[Chaunce1234]

“watchful waiting” is often a valid approach to hernia management if a hernia is not bothering you. Many people have small non-problematic hernias their entire life and never get them fixed, and many aren’t even aware they have one.

At the very least do extensive research before you make any decision, and be comfortable with your decision. The biggest risk of groin hernia surgery is chronic pain, it is your groin and full of nerves.

If you want a second opinion, search around on these forums and you should find some options for well-known hernia surgeons in Europe and the UK. Germany has Dr Ulrike Muschawek and Dr Andreas Koch, for example, and I believe both of them consult in UK as well.

Good luck and keep us updated on your case.

[Chaunce1234]

I’m sorry you’re going through this.

As for the MRI being conclusive or not in terms of showing a hernia, that may depend on who looks at the actual imaging and not just reading the written report. Dr Towfigh has studied this specifically before. Also keep in mind most people are laying down on their back during an MRI / CT, which can hide a hernia.

You could also request a “dynamic Ultrasound with Valsava” at the location of pain and the area of the prior hernia repair, often the dynamic ultrasound while bearing down can show a hernia that is otherwise difficult to see. Some clinics perform that ultrasound while the patient is standing for added abdominal pressure / gravity.

I don’t specifically know of any hernia expert in Kansas, but perhaps another forum user or a surgeon on this forum can offer some nearby options. As general advice, you will want to seek out a surgeon with significant experience doing re-do surgeries and with managing hernia related pain. Ask if they have seen cases like yours, and if they were able to resolve it.

Some potentially helpful resources, though they are not in your immediate state, include the following:

– 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 Igor Belyansky in Annapolis Maryland

– Dr Shirin Towfigh in Los Angeles, California

– Dr David Chen in Los Angeles, California

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

[Chaunce1234]

quote mackerel:

Thanks for the responses. 34 year old male, athletic, like to run, hike , stay active. Burning sensation, when coughing , or doing ab work like leg lifts, crunches. Los Angeles area. Pain in is right side of groin near Pubic bone. Essentially right where you feel your pubic bone. Only feel pain when doing certain activities. Not when at rest Surgeon said it is small. She was young so but graduated sc Med school. Don’t know how much experience since she is surgeon for minor surgeries. Probably does a wide range of surgeries

If you’re in LA, you could always see Dr Shirin Towfigh, she’d almost certainly be able to tell you with certainty one way or another.

[Chaunce1234]

quote Good intentions:

Without high quality oversight from regulatory agencies or good guidance from professional organizations, it’s just a crowd of individuals working on separate puzzles with a huge selection of puzzle pieces. You can’t trust just a material or a method. Find a person who had a successful repair and get that exact repair from the same surgeon. Or find a surgeon who has known history of good repairs. But I wouldn’t simplify it down to open versus lap, or assume that certain medical device will always give good results.

I would agree with the point that [USER=”2029″]Good intentions[/USER] is making here. Try to focus on finding an expert with a history of patient success.

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

[Chaunce1234]

If you have no pain, no other bothersome symptoms, and a surgeon said you have no hernia, then you probably should just not worry about it. Of course it’s possible it is one that is just hard to detect, which is the so-called “occult hernia” situation but usually those are only relevant if you have significant pain with no obvious diagnosis.

If you are concerned, or curious, you could always request an ultrasound with valsava on the location of concern, it is pretty accurate to confirm a hernia diagnosis.

[Chaunce1234]

I posted a longer reply but it has been held for review, probably because it included many links.

Anyway, here’s another limited study on Desarda vs Lichtenstein (the original simple open flat-mesh repair) from Europe (Poland), it appears that recurrence was the same risk in both categories, and chronic pain was also low in both. Perhaps they’re just very skilled surgeons in Poland to get the numbers so low?

https://www.ncbi.nlm.nih.gov/pubmed/22392354

[Chaunce1234]

Dr Shirin Towfigh apparently offers a laparoscopic no-mesh repair to select patients, I do not know what the criteria is, or if it applies to all hernia types (indirect, direct, femoral).

Dr Todd Ponsky is also apparently researching a laparoscopic no-mesh repair for indirect hernia, again I do not know the criteria but I do know it is limited.

Interestingly, children can often get a laparoscopic no-mesh repair and it is one of the standard pediatric repairs, using a looped suture to close the inguinal ring internally, but I think it also only applies to the indirect hernia. Supposedly the recovery period is very fast with very low risk.

This is all based on information gathered from these forums, which [USER=”935″]drtowfigh[/USER] runs, so she may have some additional insight into these questions.

If you adventure around on YouTube you can also stumble upon some other rare videos of attempts at laparoscopic repairs without a mesh. I recall seeing one with a doctor in Venezuela repairing a femoral hernia without mesh using a laparoscope.

[Chaunce1234]

Here are a few videos of Dr Robert Tomas in Florida performing a Desarda repair

https://www.youtube.com/watch?v=FcN0T2KSJg0

https://www.youtube.com/watch?v=Mm6rBnTPQt8

And the same Dr performing the same repair on an enormous hernia that appears to contain internal organs:

https://www.youtube.com/watch?v=1IsuuD5keEI

The Desarda repair is certainly interesting but it’s relatively new, and I don’t think there have been any longterm studies done on the outcomes yet, both in terms of chronic pain and recurrence. I would also be very interested to see how the repair holds up with athletic individuals, and to other activity related, lifting, and lifestyle stresses over time. And what about using Desarda for mesh removal patients? Or Desarda outcomes for patients with chronic pain, or a very painful hernia? Hopefully there is a large study being done on Desarda to answer these questions and others, and hopefully Dr Tomas is keeping track of patients and their outcomes.

Some meta-analysis exists to compare Desarda with Lichtenstein (simple open mesh) but is not particularly informative for these questions:

https://www.ncbi.nlm.nih.gov/pubmed/28889330

https://www.ncbi.nlm.nih.gov/pubmed/29277678

I would also be very curious to hear other surgeons thoughts on the Desarda repair, particularly those who have extensive experience with no-mesh repairs and other open repairs.

And if anyone has a personal experience with Dr Tomas, or a Desarda repair in general, and would be willing share it here, surely others would appreciate reading it.

[Chaunce1234]

A quick update on this:

I stumbled upon a website on another forum and it appears to chronicle a man who is trying to manage his inguinal hernia through exercises and other behavioral changes. I don’t know the efficacy of it, but I thought it was worth sharing given the topic:

https://mynaturalherniacure.com/hernia-exercises/

He also has a YouTube channel where he discusses specific exercises that seem to be helpful for him, along with other activities.

https://www.youtube.com/watch?v=wRVYHl_eRsk&feature=youtu.be&a=

https://www.youtube.com/channel/UCy6Xz3UTmMLAPr8BP1p6k7w/videos

Does it work? Who knows? But as an anecdote he claims he has been able to reduce his bulge from “two golf balls” to non-existent. Interesting certainly. Perhaps there is something to the exercises, yoga, etc?

[Chaunce1234]

Ultimately you can find good and bad stories about every type of mesh, and every type of hernia repair. That’s just the nature of these type of surgeries.

This is also why many people will recommend seeking out a hernia specialist who does the surgery often and has become an expert in the specific procedure. It’s that whole “practice makes perfect” thing, which is basically the belief of Shouldice too. That’s not to say you can’t end up with a bad outcome from a great surgeon, but it may help to minimize the risk.

[Chaunce1234]

quote Smurph71904:

Just an update for anyone searching on this thread… open hernia repairs.

I am now 4 months post op.

I have 0 pain. Still extremely numb, that is always weird. But I can work out like normal, run and everything. My surgeon was phenomenal. I cannot say enough great things about him. I feel so much better since having the surgery, I cannot believe I let it go for nearly a year.

The recovery was difficult. It was painful to sit up, roll over, breathe, cough, sneeze. I slept a lot but did not take pain meds stronger than tylenol. That pain subsided after about 1 1/2 weeks. The swelling DID go away. It felt like there was a finger in my abdomen for a long time. I kept thinking, “maybe he left something in there”. but it is gone.

thanks for all of the responses, it was nice to know I wasn’t losing my mind! 🙂

This is fantastic to hear, thank you for the follow up.

I will echo [USER=”2029″]Good intentions[/USER] and please do share some more details about your specific hernia repair, the surgeon, and location of where the surgeon is, as other patients may be very interested in this.

Thanks again, best of luck.

[Chaunce1234]

I don’t think it’s possible to ‘heal’ a hernia without surgery, simply because it’s a hole, and, unless the herniated tissue is not going through that hole for an extended amount of time, I don’t see how it could heal because anything going into the hole would prevent the tissue on the sides of the hole from touching to eventually heal and re-join. As a laymen it seems like herniated tissue basically prevents a normal healing mechanism because it’s keeping the hole open. But I’m not a doctor so what do I know, this is an idea that may have no basis in medical reality or anatomy.

Ultimately if a hernia is not bothering you, then “watchful waiting” seems like a very reasonable option. There are many people that have hernias and aren’t even aware of it, and many who are aware but never fix them. And of course there are countless hernia repair surgeries as well, with various outcomes.

Anyway, it’s an interesting topic and worth discussing, particularly if there’s any evidence to demonstrate efficacy or an alternative approach. Obviously nobody wants to have a surgery, so if it could be avoided that’d be great.

[Chaunce1234]

Have you contacted the Shouldice clinic and asked them about their chronic pain rates? I know they are reported to be very low, but it’d be interesting to hear what they say. It’s always a good idea to ask any surgeon about their own experience and outcomes regarding chronic pain and other complications and risks.

Don’t be scared, but do informed. There is plenty to ask, understand, and ultimately you’ll want to make a decision that you are comfortable with.

I personally think chronic pain is the biggest risk of hernia surgery and that it should be the primary outcome determinant. It’s your groin, it is highly innervated and an area that is virtually impossible to ignore if it hurts. Recurrence is a theoretical risk too, but it should be low with any skilled surgeon.

If you’re from Canada, Shouldice clinic is world-renowned as hernia specialists, it’s certainly a well regarded option.

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

[Chaunce1234]

I’ve read many stories that Dr Brown is very responsive and highly engaged with patients both before and after surgeries. Likewise I’ve read similar stories with the physicians at Vincera Institute in Philadelphia, Dr Grischkan in Ohio, Dr Brian Jacobs in NYC, and many others frequently mentioned on these forums. It’s good to know that some of the specialist clinics out there are personable and old-school in their approach to interacting with patients.

As for a traditional hernia repair in Texas, if you seeking a no-mesh hernia surgeon, you might try reaching out to:

– Dr. John Etlinger in San Antonio, Texas

You would want to confirm that independently however, and see if the no-mesh repair procedure is appropriate for your case.

Other no-mesh surgeons vaguely nearby in the Southwest:

– Dr Zafar Parvez in New Mexico

– Dr Kevin Petersen in Nevada

And in California there are a handful of no-mesh options as well, of course there is Dr William Brown who you found, as well as Dr Shirin Towfigh in Los Angeles, Dr Edward Phillips in Los Angeles, and Dr Robert Burns in Newport Beach.

Again, you will want to consult with surgeons directly, and do your own research to see what makes sense for you.

Best of luck and keep us updated on your case! And you go through with the surgery with any doctor, please share your experience.

[Chaunce1234]

What is your symptom and/or complaint?

If you just have a hernia occasionally palpated on exam and it does not bother you in any way, ‘watchful waiting’ is very reasonable.

If you have no bulge, and there is no troubling symptom, again “watchful waiting” is very reasonable.

If you have pain as a complaint, it could be a hernia or other possibilities. What is the pain? Where is the pain? Are you athletic? Thin? Overweight? Male/Female? Age? When did the pain start? Was there an event like an injury or movement? How long have you been in pain? What makes the pain better or worse? Is the pain constant? Is it tearing, burning, tingling, throbbing?

An ultrasound with valsava is pretty effective at finding a hernia, the valsava is necessary to appreciate the hernia because it increases abdominal pressure to push anything through a hole, if a hole exists. MRI and CT can be effective too but are very dependent on who reads the images.

Chronic pain is the biggest risk with hernia surgery. It is your groin, it is highly innervated and the area is full of complex anatomy. Seek out a specialist if possible, with plenty of experience. Recurrence is a smaller and vague risk as well but that’s not nearly as life altering as chronic pain in the groin.

There are many possibilities, for both the causes of pain, as well as for diagnostics, surgeries, etc, perhaps share some more details about your case, and your general location.

Good luck and keep us updated.

[Chaunce1234]

quote Dave Graham:

I am planning open IH surgery with mesh in the near future. One point I am really concerned about: I am pretty active (run or jog at least 30 minutes a day, do a lot of hiking, play some tennis etc.). All I want from the surgery is to be able to continue at the same level after I recover. Those who have had this procedure and are physically active: after recovery, could you do everything you did before? Thanks for any response-I’m really concerned about this point.

Is your hernia currently painful? How old are you?

You could always get a second opinion, and that’s often a good idea before any procedure. Regardless you will generally want to find someone who is a true hernia expert and who has significant experience in the procedure as they plan on performing it on you, as well as a good track record of success. Ask what their personal chronic pain rates are, and how they manage it. Ask what their personal recurrence rate is. [USER=”2029″]Good intentions[/USER] makes a great point, the true outcomes can be hard to track over time and not all doctors do it, so it’s something to think about.

Best of luck and keep us updated on your case.

[Chaunce1234]

[USER=”2468″]Baris[/USER] Thank you for the update and for sharing your experience, this is important data to know and it will undoubtedly help other patients in decision making. I’m sorry to hear that your initial procedures failed and I wish you the best in your future re-do surgery, and please keep us updated on you progress and how that goes.

I believe the Shouldice clinic uses ultra-thin stainless steel sutures, which are presumably very strong and maybe that’s another reason why they have such great success at the Shouldice hospital in Toronto. Just theorizing here but maybe the absorbable sutures used in your first repair dissolved before the muscles had a chance to fully regrow to one another.

Out of curiosity, what is the general weight-loss diet that Shouldice recommends to their patients? Low carbohydrate?

[Chaunce1234]

quote Samson1nite:

… On the 17th day post op, I had my 2 week follow up with the surgeon. I described to him, that I still had the original pain( burning,stinging). He said that this was normal, especially since I had pain preop, that the nerves were probably still stretched inflamed and it would take awhile for them to “calm down”.
It is now a little over 3 weeks post op and the pain is about the same. If I walk, the area becomes inflamed again. Advil does little to help. The only thing that helps is lying down. While the pain is not horrendous, it definitely affects my daily routine and can’t concentrate on much else. ….

If you had pain in the region before the surgery, what your surgeon said could certainly have some validity. Constant pain sensitizes the region and works a pathway to/from one of the most highly innervated regions of the body (the groin) and the brain, and it can absolutely take a while for that to settle down. There’s also always the risk of chronic pain with hernia surgery in general. Regardless, you can help that nerve/pain calming process along by engaging in mentally challenging activities (learning a foreign language, puzzles, sudoku, math problems, learning programming, learning an instrument, producing art, etc), anything that causes neurogenesis in a positive way.

But remember, you’re only 3 weeks out from surgery, and surgery causes additional trauma, swelling, inflammation, scar tissue, and irritation to a very sensitive area and nerves, so all of that can certainly contribute to discomfort. Try not to be overly concerned, as there are also many studies that demonstrates pain diminishes slowly over time regardless. Eat healthy and continue to be as active as you can tolerate and within doctor recommendations.

You could always follow-up with the surgeon again, and discuss a few options like:

– Confirm there is no recurrence (unlikely but possible)

– Nerve block injections, would probably similar effect to the pain pump but many people report success with these especially if they’re generally effective. Often they have to be repeated several times.

– Strong prescription NSAID / anti-inflammatory daily for 30-60 days (assuming your general health is tolerant to NSAID)

– Targeted physical therapy can help people recover from surgery faster (you’ll notice all professional athletes have physical therapy and rehab after injuries and surgeries, for an obvious example), likely focused on the pelvis, lower abdominals, upper legs, etc

– Daily Vitamin C supplement, there is evidence this helps neuropathic pain diminish over time

– Daily alpha-lipoic acid, there is also evidence this helps neuropathic pain over time

There are certainly other options too, things to try or to investigate, but given you’re still fairly fresh out of surgery they’re probably not worth considering yet.

Anyway, best of luck and keep us updated on your progress.

[Chaunce1234]

quote Frank Chapman:

I am curious if anyone here has experience with BioHernia? I read on this website that Dr. Muschaweck performs non-mesh hernia operations on many top football players. They also offer non-mesh hernia repairs which could be reimbursed by the NHS, but I would have to travel to Germany in that case. I made an appointment for a consultation with Dr. Muschaweck in London next week. I will keep you updated on how the consultation went.

https://biohernia.com/en-gb/

Dr Muschaweck is very well regarded in professional athlete circles for sports hernias, inguinal disruption, groin pain, and regular groin hernias. Presumably she sees mostly European patients but I do know that some US athletes fly over to Germany to see her as well. Based on her extensive experience she would likely be an excellent resource to consult with.

Let us know how it goes!

If you want some added details, here’s an (older) clip from a US TV program about sports injuries and Dr Muschaweck along with a patient of hers is interviewed, it’s geared towards athletic injuries but in the surgical segment they mention the patient had a real hernia as well.

https://www.youtube.com/watch?v=JXn4NggRz4k

Here’s another clip of Dr Muschaweck presenting at a global conference on groin pain:

https://www.youtube.com/watch?v=w-Rz4V-eGZI

Anyway, keep us updated on your experience and decision making.

[Chaunce1234]

Thanks for the update on your case. I’m sorry to hear about the infection, but hopefully overall things are improving.

Have your original aggravating symptoms changed since your surgeries? Are you feeling any better, worse, same, or different? Aside from the hematoma/infection of course.

Can you share any additional thoughts on Dr Brown and the surgeries?

Follow the wound care clinic instructions closely and eat as healthy as possible (try to eat more protein and vegetables than usual, and try to avoid excess sugars and junk food). I know that some clinics recommend to drink protein shakes too, specifically the “Ensure” and “Ensure Enlive” drinks with HMB protein, so that may be something to look into and ask your doctors about. Just throwing out some ideas, hopefully they are helpful, I’m just a fellow patient and not a doctor so of course you’ll want to follow the docs orders first.

Best of luck, heal up and keep us updated on your case and progress!