[Chaunce1234]

I would second “Good Intentions” recommendation and reach out directly to a skilled hernia expert that has experience in these type of situations and re-do surgeries.

Here are two well-known experts in the USA, though neither are in Texas they may be able to redirect you to someone who is:

– Dr Shirin Towfigh in Los Angeles (310) 358-5020

– Dr Bruce Ramshaw in Tennessee 865-305-9230

Good luck and keep us updated on your husbands case.

[Chaunce1234]

How are you doing now? Did you contact your original surgeon and ask their advice?

If the pain is mild and only at the incision site and you are otherwise comfortable, I wouldn’t be particularly concerned given that you’re only a few weeks out.

[Chaunce1234]

I am sorry you’re going through this.

How long ago was the original surgery and the second surgery? Presumably you have been checked for recurrence and that was ruled out? Have you found anything in particular that helps to reduce the pain?

Nerves are strange and can send erroneous signals or can refer pain to elsewhere even if they are unrelated to a location of injury or damage, or even if the nerve no longer exists. Two classic examples of this are a heart attack patient might feel pain down their arm, or sometimes people missing a limb may feel phantom limb pain.

You may want to work directly with a pain clinic if possible, they can be helpful. Perhaps speak with a doctor to see if any of these alternative therapies are applicable to trying in your scenario:

– TENS unit, it’s a little electrical stimulator you can buy and use yourself at home, for some people this can ‘interrupt’ the pain signal or quiet it down, or offer a distraction

– gabapentin can be helpful for some people

– Ketamine infusion therapy

– Medical marijuana

– Targeted physical therapy regimen and exercise

– Once daily Alpha-Lipoic Acid may reduce nerve pain over time

– Longterm once daily Vitamin C 500mg tablets may reduce nerve pain over time

– Opioid medication can be effective, but has consequential side effects and should be considered a ‘last resort’

If at all possible, try to engage in as many activities you can that strain your brain in new ways and by doing new things. Anything that is mentally challenging or involves learning something new. Things like learning a new foreign language, participating in art, learning a musical instrument, learning how to program computers, puzzles, sudoku, complex math, memorizing poetry, going new places and paying as much attention as possible to surroundings, etc. I realize this sounds a little strange but the basic idea is to try and cause new neuroplasticity to occur by utilizing your brain so that it recruits neurons for learning and memorizing the new tasks.

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

[Chaunce1234]

These are all good questions, and your case mimics many others seen on these forums and elsewhere (longterm groin pain, uncertain diagnosis, doctors punting the case). Hopefully a doctor can answer your questions and offer some insight.

[Chaunce1234]

How has physical therapy progressed so far? Any adjustments or changes to how you feel?

Your prior post may have been blocked if it included a link, I have noticed any post with a link is automatically discarded for whatever reason, probably to reduce spam.

[Chaunce1234]

It may be difficult to find a Shouldice practitioner in Connecticut, as it is challenging to find no-mesh hernia repair practitioners in general. A few options that are fairly close to you:

– Dr Samer Sbayi at Stony Brook in Long Island, New York trained at Shouldice and has apparently performed the procedure many hundreds of times

– Shouldice Hospital in Toronto Canada

A few other options for no mesh hernia surgery on the east coast are:

– Dr William Meyers at Vincera Institute in Philadelphia PA

– Dr Alexander Poor at Vincera Institute in Philadelphia PA

I am not sure what specific no mesh repair technique(s) are used at Vincera, but they are well known in athletic communities.

There are likely some other North Eastern USA specific non mesh hernia surgeons as well, perhaps other forum users can chime in with what they know.

Good luck and keep us updated on your progress and decision making.

[Chaunce1234]

Have you been checked for hernia recurrence? Perhaps get an ultrasound with valsava done on the location of the throbbing.

Singapore publicly states the prices of procedures, and there’s another recent thread on these forums about Dr Kang in South Korea who performs hernia surgeries. If you have symptoms similar to a hernia, getting checked for recurrence seems like a good first step.

[Chaunce1234]

Perhaps it should become standardized in the USA for all surgical patients to receive follow-up surveys after surgery? At 1 month, 3 month, 1 year, 3 year, 5 year, 10 years even, with questions about quality of life, pain or lack of, recurrence, followup, etc. This would surely be a treasure trove of revealing data. I know that some European countries are able to do this, which is often where the world gets the best large-scale study and medical data from simply because those countries make it easier to track patients and patient progress down the road.

I can’t help but wonder if the massive bureaucracy of insurance, billing, administrators, etc is the significant impediment to both direct follow-up and longer term follow-up becoming routine in most of the USA.

[Chaunce1234]

This sounds like an excellent option for individuals in Korea or nearby. Or if you feel like taking a vacation to South Korea to also have a surgery.

Do you know if Dr Kang has published a paper detailing his specific repair method? Does Dr Kang teach the repair method to other surgeons so that this approach can offered beyond South Korea? If not, perhaps those would be two useful avenues going forward for Dr Kang, particularly given the positive patient experiences reported. Share the knowledge, it is undoubtedly valuable.

[Chaunce1234]

I’m sorry to hear you’re uncomfortable after the nerve block, how do you feel now a few days later? Any different?

Do you know if they targeted a specific nerve with the block (ilioinguinal, iliohypogastric, genitofemoral), or was it generalized in the inguinal region? Was the nerve block guided by ultrasound?

Did the nerve block alleviate the pain while it was in effect and the numbing sensation persisted? Or did it still hurt even when numb?

I have read and heard reports about nerve blocks causing an increase in pain for some people either immediately or as they wear off. I think it is insightful information to take with you to future appointments, as it may be helpful data for clinicians to work with.

How has physical therapy gone so far? Have you tried other treatments with any luck?

Stay positive, and keep us updated on your progress and decision making.

[Chaunce1234]

Often a good starting point is the American Hernia Society website, which has a “find a surgeon” tool that can help you locate a nearby surgeon who has interest in the field of hernia repair. You will then want to inquire directly to know their experience, rates of chronic pain, rates of recurrence, etc.

Also, asking other doctors or medical professionals who they would have do their surgery can be insightful, if you have those contacts or relationships. Note you’re not necessarily asking for a referral, you’re asking who THEY would personally have perform the same surgery if they were to need the procedure themselves.

I have not seen any specific surgeons in Georgia mentioned on these forums, but off the top of my head there are a few regional choices for the south eastern USA for names that have routinely popped up on these forums and elsewhere:

– Dr Jonathan Yunis in Sarasota Florida has extensive experience in all notable hernia repair methods (open mesh, open non-mesh shouldice, laparoscopic, re-do, etc)

– Dr Robert Tomas in Florida primarily performs open non-mesh desarda repair

– Dr Bruce Ramshaw in Tennessee is considered one of the nations most knowledgable hernia surgeons with extensive experience with primary repair as well as re-do surgery and dealing with complications

There are likely surgeons in Georgia that are experienced and skilled as well, perhaps another user or doctor on these forums can chime in with additional information.

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

[Chaunce1234]

Have you tried some of the other options for pain treatment or management?

Let us know how your appointment at the pain clinic goes, and if you try the nerve block injections and to what effect they have.

[Chaunce1234]

This is a great idea, please reach out to patients who specifically have had complications relating to hernia surgery, and patients who have had complications with mesh products.

A few general thoughts/topics/suggestions for discussion:

– Chronic pain mitigation and reduction should be the highest priority for groin hernia repair, particularly given its impact on life, and the current opioid hysteria. People would not need pain killers if they were not in pain in the first place.

– Medical schools should routinely teach non-mesh repairs along with mesh repair, and hernia surgeons should be confidently competent in both repair types, knowing when to use what for each individual patient

– Mesh should be made so that it is easy to identify on any MRI, CT, ultrasound

– Mesh should be made so that it is relatively easy to remove if necessary

– The concepts of hidden hernia and sports hernia / inguinal disruption should be well understood by surgeons, as well as proper diagnostics and proper treatment

– For groin and/or pelvic pain, a clear diagnostic protocol should be established, which would be particularly helpful for the cases that do not have an obvious presentation or cause, and something that routinely pops up on these web forums

– Research and investigate cellular printing of muscle and tissue replacement using the patients own cells, Wake Forest Institute for Regenerative Medicine is working on this so perhaps adapt those concepts specifically for hernia repair

[Chaunce1234]

Dr Towfigh has a lot of experience reading scans and likely would be a great resource for this. Perhaps send her clinic an email directly?

[Chaunce1234]

“Good Intentions” offers good advice. Surgery is permanent and has risk, so you want to be comfortable with your surgeon as well as the surgery itself.

The two Oregon hernia surgeons that are usually referenced on these forums are:

– Dr Robert Martindale at OHSU, non-mesh option to eligible patients

– Dr Orenstein at OHSU, laparoscopic option to eligible patients

Obviously there are many other surgeons in your state. Perhaps someone else can offer additional recommendations for talented hernia surgeons in your specific area.

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

[Chaunce1234]

Sorry to hear you are going through this.

– Where are you located? Perhaps a nearby expert can be recommended by someone on this forum

– Have you had an ultrasound with valsava on the groin to check for hernia?

– Have you had a pelvic MRI?

– Do you recall a particular aggravating event or incident? Were you extraordinarily active the day before you woke up in pain?

– Can you reproduce the pain with any particular movement or activity?

– Were the injections nerve blocks? Did any of the nerve blocks stop the pain? That could be a clue

Groin and pelvic pain can be notoriously complex to diagnose when there isn’t an obvious presentation. If possible you will want to seek out an expert.

Good luck, keep us updated on your case.

[Chaunce1234]

I would recommend just experimenting with the TENS unit, placement, and strength. I don’t know if there’s an exact science to it, perhaps because targeting a particular nerve can be challenging and every person is slightly different depending on body composition. You might try looking at nerve pathway charts (google them) of pelvis, groin, lower abdomen, and back, to try and figure out ideas of what/where to target. Sometimes aiming higher or lower on a nerve path can produce very different results. It may be helpful to visit a Pain Management clinic to get advice since they (should) have thorough knowledge of anatomy and nerve pathways.

Just out of curiosity, when they did an exploratory surgery and found the folded mesh, did they correct that? It may be worth getting a second opinion from a hernia expert that has extensive experience with post-op pain and re-do surgery. Just a thought.

Best of luck and keep us updated on your progress.

[Chaunce1234]

Did you always have pain after the repair, or is the pain new? Did you have pain before the hernia was repaired? Were you checked for recurrence with an ultrasound or scan, or just by hand? Does pain respond to anything, or does anything in particular make it worse?

Dr Grishkan in Ohio has apparently performed 10,000+ hernia repairs, and could be a helpful resource in your region

Dr Paul Szotek is in Indiana but may also be a helpful resource, he is a colleague of Dr Towfigh

Best of luck and keep us updated on your case

[Chaunce1234]

I am a just fellow patient, not a doctor. Here are some questions that may be helpful for this forum and future clinical visits:

What is your pain like? Where is it located? Do you currently have a mesh repair or was the mesh removed? Was it laparoscopic or open? Did the pain exist before the hernia repair, or did it only appear after the repair? Did pain change from before or after the repair? Are you athletic? Do you have a specific event when pain first appeared? Have you ever had a nerve block and did it help? Does anything specifically help the pain or make it worse?

Have you been checked for athletic pubalgia or osteitis pubis? You can research these on your own as well to see if they fit descriptions of what you are experiencing.

Are you able to consistently replicate the pain with adductor strain? Try laying flat, placing something between your two knees (like a tennis ball or someone elses fist) and squeeze the knees together like you are trying to crush the tennis ball – does that elicit strong pain? That is a common test done for adductor injuries. You can find many other physical tests for replicating pain from groin and pelvic injuries, resisted sit-ups is another common one.

Perhaps seek out a pelvic / groin pain expert, but you may have to travel.

For example, Dr William Meyers and Vincera Institute in Philadelphia is highly regarded, routinely performs procedures on professional athletes. You can contact them, send your images (MRI etc, operative reports, etc), and they may review your case for you. Just a thought.

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

[Chaunce1234]

Dr Jonathan Yunis in Sarasota FL is apparently able to perform all hernia repair types (open, laparoscopic, mesh, non-mesh)

For no-mesh simple inguinal hernias, Dr Robert Tomas does Desarda repair in FL as well.

If you’re uncertain of a diagnosis, a scan with valsalva is often helpful. Ultasound, CT, MRI all can be done with valsalva and can help to diagnose hernias, though MRI is sometimes more challenging for the clinic if they have not done it before.