguinal disruption, and inguinal hernias, and some patients and pro-athletes from the USA even fly out to see her. I believe this is a UK contact for her, but I am not 100% certain:
https://www.fortiusclinic.com/dr-ulrike-muschaweck
There is also the Gilmore Groin Clinic in London.
What was your ultrasound diagnosis of? What was the onset of your symptoms / pain like, was there a particular event with immediate pain? Does it hurt more when you cough or strain for a bowel movement? How old are you?
Good luck and keep us updated on your case.
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quote lukeyamaguchi:I did not have a hernia repair after mesh removal. So I still have a small hernia, but it isn’t causing me any problems at the moment. Maybe thanks to the mesh/scar tissue still inside my body.
Have you found anything in particular to be helpful for relieving your remaining symptoms, whatever they are? Many patients on this forum and elsewhere struggle with chronic pain or side effects from procedures, and any direct knowledge can be helpful to others even if it is anecdotal.
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quote koohiisan:[USER=”1916″]Chaunce1234[/USER] , thanks for the detailed info!
There were four pictures taken…well…four that were printed and given to me, anyway. The doc said he didn’t see anything.
Regarding her symptoms: in certain positions of sitting, stretching, or at times laughing hard causes a firm bump to protrude out at a location to the left of her navel. I’ve seen it, and felt it, and it’s definitely ‘something’. She has to stretch out flat and force this ‘thing’ back in from whence it came. It is very painful for her.
No MRI or CT was ever taken at all, and I’m thinking that there also was no ultrasound (90% certain of that). The doc simply asked where it was and felt like he could find it based on her symptoms. She’s never been able to make this happen on command so as to demonstrate it, although we circled it once when it was protruding at home so we could show him where it was located. According to his analysis of the photos he showed me, he examined that area with her abdomen inflated but was unable to locate anything.
Just based upon your description of a visible lump, I would try and request an ultrasound (they are fairly cheap and so insurance usually doesn’t fight them), and try her hardest to get the bump/protrusion to be reproduced during the ultrasound with valsava. Sometimes an ultrasound is a preliminary step for insurance to “OK” an MRI/CT as well, depending on how many hoops the insurance makes you and your doctors jump through.
I am not a doctor but I do find it puzzling that an exploratory laparoscopy did not see something if there is actually a protrusion of any sort that becomes visible, since my limited understanding is that a hernia is usually visible upon laparoscopic inspection, but I don’t enough about umbilical anatomy or the abdominal wall in general to help explain any of that.
It’s always possible it’s not a hernia at all, and it could be something else, so try and keep an open mind. In the meantime, reach out to Dr Szotek since he is within your state, he could be a valuable resource.
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I would agree with [USER=”2029″]Good intentions[/USER] and consider visiting a specialized wound care clinic in your area, as expertise can make a difference for nearly all situations.
Best of luck and keep us updated on your case.
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quote drkang:Hi Chaunce1234,
Before performing hernia repair, it is our principle to accurately diagnose what type of inguinal hernia it is. This is because not only is the surgical method different for each indirect inguinal hernia and direct inguinal hernia, the location of skin incision is also different. The subtype of inguinal hernia can be precisely identified by ultrasonography.
Surgical methods for open inguinal hernia on adults is largely divided into two. It is similar to a football match where it is divided into first and second halves. For the sake of convenience, I will refer to “open indirect inguinal hernia repair for adults” as “INDIRECT HERNIA REPAIR”, and “open direct inguinal hernia repair for adults” as “DIRECT HERNIA REPAIR”.The first half of INDIRECT HERNIA REPAIR is the step when the hernia sac is located then tied off and the stump is placed back into its preperitoneal space. This step is proceeded on every INDIRECT HERNIA REPAIR; whether it is a mesh or non-mesh repair. However, it is different in the second half. In Lichtenstein repair, the inguinal floor is completely covered by mesh sheet, and in mesh plug repair, the mesh plug is placed where the hernia sac is. In the case of tissue repair as well, the inguinal floor is reinforced each in its own method whether Bassini, McVay, Shouldice or Desarda. As such, all INDIRECT HERNIA REPAIR are composed of two sections. In DIRECT HERNIA REPAIR, there are at times when the handling of the hernia sac (first half) is not clearly carried out. But the second half, when the inguinal floor is reinforced, is always carried out.
However, inguinal hernia repair on children is certainly different from that on adults. For children, inguinal hernia is unconditionally the indirect type and surgery is completed by handling the hernia sac and simply placing it back to its preperitoneal space. This is called high ligation. The second step is unnecessary for children because in infantile hernia, the muscle break called the deep inguinal ring is too small for the hernia sac to escape in the first place.
It is unfortunate that many people are confusing high ligation with Marcy repair. Marcy repair consists of both the first and second half mentioned above. This means that in the latter half of Marcy repair, the deep inguinal ring is stitched and closed. In most textbooks, it is written that Marcy repair can only be applied on small indirect inguinal hernia; when the deep inguinal ring is very small. However, I have conducted my repair(Kang repair), which has a similar concept to that of Marcy repair, for the past 5 years on more than 3,500 patients with indirect inguinal hernia continuously with a recurrence rate of merely less than 0.5%. Among these patients, there were many who came to me due to recurred indirect inguinal hernia, and many who needed partial omentectomy during surgery due to an immense amount of omentum being incarcerated. Thus, I have applied my repair on all indirect inguinal hernia patients without exception and have found out that in contrast to existing knowledge, my repair successfully works no matter how severe the indirect inguinal hernia is.
Dr. Todd Ponsky’s laparoscopic repair is a method where the orifice of the hernia sac (peritoneum) is closed and thus, has the same surgical concept as high ligation. This method does not include the procedure of blocking the deep inguinal ring; making it completely different from Marcy repair.
In addition, I’d like to further explain. It is similar to the content of my previous posting.
Most of the existing tissue repairs, as latter parts of the procedure, are surgeries reinforcing the posterior wall of the inguinal canal called the Hesselbach triangle. And according to the difference in the method of reinforcement, they are each called Bassini, McVay, Souldice, Desarda and more. The surgical method for reinforcing the Hesselbach triangle is the ideal surgery for direct inguinal hernia. This is because hernia that is formed as the Hesselbach triangle weakens and widens is direct inguinal hernia.
In contrast, indirect inguinal hernia doesn’t form in the Hesselbach triangle but rather forms slightly above on the lateral where the deep inguinal ring loosens and widens for it to come out. Therefore, INDIRECT HERNIA REPAIR has to block the widened deep inguinal ring. Marcy repair is a method that carries out this concept. However, as there are several surgical methods according to the difference in the method of reinforcement of the Hesselbach triangle, there can be many ways in blocking the deep inguinal ring. Marcy repair is one method, and my repair method is another of them. And my surgical mehod for a direct inguinal hernia is similar to Shouldice repair; except it has been very simplified.Dr Kang, I want to thank you directly for your detailed explanations and posts here, your knowledge is extensive and you are doing a great service to share this information with the public.
Out of curiosity, how common is it for patients to have BOTH the indirect and direct hernia? Does that make the repair more difficult? Do you ever unexpectedly find the other hernia type once you have already begun the operation? Finally, does the procedure work with a femoral hernia?
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[USER=”2019″]drkang[/USER] I would echo what [USER=”2533″]Jimbohen[/USER] said and kindly request that you share your particular experiences and details of your surgical approach with some US-based surgeons so they too can learn from your technique. I imagine both Dr William Brown and Dr Shirin Towfigh [USER=”935″]drtowfigh[/USER] would be receptive to learning more and perhaps applying it themselves as they are two of the more open-minded hernia surgeons in the USA.
With luck, perhaps the repair can become widely adopted and named after you – The Kang Repair! – and it could be expanded to other patients around the world who are unable to travel to South Korea for your expertise.
Thank you for the consideration and responses.
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[USER=”2563″]Excalibur[/USER] I would not worry or be concerned, if you are post-surgery and don’t have any particularly worrying symptoms (ie; unusual pain, severe pain, or some other life changing problem) then you’re probably fine – from a statistical standpoint, the odds are already in your favor. The reality is most people do fine with the average hernia repair with mesh, though there is indeed a disturbingly high percentage of people who do end up with chronic pain or some other unfortunate issue after hernia surgery.
How long ago was your surgery? How are you feeling? In terms of side sleeping, or most other activity for that matter, I would try to do what is comfortable, and what is within the limits as set by your surgeon, particularly while you are still healing.
Do you mind sharing the name of your surgeon? who offered you a tissue suture repair, as well as the laparoscopic repair? It can be helpful to other patients to have options like that.
Keep us updated on your case and progress!
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I’m sorry to hear you still have some health problems, but any improvement is good I suppose. If you are still suffering with pain/discomfort you may want to explore some alternative treatments. If you’re in Seattle, you may even try some of the medical marijuana solutions, as some people report positive experiences with GI issues as well as pain. Just something to consider, but given how well you research things I assume you’ve already explored the gamut.
I find it to be a terrible trend that medical schools are not teaching no-mesh repair to new students. I am strongly of the opinion that all medical students should know how to successfully repair a hernia without mesh, as well as with mesh (simpler the better, Lichtenstein probably), and know when/why to use either procedure per patient.
Did you have another hernia repair along with the mesh removal procedure? Or was your hernia not visible after mesh removal?
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It is hard not to be cynical about this.
Speaking of the FDA, they do have some publicly searchable databases for reporting adverse medical events with medication and medical device products.
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm
And another searchable database:
You can also search the 510k database too for approvals “equivalent” products.
Each of those databases can be interesting to browse through.
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[USER=”2029″]Good intentions[/USER] you’re a great contributor to this site so please don’t feel like you’re over-posting. I know what you feel, but ultimately knowledge is good. If even one single patient can be helped by what any of us post on any topic, it is worthwhile. That’s my opinion anyway.
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Have you visited a wound care clinic specifically? I wonder if they’d have any different ideas?
Did you ever have to pack the wound to let it heal from the inside out?
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You could try having a dynamic ultrasound with valsava directly on the spot of the bulge / discomfort. Often that ultrasound is done both laying with valsava and standing with valsava. It may see something that wasn’t found on the MRI / CT since you are usually laying down for those procedures.
It seems reasonable to investigate GI causes as well.
Keep us updated on your case and decision making, good luck.
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Try Dr Shirin Towfigh in Los Angeles, at the very least I would assume her clinic could recommend someone.
Good luck and keep us updated on your case and decision making.
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Indeed as other have stated, Dr Szotek is in Indiana and I believe works with Dr Towfigh from time to time.
Are there any pictures taken from the exploratory laparoscopy? I believe you can usually see hernias if they are visible this way, so if it was explored and none found it may suggest another issue.
What are your wifes symptoms? How long have the symptoms existed? Do they ever go away or are they constant? Does anything make them better, or worse? Has she had other testing done to rule in/out other causes? MRI? CT? Ultrasound with valsava?
A handful of surgeon names around the country that may be helpful as a starting point, surely there are others as well:
– Dr Shirin Towfigh, Los Angeles, CA
– Dr David Chen, UCLA CA
– Dr Paul Szotek in Indianapolis, IN
– Dr Bruce Ramshaw in Knoxville, TN
– Dr Jonathan Yunis in Sarasota, FL
– Dr Igor Belyansky in Annapolis MD
– Dr Bruce Ramshaw in TN
– Dr Jonathan Yunis in FL
– Dr Brian Jacobs in NYC
Some of those doctors are quite receptive to patient inquiry, so it may be worth reaching out, perhaps with images, and a brief overview of the case (symptoms, imaging, diagnostics, tests, etc)
Good luck and keep us updated on your case and progress.
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Sometimes Ultrasound can differentiate between direct and indirect, and femoral, but sometimes it can erroneously display one or the other, or none, they are not perfect, and I suspect operator and interpreter matters as well.
As far as I know, Marcy repairs are usually done in children and adolescents, I think it basically shrinks the entrance to the inguinal canal so as to make it too small for something to pass through it that does not belong, therefore it would work on indirect but not direct or femoral. I personally know people who had those marcy hernia repairs as children and have never had a recurrence or any other problem.
Interestingly, Dr Todd Ponsky appears to be actively involved in a study on testing this repair done laparoscopically on adult indirect hernias.
https://www.youtube.com/watch?v=nsIHTlfhrM4
Comment from Dr Ponsky found in that YouTube comments says the following:
“We will soon have data from a prospective trial treating all adult in directing a hernia is with this technique and we will have a better understanding on who fails and who succeeds.”
Does your hernia hurt or bother you in another way? Is it large or small?
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Thanks for sharing. These stories are important to share, and I think you make a lot of great points.
Do you mind sharing a few additional details on you case?
– Were you in pain prior to surgery?
– Was your original hernia a direct or indirect, both?
– Did your pain change or improve after surgery?
– Did you have a neurectomy?
– Did other symptoms change or improve after surgery?
– Who did your mesh removal surgery?
I find it interesting but troubling that looking back you and many others say “I wish I had went to Shouldice”. Given the interest in no-mesh hernia repair in the USA I am continuously surprised there are no similar clinics in the USA that specialize in hernias only, mostly no-mesh repair, in a similar manner as Shouldice. One would think the market would meet the demand, but instead the market appears captivated by medical devices and medical products.
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Is your pain all the time, or only with certain movements? Two weeks out from surgery is still pretty early, but if you have tack pain one would imagine it could be dealt with directly.
Did you ask the surgeon if he can look at the region that is hurting so much? Did you ask the surgeon if he can investigate and/or remove the tacks if they align directly with your area of pain?
I know that some thoughtful doctors do a CT / MRI of the patient with a little marker at the patients pain focal point(s), so that those particular areas can be investigated directly. It may be valuable in a case like this if you think you have a tack that is not quite right.
Mesh removal is far more complicated than simply removing a tack however, and it’s really a specialty in and of itself, but some helpful resources may be:
– Dr Igor Belyansky in Annapolis MD
– Dr Bruce Ramshaw in TN
– Dr Jonathan Yunis in FL
– Dr Brian Jacobs in NYC
– Dr Shirin Towfigh in Los Angeles California
As for sports hernia specialists, which is also a unique specialty in and of itself, here are some potential resources:
– Dr William Meyers – Philadelphia PA
– Dr Alexander Poor – Philadelphia PA
– Dr Litwin – UMass MA
– Dr Brian Busconi – UMass MA
– Dr Andrew Boyarsky – NJ
– Dr William Brown – Fremont CA
Best of luck, and keep us updated on your case and progress.
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I have read a lot of similar reports on these, and my assumption is that after a week out it is not unusual to still have pain, discomfort, and swelling in the area of surgery. As for the swelling itself, it’s conceivable to be inflammation or fluid accumulation as the body heals from the surgery. But I am not a doctor, so this is just my best guess.
Are you taking anything for the pain, like advil or? Does laying down alleviate the pain? What was your pain like pre-surgery?
If you are particularly concerned, you should reach out to your surgeon for a sooner appointment, or talk to the advice nurse for advice. Otherwise I would not worry too much, the majority of hernia surgery patients do great.
Best of luck and keep us updated on your case and progress!