[Chaunce1234]

quote drkang:

Hi Chaunce1234,

Yes, about 30% of my hernia patients complained of pain together with a hernia bulging.
And occasionally, I have some patients who had inguinal pain for some periods before they finally got the visible inguinal hernias.
But I don’t do the hernia repairs without the sonographic diagnosis of inguinal hernias, even if they complain of inguinal discomfort.
Of course, the sports hernia is a different story.

Actually I don’t know exactly what the ‘hidden hernia’ means, I am afraid.

Thank you!

Thank you for the response. The “hidden hernia” I reference is a situation where a patient has groin pain but no visible or palpable hernia, though a hernia may show up on ultrasound or imaging only, and is found during a surgical procedure. This is a common topic on these forums but I understand it is controversial in the medical community perhaps because of the ambiguity.

[Chaunce1234]

The “groin pain, found a hernia on ultrasound, but no hernia on palpation test” a fairly common topic of discussion on this forum and it’d be great to hear surgeons chime in with their thoughts and experiences.

Just out of curiosity, are you a male or female? Are you thin and/or athletic, or overweight? When did the pain begin, and was there a particular event that you recall which started it? Is there anything that makes the pain better or worse?

Many surgeons take the approach yours did of “no bulge / no palpation = no hernia”. Shouldice has that approach, as do many other doctors.

The other commentators are correct in that many/most people with a groin hernia simply have a bulge with no pain. The hernias with pain are less common, and even more rare are the hernias that are painful but do not show up at all. That is also why it’s important to make sure that other causes of pain have been ruled out, because groin hernia surgery has a high risk of chronic pain in general and that should arguably be your biggest concern, though most surgeons focus on recurrence, which I think has it wrong. A recurrence is a nuisance, whereas chronic pain can be life changing. Particularly in the current era of mania regarding opioid usage and prescribing, chronic pain should be the most important outcome since nobody would need opioids or anything else for chronic pain if they did not have chronic pain to begin with.

You may want to find someone who is an expert at diagnosing the many various potential causes of pelvic and groin pain, hernia included.

[Chaunce1234]

I’m sorry to hear about your daughter.

Is the pain in the typical region of a groin hernia, in the general inguinal or femoral region?

Was the ultrasound specifically looking for a hernia of the groin, performed with valsava? Or was it just looking at the general abdomen? These are typically different ultrasounds and do not overlap, so it would be worth confirming.

Presumably she has been tested for intermittent or chronic appendicitis? Does she have rebound pain upon pressure release?

Checked for endometriosis? PCOS?

Do any particular foods make it worse? Have you tried an elimination diet to rule out anything that could be dietary related? Or some other GI issue like IBS or Crohns?

Sorry, I am not a doctor and am just tossing out a few ideas. Hopefully you’ll find a physician that is a good diagnostician that can help go through a workup.

In terms of CT / MRI, it may be helpful to have a hernia expert look at them just in case they see anything notable. As “Good Intentions” mentioned, Dr Towfigh will review scans, as will some other physicians that are often mentioned on these forums.

What region of the country are you located in? Perhaps someone is aware of a regional expert.

Best of luck, keep us updated on her case and your progress.

[Chaunce1234]

quote SighFigh:

[h=1]Laparoscopic, Non-Mesh, Inguinal Hernia Repair (Todd Ponsky)[/h] Hello, I just found this on youtube

This is copy and pasted from the video description.

“Here is a video with both animation and two case demonstrations exhibiting the technique for laparoscopic high ligation of an indirect inguinal hernia in a male. We utilize this technique from infancy to adulthood. I propose that this technique may be an alternative to a mesh repair in an adult with a small indirect inguinal hernia. This technique has almost no post-operative pain, almost no visible scars, low risk to the cord structures, and preliminary data shows a recurrence rate between 1- 3%. This may be ideal for young patients who do not want mesh.”

https://www.youtube.com/watch?v=nsIHTlfhrM4

This is very interesting, I think that is very similar to what is routinely performed on kids with hernias. What would be the downsides to this approach for an adult patient?

[Chaunce1234]

Dr Kang,

Do you have any particular experience with patients who have painful hernias? And separately, do you have experience treating patients with chronic groin pain that is possibly related to a hernia, like the “hidden hernia” phenomena? And if so, has your method been effective for treating those patients to find pain relief?

Thanks in advance, though this may be better suited for a new topic thread.

[Chaunce1234]

Was the ultrasound looking specifically for a hernia? If not, you may want to request a dynamic ultrasound with valsava manuever of the groin / site of pain, usually by an actual radiologist rather than just a tech, as that can often reveal a small hernia that may not typically display without a bulge. Of course it’s possible that something else is causing the pain too, so keep an open mind.

For North Carolina hernia experts, you may want to reach out to Dr Henniford, who is well published regarding hernias and hernia repair. At the very least, his office should be helpful to refer you elsewhere if necessary:

– Dr B Todd Henniford in Charlotte NC 704-355-1813

Hopefully someone can chime in with some additional recommendations for experts on groin/pelvic pain in the NC area.

[Chaunce1234]

Just wondering but how were you diagnosed with a hernia? Were you given an ultrasound of groin or was there a positive palpation during the standard cough test? Is it inguinal or femoral? Are you an athletic fit person or more average body type? Was there a particular event that caused the hernia/pain or was it gradual?

Almost every doctor will tell you that groin/pelvic pain is not related to pain felt in the leg or foot because the nerve does not extend that far down, but interestingly enough you will often read patient reports of having groin/pelvic pain along with foot pain.

Pain is known to radiate, and nerves can behave strangely. A common example of radiating pain is some patients who have heart attacks report pain in their arm, or jaw. Perhaps there is a similar mechanism with some cases of groin/pelvic pain, where it’s radiated or interpreted by the brain to be in the foot, or leg, but this is pure speculation on my part, as I am not a doctor. Another theoretical possibility is that the groin/pelvic pain causes guarding or a change in gait or abdominal and pelvic muscle usage, which could cause some indirect nuisance to another nerve or muscle group, kind of like how a lot of desk workers end up with neck or back pain from prolonged sitting.

In terms of the operation, that’s something you will want to decide after having a consultation with a surgeon (or two), and you can do your own research as well which is never a bad thing to be a more informed patient. Be aware much of what you will find on the internet is negative, and fearful, perhaps because people don’t generally rave about a good surgical experience, but people often will give voice to a bad experience. Most hernia repairs go fine and without incident, but the risk of chronic pain is arguably the most important thing to consider. Also consider your age, activity level, and general fitness, as athletic and thin patients sometimes seek out different options than people who are more sedentary.

[Chaunce1234]

I’m sorry you’re going through this.

Just out of curiosity, did the groin pain begin only after the later incident/injury? And what was the injury that occurred in 2017 that brought about the change?

Have you been checked specifically for a hernia recurrence? They are sometimes overlooked on CT or MRI, particularly when the radiology is outsourced or not viewed directly. And what was your original surgery type, was it open or laparoscopic?

The big thing you will want to do is find a surgeon who has a good amount of experience with groin and pelvic pain, re-do surgeries (including mesh removal), along with diagnosing other potential issues with the groin and pelvis. Unfortunately that may mean traveling to a different state. Here are a few specialist surgeons in your general region of the country whose names frequently come up on these forums and elsewhere that have been reported to be helpful, experienced, and knowledgable on complex hernia situations:

– Dr Igor Belyansky, MD

– Dr Brian Jacobs in NYC

– Dr William Meyers in Philadelphia PA

– Dr David Grischkan in Ohio

– Dr Bruce Ramshaw in Tennessee

– Dr Jonathan Yunis in Sarasota FL

– Dr Shirin Towfigh in Los Angeles California

Dr Earle is quite knowledgable and occasionally does correspond on these forums, he will be a good resource to reach out to. I am not sure if he performs mesh removal, you would need to ask he or his office directly. If he does not, perhaps he could offer a referral to someone who does that is near you.

Another option is to gather your imaging discs (CT pelvis, MRI pelvis, etc) and communicate directly with someone like Dr Towfigh, Dr Jacobs, or Dr Belyansky to review the images for anything that may have been overlooked by a radiologist.

In terms of pain management, you may want to consider some alternative options:

– medical marijuana or marijuana derivatives, be sure to communicate with someone knowledgable about the topic specifically for pain management as there are different types

– ketamine infusion therapy

– work with a pain clinic, if possible

Please keep us updated on your case and progress.

[Chaunce1234]

Any update on your progress or case? How are you doing now?

A few other surgeons elsewhere in the USA who perform mesh removal and re-do hernia surgery:

– Dr Igor Belyansky in Annapolis MD

– Dr Bruce Ramshaw in TN

– Dr Jonathan Yunis in FL

– Dr Robert Tomas in FL (may be open repair only?)

– Dr Brian Jacobs in NYC

[Chaunce1234]

Where are you located?

Unfortunately there are not many sports hernia experts in the USA (or the world!) but here are two that are fairly well known and often mentioned on these forums and elsewhere:

– Dr William Meyers in Philadelphia PA

– Dr William Brown in Fremont California

[Chaunce1234]

I am sorry you’re going through this. Here are a list of hernia surgeons who are frequently mentioned on these forums and elsewhere that may be helpful to you as a starting point, but be sure to do your own research:

– Dr Brian Jacobs in NYC

– Dr Igor Belyansky, MD

– Dr William Meyers in Philadelphia PA

– Dr David Grischkan in Ohio

– Dr Bruce Ramshaw in Tennessee

– Dr Yunis in Sarasota FL

– Dr Robert Tomas in FL

– Dr Shirin Towfigh in California

Best of luck and keep us updated on your case.

[Chaunce1234]

In addition to the US based surgeons I listed, for Europe a well-known sports hernia specialist is:

– Dr Ulrike Muschaweck in Germany / UK

[Chaunce1234]

Thanks for the added details about sports hernias / inguinal disruption.

On a related note, here are a list of surgeons in the USA who are reported to be capable of diagnosing and performing surgery sports hernia / inguinal disruption / athletic pubalgia injuries. The sports hernia repair is typically a non-mesh tissue repair, or similar.

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

I believe Dr Shirin Towfigh may perform sports hernia surgery as well, but I am not certain of that.

If anyone knows of any other sports hernia surgeons, feel free to add them to the list.

[Chaunce1234]

It’s good to hear you are doing well so far. Keep us updated on your case and progress.

[Chaunce1234]

quote LostNPain:

I have been presented with options and am unsure which direction to go. It seems like each path is undesirable and I feel stuck.

Just out of curiosity, did a surgeon offer this trio procedure (mesh removal, phasix placement, neurectomy) to you? If so, have they performed the exact same procedure on other patients? What were the outcomes?

Phasix and other absorbable mesh could have potential but are unproven as of now, as clinical trail data awaits. Recurrence is always a concern, but I’d personally be much more interested in chronic pain outcomes and data points.

As for neurectomy, my personal opinion is that it is a gamble simply because nerves are unpredictable. You will find some patient stories regarding neurectomy here on these forums and elsewhere on similar forums, read through them if you’re considering it. Dr David Chen at UCLA Hernia Center has a fair amount of clinical experience and research on this topic and that data may be a good resource.

Best of luck and keep us updated on your case.

[Chaunce1234]

Is the pain the result from a surgery, an injury, random onset, or other? What have you or clinicians tried to treat it so far, if anything?

Did the ultrasound identify an issue with the nerve, or was it used for a nerve block? Was it for diagnosing a hernia?

Good luck and keep us updated on your case.

[Chaunce1234]

I believe that Dr Towfigh offers tissue repair to thin patients.

For what it’s worth, Shouldice Clinic in Canada has weight requirements on their repairs, which suggests that a tissue repair works best on people who are not obese. They routinely prescribe diets to people if they come in and don’t fit into their BMI criteria, telling them to come back after they have lost weight.

quote Good intentions:

See work by Dr. William Meyers, Dr. Ulrike Muschawek, and Dr. William Brown.

Seconding that comment by “Good Intentions”, those three doctors routinely work on professional athletes and thin patients, and my understanding is that whenever possible they default to using tissue repair.

[Chaunce1234]

I would give it time for swelling to go down. Keep in mind for laparoscopic surgery they inflate your stomach like a big balloon, so that can cause all sorts of curious bloating and swelling too.

How do you feel otherwise now that you’re a few days out from your surgery?

[Chaunce1234]

This caught my attention:

>>>> “I have developed a painful sensitive knot/bump in the area where my pain has been concentrated for the past year.”

Just out of curiosity, if your pain is centrally located at what feels like a knot or bump, has a clinician determined that the exact spot is or isn’t the location of a tack used to secure a mesh implant? I recall reading a few stories about spot-specific pain that resulted from a particular tack or fixation, so perhaps it is something to investigate?

Some clinics do repeat nerve block injections every few weeks to gain maximum effect, it may be worth pursuing if you had some relief from the first one, at least before considering another surgery.

Likewise if you have some relief from the nerve block injections, you may want to research something like ultrasound guided radio-frequency ablation or ultrasound guided cryoablation.

As for DRG stimulators, I am not informed enough on that topic to offer much of an informed idea or thought, but you might want to try browsing NIH PubMed for papers specific to DRG with ilioinguinal or genitofemoral nerve conditions.

Good luck and keep us updated on your progress.

[Chaunce1234]

I am sorry you’re going through this.

When did you first notice the pain? Was the onset related to any particular activity? Is the pain constant or does it come and go? Are you athletic? Does anything relieve the pain or make it go away?

Was your recent Ultrasound done in the inguinal and femoral region, with Valsava? Was it performed by a tech or by a radiologist? For best ultrasound results you’ll usually want a dynamic ultrasound with valsava, dynamic means they’re recording motion so when you bare down, any tissue movement is captured on the film. Fortunately Ultrasound is relatively cheap so insurance usually never fights it.

Hernia, athletic pubalgia, inguinal disruption, osteitis pubis, endometriosis (for women), and myriad other causes of groin and pelvic pain are often routinely overlooked or not seen on CT and MRI scans, though viewed by true experts they can sometimes find things that a standard radiologist may ignore or not notice.

I am not sure of any groin pain experts in Oklahoma or particularly close to you, though searching on the American Hernia Society website may reveal some choices for those with an interest in hernias specifically. Vaguely in your region of the country, you may try reaching out to the following hernia experts:

– Dr Paul P Szotek in Indiana

– Dr David Grishkan in Ohio

– Dr Bruce Ramshaw in Tennessee

Good luck, and keep us updated on your case and progress.