Chaunce1234
Forum Replies Created
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I’m sorry you’re going through this.
Just out of curiosity, did your symptoms or pain change at all after your hernia surgery? Are symptoms the same or worse, or different? Have you tried some of the sports hernias / adduction tests yourself to see if they elicit pain?
The video below may be helpful in demonstrating some of the common tests for diagnosing a groin sports injury
https://www.youtube.com/watch?v=06ejoNb5psU
I would echo “Good Intentions” advice to look into the possibility of a sports injury of the groin or pelvis, whether it’s something like inguinal disruption, or athletic pubalgia, or an adductor issue, or the other potential causes (some of which sounds like you’ve already ruled out). These injuries can be extremely painful but are surprisingly not well understood, diagnosed, or even treated. Dr William Meyers at Vincera Institute in Philadelphia is very well known in professional athletic circles and their clinic is an excellent resource too.
Where are you generally located? Perhaps someone can recommend a nearby specialist. Here’s a list I had posted in another thread that you may find helpful:
EAST COAST SPORTS HERNIA SPECIALISTS:
– Dr William Meyers – Philadelphia PA
– Dr Alexander Poor – Philadelphia PA
– Dr Litwin – UMass MA
– Dr Brian Busconi – UMass
– Dr Andrew Boyarsky – NJ
WEST COAST SPORTS HERNIA SPECIALISTS
– Dr William Brown – Fremont CA
Good luck and keep us updated on your progress.
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quote Good intentions:Chaunce, do you have a link to the internet forum thread with the surgeon’s discussion?
Many of the SAGES presentations end up on youtube. I don’t know who decides what gets released but I hope that the mesh discussions are.
The discussion I stumbled onto was found on Google between surgeons discussing the SAGES conference on the website Twitter, it is sort of hard to follow the discussions as the Twitter format is not laid out like this forum is. Here is one of the threads:
https://twitter.com/andrewswright/status/984184051404652544
Another thread on Twitter which I can not locate at the moment included several other doctors discussing patients who do not want mesh, or who have chronic pain, etc. Some of them I found to be very dismissive of this as a problem or a patient concern, which seems odd and not particularly patient focused.
I did notice that two of the surgeons who were sympathetic and understanding on this topic were two surgeons who also happen to frequent these forums: Dr Szotek and Dr Towfigh, so credit where due, and huge bonus points to those two doctors for being patient focused and listening to patient concerns!
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[USER=”2514″]inguinalpete[/USER] I’m sorry you’re going through this. Just out of curiosity, did you feel a sensation of tearing when the original repair failed, and that started the onset of your current pain and discomfort? Or did the current pain and discomfort start after the second surgery only? This could help to provide a clue as to what is causing discomfort.
Unfortunately you may need to travel to a regional expert with sufficient experience managing recurrences and re-do surgeries, as it’s a separate field of expertise. If you don’t mind sharing your general location perhaps a few surgeon names could be passed your way.
As a starting point, here are a handful of surgeons spread around the country who are typically considered well experienced in re-do surgeries:
– Dr Shirin Towfigh in Los Angeles CA (she runs these forums)
– Dr David Chen at UCLA, CA
– Dr Robert Martindale in Portland, OR
– Dr David Grischkan in Cleveland, Ohio
– Dr Bruce Ramshaw in Knoxville, TN
– Dr Igor Belyansky in Annapolis MD
– Dr Jonathan Yunis in Sarasota, FL
– Dr Brian Jacobs in NYC, NY
– Shouldice Clinic in Toronto CA (I believe they only do open surgery)
There are certainly others as well, and perhaps some closer to you.
I don’t know enough about the wildly complex anatomy to comment much on the Bassini repair in general, but I’d figure under proper hands it should have a low recurrence rate and reasonable success as that was the standard procedure until fairly recently, but like most tissue repairs it is becoming increasingly rare to find surgeons who have the routine experience in the USA. I think the Shouldice repair is basically the Bassini repair but with another layer of suturing as a reinforcement mechanism.
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Is the bulge on a single side, or in the middle? Is it painful? Does it move if you cough? Does it go away if you lay down on your back?
A general surgeon should be able to determine if it’s merely fat above the pubic area, or a hernia. If there is doubt about it, you could request an ultrasound with valsalva for a hernia.
Fat on the mons pubis area is fairly common, particularly if you recently gained weight, or are overweight, or obese, but some thinner people have fat deposits there too. I think it just depends on the person and their individual body, and perhaps diet and exercise. But simple fat on the mons pubis is not a hernia, at least as far as I know.
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Dr Ulrike Muschaweck is based out of Germany but I think also does surgeries in UK sometimes, she is very well regarded for professional athletes and in the athletic community, and does traditional hernia surgery as well.
There is also the Gilmore Groin clinic in the UK, which you sometimes hear about in sport circles.
Perhaps another poster can chime in with some additional information that is appropriate to your region.
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I believe most athletic pupalgia, osteitis pubis, hip and tendon issues, are usually identified on a 3T MRI with contrast, but I could be wrong about that.
The inguinal disruption type of sports hernia and/or muscle tear of inguinal wall type of sports hernia is I think usually found on an ultrasound instead, more similar to looking for a traditional hernia. Sometimes they find a traditional hernia in that process as well apparently.
Both usually require radiologists that are skilled in identifying these issues, as many are not aware of the injuries.
Dr William Meyers at Vincera uses MRI and physical exam, as Good Intentions points out. You could probably call the Vincera Institute office and ask them details, they’re usually very helpful.
I am not sure what Dr William Brown uses to identify sports hernia, I believe it’s physical exam and possibly imaging. Again I believe his office is very receptive to inquiry.
Dr Ulrike Muschawek in Germany uses Ultrasound and physical exam to identify inguinal disruption / sports hernia, I think with that particular injury they’re basically looking for a bulge or rupture in the muscle wall that pinches against a nerve.
I am not sure what Dr Shirin Towfigh uses to identify sports hernia, but I believe from other posts she uses MRI and ultrasound for finding regular hernias so it could be a similar protocol.
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Keep in mind you will be medicated after surgery, so you might find sleeping on your back to be a bit easier than normal.
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Was your original surgery for an inguinal hernia, or a sports hernia? Did the symptoms go away after that surgery, but reappear with the recurrence? Do you mind sharing who performed that original bassini procedure?
I have read Dr Towfigh discuss on these forums using Bottox injections for tight repairs, I wonder if that could be helpful in your scenario?
Where are you located? Perhaps a regional expert could be recommended that may be helpful to you and your case.
Best of luck and keep us updated on how you’re doing.
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Just out of curiosity; Have you already been diagnosed with inguinal hernias? Or a sports hernia? Are you experiencing groin pain or another primary symptom? What is your age? Are you thin or overweight?
Did you ask Dr Brown about the impact of his hernia repair on the cremaster muscle?
As for cremaster, I believe it usually depends on the repair type itself, and I am not sure what type of non-mesh hernia surgery he performs. I know it is considered routine to cut the cremaster muscle in a typical Shouldice hernia repair as it becomes part of the tissue repair itself, but I think they usually re-attach the remainder of the muscle a bit higher up so that the testicle does not dangle too low. It’s an understandable concern, but at least at the Shouldice clinic in Toronto they seem to know what they’re doing with it since they have such excellent results with recurrence and a lack of chronic pain.
As for Dr Brown, I recall a prior post on these forums about various athletic forums where surgeries with him were discussed, but they might be sports hernias. Of course some assumed ‘sports hernias’ end up being an inguinal hernia, so there could be some crossover there.
Keep us updated on your findings, progress, and decision making.
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Dr Igor Belyansky in Maryland is apparently well regarded and is certainly experienced in hernia repair and re-do surgeries for a variety of reasons. You might want to reach out to him directly through email or by phone to start a dialog.
I also find it interesting that he posts some of his surgery videos to YouTube, but be aware they are very graphic as they are intended for a medical audience. Nonetheless if you have the stomach for it, here’s the link to his surgical videos if you are interested in seeing them:
https://www.youtube.com/channel/UCXP…V6Sy83w/videos
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quote SomeGreyBIoke:Hi Good intentions,
Thank you so much for your message. I’m in a bad place as my pains started after another operation back in January, part of me thinks that pain is still to do with that op and not hernia, and probably hang on and don’t do anything drastic at this stage.
Was the other operation done laparoscopically? Have you tried to do anything to treat the primary symptom (pain) like a nerve block?
Does laying down flat on your back help the pain? Or does anything else make it better or notably worse?
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quote newagehernia:Hi, I saw your post.
I have a right Inguinal hernia . Started 1 year ago. Pain developed quickly and have been suffering in very high pain , discomfort, groin weakness and heaviness since. I force myself to walk 5km to 7km a day though it’s not fun. Strangely walking is less painful than sitting, standing , or walking slowly (like a museum) . Very up and down. Mostly down. When irritated, can be painful for a few days above normal background pain.
I do not want plastic mesh. And I have some (irrational?) fears and anxiety of both current access methods of repair.
My research has found the following assuming it is an indirect hernia down the canal like mine is (from a coughing accident due to a bad cold )
1. Lcepc, pediatric laparoscopic extracorporeal non mesh repair. I have seen a Japanese study online and a USA doctor in Ohio doing it on adults. How simple ! Ultra minimally invasive. Don’t know if it works but why not? This kind of hernia is not always from a broken Inguinal floor.
2. Tigr matrix , a mesh dissolves in 2 phases ultra long term. The founder ( see novus scientific website) says he has to educate surgeons that long term dissolvable mesh 100 percent works for indirect hernia . Can be used tep lap or open.
3. Ovitex , a mesh of sheep and dissolvable plastic. It is almost better then number 2 as it’s biological mixed with a dissolvable support of plastic making it easier to insert. Very new not yet available in europe. There is some doubt of biomesh degrading too soon but studies I read say 90 percent of these indirecr hernia can be fixed this way but at higher cost and maybe higher recurrence. Is there added risk (plastic mesh or no mesh has risk too)
4. As a last resort , there is convincing evidence that pvdf (dynamesh) has low inflammation and elasticity superior to polypropylene. It’s not ultra light but apparently material matters more then weight. As a second choice in this category maybe a dual absorption mesh like ultrapro, seramesh pa, or maybe timesh?
Problem. Who to find to do these new and non standard fixes that soon will be standard for this specific subgroup? Or to have a customized approach and choose best option for you ?
Most centers do the nuclear option , they don’t care what specific hernia type or location you have.
a surgeon who is open minded and sees the advantages of above would be great.
I’m also travelling making it hard to find a surgeon since they are everywhere and don’t know if it’s worth the cost and bother to find out. Most don’t answer email so If you pick a traditionalist you’ve just wasted a big consulting fee and travel expenses.
What to do ? So far I’m struggling along but no doubt a surgery is necessary, current methods or better methods not withstanding. Part of me thinks it would be a pity to have a repair I hate because I don’t have time to use a newer method or technology that is already having many studies but not enough data . Sometimes you can’t have data for everything in time sadly.
Ps, whatever method is used with foreign object make sure they use glue and are a specialist hernia expert.
You might want to post this to a new question thread for best response results.
Where are you located? Perhaps a regional expert can be recommended that would suit what you’re looking for, or help you make a decision.
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You’re only a few days out from surgery so swelling is normal and to be expected. I wouldn’t worry too much, but if you are concerned then contact surgeon for advice and follow-up.
I would echo what the other posters said too; after any abdominal surgery, try to brace a pillow or something like folded up towel against your abdomen and incision area to reduce the sudden expansion when coughing, sneezing, going to the bathroom, etc.
Good luck! Keep us updated on your progress and how you’re feeling.
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Most people who get a hernia repaired will have no problem with it. That’s the good news.
The bad news is there are a substantial number of people who do end up with a problem. Much of what you read online is tilted to the negative because those are the unfortunate people that have the problems, usually chronic pain, or a non-specific sense something is wrong, and then they’re left trying to figure it out on their own.
It’s always a good idea to get an opinion, and maybe even a second opinion or third. Do your own research on repair types, approaches, outcomes. Ask the surgeons what their particular experience is, how many times they have done the same surgery, what their rate encountering chronic pain and recurrence is, or if they track that outcome data, how each is handled, etc. Also consider your own body and your own expectations, if you’re athletic or thin you may have different expectations than someone who is overweight and inactive, and you may have different surgical possibilities as well.
As for your locality, the only surgeons name I have read regarding hernia surgery in Texas is Dr John Etlinger in San Antonio, TX.
Good luck and keep us updated on your decision making and progress.
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What was your major abdominal surgery and where were the incisions? That could be a clue as Good Intentions mentioned.
You can be checked for a hernia relatively easily by exam, but also by ultrasound which may be more definitive if there is some ambiguity. It’s also possible that you may have a hernia but your symptoms are unrelated to it. The groin and pelvis are highly innervated and very complex, there are many different potential causes of pain to rule out.
As for groin pain and you being a male bicyclist, there could be a relationship there, almost certainly based upon the bike seats compression against very delicate anatomy. Whether you think riding a bike is worth it is entirely up to you, but perhaps try not riding a bike for a few months and seeing if the pain goes away or changes.
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I am sorry to hear about your discomfort.
What part of the country are you located? Perhaps someone can recommend a regional expert on hernias, hernia recurrence, and related issues.
The anatomy is very complex and unfortunately there are fewer true experts on the topic than there should be, so unfortunately that may mean traveling to find someone with appropriate expertise.
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quote ajm222:An experience I had this evening made me wonder about something. Incidentally, I’m about 5 1/2 weeks post op from an indirect inguinal hernia repaired with mesh laparoscopically (using robot).
Anyway, I also have a recent history of some mild IBS. I’ve ultimately pinpointed that diet soda seems to be a problem for me in that regard. If I have more than one per day, I occasionally get really bad cramps and bloating. Well, today I had more than one and the bloating became really uncomfortable. It didn’t help that I had tight cloathing on that didn’t really stretch.
After a while I also noticed that the inguinal area seemed to be getting really sore, more than it had since the first week or so after the operation. It has subsided already, at the same time as the bloating itself, but for a couple of hours I was super uncomfortable. It made me wonder if it was the bloating and my insides pressing against the mesh. Which then made me wonder if significant weight gain later on in life could potentially cause problems with the mesh due to stretching and pressure, especially if the mesh tends to shrink over time.
About two years prior to the surgery I had lost about 50-55 pounds (my reward apparently being an eventual hernia). I had been overweight for about 18 years at that point, starting a year or two after college. So there’s always a chance I could gain the weight back, and I’m concerned that weight gain could be problematic when it comes to the mesh.
I don’t recall reading anything about this before, except for maybe one random story where someone suggested when they gain some weight they start getting some discomfort.
Just wondering if anyone had any thoughts or come across anything relating to this. Just curious.
Thanks
Given your comment about diet soda causing you discomfort, you may want to consider an elimination diet, or avoiding certain types of non-sugar sweeteners as there is some evidence that certain artificial sweeteners can cause GI distress for some people.
Congrats on your weight loss and keep it up, your body will thank you. I do know that Shouldice clinic has strict BMI requirements and will not perform surgery on the overweight, and they strongly recommend avoiding weight gain after a repair, presumably that same logic applies to all hernia repair types.
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Is it accurate to say that some “sports hernia / inguinal disruption” is basically the painful start of a direct inguinal hernia, but that has not broken through to full herniation completely yet? I recall reading that somewhere, but I do not understand the complex groin anatomy well enough to make sense of it.
On a related note, this video presentation from Dr Ulrike Muschaweck on inguinal disruption / groin injuries may be of interest to some readers here, she describes the classic inguinal disruption injury, as well as her particular approach to repairing these injuries:
https://www.youtube.com/watch?v=w-Rz4V-eGZI
Note the video is intended for a medical audience and has some graphic imagery, so the squeamish may want to avoid.
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You may try searching these forums, or as Dr Towfigh suggests the American Hernia Society website.
I have read on a forum that Dr John Etlinger in San Antonio, TX has notable experience with groin hernia surgeries so that may be a starting point, but I have no additional details. Healthgrades.com suggests he performs a “very high” number of inguinal hernia repairs but I do not know where they get that data and if it is accurate.
One would imagine with the large population size, and large volume of manual labor in Texas for oil/gas/ranching/construction that there’d be a fair number of surgeons with notable hernia experience there.
Keep us updated on your case.
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quote W.Parker:I believe or should differently be considered that a hernia repair should be conducted during a hydrocelectomy procedure even though the incisional site is located in two different locations. The surgery technician said both should be down at the same time,so I guess they have seen or done these procedures before. It would of alleviated over 2 years of uncomfortable mind blowing recovery and missed diagnosis of nerve pain, nerve blocks and medications including Gabapentin,Duloxetine and Ibuprofen My hernia was unnoticed in the standing position which puzzled the doctor but when I pointed out the bulge in the lying down position the RT Inguinal Hernia was confirmed.
Do you and your surgeons think your pain was caused by the hydrocole, or the hernia?