[Côme]

<div>I was operated by Dr. Conze.</div>

What do you want to know ?

[Côme]

There could be many temporary or permanent reasons that you feel like having less quantity of semen. But your question is undoubtedly legitimate, as it seems to happen sometimes. A very recent study gives some indications such as spermatic cord damage, scar tissue obstruction, pressure due to something inserted, vans deferens damage, etc., as possible problems following the surgery :

Male Fertility Following Inguinal Hernia Repair, 2023

https://www.intechopen.com/chapters/1142127

• This reply was modified 10 months, 3 weeks ago by  Côme.

intechopen.com

Male Fertility Following Inguinal Hernia Repair

Tension-free mesh hernia repair has become the standard procedure in inguinal hernia repair. The incidence of inguinal hernias has steadily decreased following mesh and laparoscopic techniques, but the potential risk of fertility disorders after surgery remains a controversial issue. The … Continue reading

[Côme]

Long lasting suture are more like 6 months I think, but yes, at that point they have lost most of their strength already.

The repair is still holding strong. However I feel like the bulge is quite big. It doesn’t feel only like the healing ridge pressing against my skin, it feels like if the “wall” created by the repair was “too thin / fragile” and the intestine was pushing against, creating a bulge. (There is no reccurence, so it’s definitely not that).

[Côme]

Hello,

yes, it’s supposed to be the same method as Muschaweck.

It hasn’t get better. I had another “flaring / crising” 8 days ago.

Since then I’m trying the carnivore diet and I have quite a lot of reliefs already.

I’m just not ready to accept all their immune suppressor, <srpx-bugfix></srpx-bugfix>corticosteroid, etc., that will just fuck up my immune system.

But if it was to be done again, I wouldn’t do the surgery. This isn’t only about luck, it’s truly that “nobody knows what the fuck they are doing or can trigger”.

Of course the surgeon is helpless and has now disappeared…

[Côme]

I’ve been thinking about the allergy. I don’t know what the absorbable thread was made of. I know I had an allergic reaction to the skin suture thread (Dr. Conze told me). When I asked the Dr. Conze if I could have had an allergic reaction to the internal thread, he just said “No” without any further investigation.

As for the CT scan, for abdominal CT Scan (where you have multiple sensitive organs including genitals), you receive 7 years worth of natural radioactivity in 1 shot. And that just doens’t feel right for me…

[Côme]

This is interesting. Because the Dr. Conze told me that I had a little allergic reaction to the skin suture thread. I asked him back then if I could have had allergy to the internal suture thread (which is absorbable but much slower), and he said “no” without any further investigation.

Because there is clearly a connection between this repair and my symptoms… And when I strain de repair, the symptoms get much worse…

[Côme]

Hmm but then why are they all refusing to do one for me without contrast ?

I will try to insist again…

[Côme]

It definitely is connected to the repair. It started right after (never had any digestive issue before, always worked lile clockwork).

Recently again, I went to a yoga class and clearly I sollicitated the area a bit much, felt very sore after. For the following 2 days, I had huge digestive issue, completely bloating in the zone of the repair, with stingy pain and gargling noise. It was more painful than before.

There is a direct link between this repair and the digestive issue.

And now the only thing they want is to do a MRI for which I have to take this contrast agent which is a complete poison. This really is a medical nightmare

[Côme]

Interesting. Mine were entirely resorbable. I’m 8 months post surgery. Perhaps they last a little bit longer than that, not sure.

Anyway they should be very soon entirely gone…

How did you diagnose your tumor? MRI?

[Côme]

Hello.

Yes but the hernia sac was very small and only made of fatty tissue. However I’ve read that adherence can form even without breach, just from inflammation. It is rare, but it seems to exist. However I asked both the gastro-enterologist who did the colonoscopy and Dr. Conze, both seems to say it’s highly unlilely.

They want to do an MRI, however I’m reluctant with the contrast agent.

At the moment, I’m not taking any medication. I take a special form of psyllium husk that helps a lot and sometimes a high dose of vitamin C powder or magnesium chloride as a laxative (maybe 1 or 2 times / months).

Adherences is one of the first thing I thought about. I found this clinic : https://clearpassage.com/

However the whole trip + treatment will cost me 10 000$ and I’m not even sure if that will do anything.

The site of discomfort that I feel is much higher than the hernia repair itself (I attach a photo). And they can’t find a connection. However I know that the ilio-inguinal nerve and ilio-gastric nerve are connect to the same branch. Could it be that the ilio-gastric nerve is irritated, creating a contraction of the psoas and squeezing the intestine…

I’m really on a medical errand…

clearpassage.com

Home - Clear Passage

Clear Passage®️ strives to provide our patients with the finest hands-on therapy in the world. Call us for a free consult: 352-336-1433.

[Côme]

I understand and it must be awful. I understand how mesh can affect the whole area (when they fail, shrink, develop adhesions…)

But here I didn’t have mesh. The hernia sac was only fatty tissue (no intestine). And even the suture thread, it was resobarble suture 100% (inside /out), means at this time I don’t have any foreign material in my body normally….

[Côme]

It was a small right side lateral inguinal hernia.

I wanted a pure tissue repair with resorbable suture inside and outside into the minimal repair technic (check it yourself online). I told him and he told me that, if the operational discovery / situation was fitted for such a solution, he would go for entirely resorbable sutures.

Basically he told me that the technic / material he will use depends on the operational situation.

In the end, I got the surgery I wanted. He also removed a lipoma on the spermatic chord (surgeons often rush and don’t take the time to do everything properly).

My recovery was painful and very long, including nerve pains and strange digestive issues. I don’t know why and I’m not blaming him. It varies a lot from an individual to another.

I’m at 5 months mark and it is still getting better. I’m not limited but I’m still careful and can still feel some tearing when I lift heavy or do some exercices, including nerves getting irritated / increased numbness. Althrough I still have some numbness, it seems to be disappearing slowly, so I guess no nerve was definitely damaged.

I had the repair checked on ultrasound, and everything is solid.

The man himself is very competent and kind, he will take the time to explain to you and, more importantely, he will listen to you. He’s also always available afterward for talking with you, reassuring you, guiding you and post-op check-up if needed.

He’s an expert not only in fixing hernia but also removing failed mesh. And althrough my own recovery was difficult, I trust he did a good job and everything will turn out fine in the end.

• This reply was modified 6 months, 2 weeks ago by  Côme.

[Côme]

Thank you, doctor.

The blood check came back and it shows nothing, no sign of infection or inflammation on blood level.

The only thing I know is that if I stop the macrogol 4000, bowel movements almost entirely stop and it gets ugly. And then there was some blood. And it all started when the wound got problem with many ingrown hairs. 2 days ago I also had some vertigo and my blood pressure dropped to the lowest limit (10.6).

I never ever had any digestive issue my whole life before, it was working like clockwork. Neither vertigo.

I’m hesitating on the scanner because I don’t want to take 10 days of radiation in that sensitive area for nothing…

[Côme]

Nice of him to give you the choice.

I had my surgery last week. Small (1.4cm), painless, uncomplicated, right side, very lateral, indirect hernia.

I had agreed with the surgeon that if he was to judge the quality of my tissues good enough and the intra-operative situation fitted for the use of entirely absorbable sutures, I would prefer that he uses them.

In the end he told me that tissues were good enough, the fact that it was very lateral and uncomplicated made him decide for kind of minimal repair (an interesting variation of the Shouldice) along with entirely long-term absorbable sutures.

Minimal Repair technique of sportsmen’s groin: an innovative open-suture repair to treat chronic inguinal pain
-> https://www.hernien.de/fileadmin/docs/Minimal-Repair.pdf

Also on the hypothesis that my collagen metabolism will be good enough to strengthen the repair.

This question of collagen metabolism is rarely taken into account, just like nutrition. As someone into high level sports, I did a lot on the nutrition level before the surgery and now during the recovery, including diet, collagen intake, chondroitine and glucosamine intake, various minerals and vitamines (see the study down there), glutamine and arginine, curcumine and peperine, etc. Many of those could help with wound healing and help maintain a high enough concentration of those nutriments in the wound area.

Pre-operative and post-operative nutrition can really help, if not the speed of recovery, at least the quality of the recovery and most doctors ignore entirely this aspect :

Multinutrient
Supplementation Increases Collagen Synthesis during Early Wound Repair
in a Randomized Controlled Trial in Patients with Inguinal Hernia
-> https://www.sciencedirect.com/science/article/pii/S0022316622021277

I’m at day 8 of recovery and everything is getting better day after day, off painkiller at day 5. The first few days are no joke through, but mostly because of the propofol and fentanyl used for the sedation.

• This reply was modified 11 months, 1 week ago by  Côme.

[Côme]

It seems pretty obviously to me that the human body isn’t made to hace foreign synthetic material inside it. I think its reaction to it (basically encapsulating through fibrosis) is clear enough.

I have read the Dasarda paper that claim such a solution, what I didn’t like is that it takes undamaged tissue from a fascia to repair the defect, basically damaging another tissue.

If the absorbable suture is only 0.5% more likely to generate a reccurence compared to non-absorbable, I think it’s a low enough risk to try not leaving any foreign material inside my body that could cause regular fibrosis and inflammation.

https://scholar.google.fr/scholar?q=fibrosis+inflammation+scarring+cancer&hl=fr&as_sdt=0&as_vis=1&oi=scholart

• This reply was modified 11 months, 3 weeks ago by  Côme.

scholar.google.fr

Google Scholar

Google Scholar

[Côme]

I understand but all this concern mesh-related problems. Again here I opted for a mesh-less solution, so the only real question for me (as I’m not doing it for the sole sack of science) is about the suture material.

Originally I came here to find people who had mesh-less repair with absorbable sutures to get a per-case but nonetheless important feedback of their experience. But they are obviously hard to find…

[Côme]

Next week, I’m scheduled for a mesh-less repair of my inguinal hernia by a specialized surgeon. While I’m not overly concerned about pain, the potential for fibrosis and inflammation without pain is still a consideration I have.

Regarding pain, I am of the belief that most it mostly arises from suboptimal surgical techniques, such as poor nerve management or improper mesh placement.

“… in daily practice, surgeons identify all three inguinal nerves as three single nerves in less than 40% of the cases, while the literature shows that this identification can be done in 70-90% of the cases. The challenge is that the course of both ilioinguinal and iliohypogastric nerves is found to be consistent with that described in anatomical texts in only 42% of patients. However, these anatomical variations are readily identifiable.” (https://en.wikipedia.org/wiki/Post_herniorraphy_pain_syndrome)

I have confidence that the surgeon will prioritize a meticulous approach to minimize any potential pain. However, I’m still deliberating between opting for a late-absorbable or non-absorbable suture.

• This reply was modified 11 months, 3 weeks ago by  Côme.

[Côme]

Most of the studies I posted above are about mesh less repair. In the last study, the data set on reccurence’s risk is huge : Between 1992 and 2000 and 46 745 cases.

I honestly don’t see where this fear comes for surgeons if it isn’t backed by research. Perhaps the idea of something permanent told “hold it up” is reassuring, but the studies are clear : statistically it’s not necessary.

I have been searching and reading because leaving a foreign body, even as small as the suture thread, generates fibrosis and inflammation (which are definitely not good thing to have permanently in your body).

The question remains open for me but I really don’t see where this fear of absorbable sutures come from (given that the tissues quality is good enough to regenerate and recover its strength / elasticity).

• This reply was modified 11 months, 3 weeks ago by  Côme.

[Côme]

The more I dig into it, the more it seems that absorbable sutures in open meshless surgery, result in less pain and about the same risk of recurrence :

Less pain

A comparative study of inguinal hernia using
monofilament non-absorbable suture versus monofilament absorbable suture
in Lichtenstein tension free hernia repair at tertiary care government
hospital

“Monofilament absorbable suture is associated with less chronic groin pain and compared to monofilament non-absorbable sutures.”

https://www.ijsurgery.com/index.php/isj/article/view/5011

Late absorbable sutures comparable (very slight increase in risk) to non-absorbable sutures in open Shouldice :

“… whereas the outcome of repair using late absorbable sutures did not
differ significantly from that with non-absorbable material.”

https://academic.oup.com/bjs/article/90/8/1004/6143297

[Côme]

Thank you for your answer.

Based on what I’ve read, the recurrence risk is pretty much the same. There isn’t much recent study, but from the 4 studies I could find, one states clearly comparing non-absorbable polypropylene or absorbable polydioxanone suture threads : “Recurrence rates in both groups were higher than expected, but there was no difference between the two groups.” ( https://pubmed.ncbi.nlm.nih.gov/10365834 )

I’m still hesitating on that. And while most studies seem reassuring, most surgeons seem to be afraid of that, so it creates a gap between surgeon’s feedbacks and scientifical studies, make it hard to decide.

Here too, not directly about inguinal hernia but for abdominal closure : “Conclusion Primary and secondary outcomes manifested that PD Synth and PDS slowly
absorbed polydioxanone sutures are clinically equivalent, and can be
used for abdominal fascial closure following midline laparotomy.” https://pubmed.ncbi.nlm.nih.gov/38205458/

And of course the Desarda study of polydioxanone suture with no reccurence : https://pubmed.ncbi.nlm.nih.gov/19568520/

I found the old study (1996) that states 5.22% reccurence (but not sure if it is Polyglycolic sutures or PDS sutures) rate compared to iron wires in Shouldice, but since then most studies seem to prove otherwise compared to prolene sutures…

My surgeon told me he would let me choose as long as I understand the risk. But this divergence between studies and surgeons make it hard to decide.

• This reply was modified 11 months, 3 weeks ago by  Côme.