[DrBrown]

@good-intentions
Dear Good Intentions.
I agree. If you review the papers from the shouldice clinic, they do not report any chronic pain after hernia repair. In my experience, if the patient does not have chronic pain before surgery, then there is no chronic pain after a pure tissue repair. There are no articles in the literature that report chronic pain after hernia repair from the 1980’s (before mesh was introduced).
Regards.
Bill Brown MD

[DrBrown]

Dear Mike.
The hernia is not the source of your troulbe.
Please see your primary doctor.
Regards.
Bill Brown MD

[DrBrown]

@good-intentions

I agree with James.
I have not used mesh to repair an inguinal hernia in 20 years and I have been very happy with the results.
Regards.
Bill Brown MD

[DrBrown]

@good-intentions
The hernias in young adult and children are indirect hernias and the results for recurrence are the same with or without mesh.
Regards.
Bill Brown MD

[DrBrown]

@rc009
The NYROSA is the best source for information on nerve blocks.

https://www.nysora.com/nextlevelnysora-atlas-of-ultrasound-guided-procedures-in-interventional-pain-management/

Regards.
Bill Brown MD

[DrBrown]

Dear Good Intentions.
We can hope that non mesh repairs will become the standard of care again soon.
Bill Brown MD

[DrBrown]

Dear Jordan.
The most important next step is to determine what is the source of your pain. Find a physician that will carefully get your history, examine you, and review the images. Once the etiology is determined, then the correct treatment can be started.
Bill Brown MD

[DrBrown]

@aj9000
Dear AJ.
Each surgeon has a different regimen. Talk with your surgeon about when to start exercises.
Regards.
Bill Brown MD

[DrBrown]

@havoc2000
There is an excellent chance that you will improve with time.
Rest. Advil. Local heat.
If you do not improve, then see your surgeon after the virus settles down.
Regards.
Bill Brown MD

[DrBrown]

Is the pain unilateral or bilateral?
How were the hernias repaired?
The pain in the scrotum and base of the penis is probably related to damage to the ilioinguinal nerve. I advise a nerve block. If you feel significantly better then that would be strong evidence that the nerve is the source of your trouble. The appropriate treatment can be started.

I do not believe that the foot pain is related.

Kind regards.
Bill Brown MD

[DrBrown]

@good-intentions
I agree. It worries me that the Corporate Alliance representative runs some of the meetings.
Bill Brown MD

[DrBrown]

@ajm222
Dear AJM.
You are in good hands and you will have a great result.
Keep us updated.
Best wishes.
Bill Brown MD

[DrBrown]

@chaunce12345
I consulted with the editor on the Harpers’ Article and strongly support the move to better inform patients and to encourage medical schools to start training surgeons with the classic non-mesh repairs.
Bill Brown MD

[DrBrown]

@ajm222
Dear AJM.
Most patients feel significantly better after mesh removal. But it would be rare to get 100% relief. The more pain that you have before surgery increases your risk for having chronic pain after the operation. Be prepared to wait 6 months for a full recovery.
Prepare your body for the operation. BMI needs to be normal. Stop smoking. Treat any medical problems your have (hypertension, Diabetes, etc).
Best wishes.
Bill Brown MD

[DrBrown]

@ajm222
Dear AJM.
Ask your local doctor to inject the mesh with a local anesthetic. If you feel better for a few hours then that would be evidence that the mesh is the etiology of your trouble. Also, if it is difficult to push the needle through the mesh,then that indicates that the mesh has become hard.
Regards.
Bill Brown MD

[DrBrown]

@kevw
Dear Kevw.
I agree with Dr. Towfigh. Avoid the Kugel repair.
The ilioinguinal nerve is not involved with erections nor sexual function.
If you are overweight, get your BMI down to normal before surgery.
I prefer the open non mesh repairs.
Regards.
Bill Brown MD

[DrBrown]

@ajm222
Dear AJM.
The mesh can be the source of your trouble. It often shrinks with time. If your local doctor injects the mesh with a local anesthetic and you feel better for a few hours that would be strong evidence that the mesh is the source of the pain.
Also, ask that the surgeon checks the nerves for you.
Regards.
Bill Brown MD

[DrBrown]

Hopefully the leaflet will be printed on a piece of mesh.
I wish our FDA would pay attention.
Bill Brown MD

[DrBrown]

Dr. Towfigh will provide you with an excellent result.
Best wishes.
Bill Brown MD

[DrBrown]

Dear James.
A small amount of free fluid in the pelvis is normal. If there is a large amount of fluid then that should be investigated.
If the hydrocele is tiny and not causing any trouble, it does not have to be treated.
regards
Bill Brown MD