[DrBrown]

[USER=”2777″]Mariel[/USER]
Dear Mariel.
I agree that you should be better by now. The bloating is not normal.
A physical examination is needed to determine if your pain is related to the nerves.
Diagnostic injections are often helpful.
A CT scan or a MRI can help evaluate your organs.
An ultrasound can often be helpful.
Do not hesitate to call you surgeon every day.
It is his/her responsibility to care for you.
Regards.
Bill Brown MD

[DrBrown]

[USER=”2886″]Love4852[/USER]
The most common source of pain after surgery is a recurrent hernia, fibrosis of the mesh, and damage to the nerves.
Your surgeon should be able to evaluate you and determine which is the source of your pain and then start appropriate treatment.
Regards.
Bill Brown MD

[DrBrown]

[USER=”2981″]Smawgunner[/USER]
You may have a hernia. See your primary doctor for an evaluation.
The best imaging test is a standing ultrasound with valsalva maneuver.
Regards.
Bill Brown MD

[DrBrown]

[USER=”2923″]Joshio4473[/USER]
Since the mesh is affecting you both mentally and physically, go ahead and let Dr Y remove the mesh for you.
Regards.
Bill Brown MD

[DrBrown]

Each hernia repair needs to be tailored to the patient’s anatomy. Your surgeon should have all these various methods available and then choose which will give the best result for your situation. For example, in a young athlete with an indirect inguinal hernia, the Marcy hernia repair yields excellent results with minimal dissection and minimal postoperative pain.

For direct inguinal hernias the Bassini, the Shouldice, and the Desarda are all excellent choices. The Bassini repair is a very good choice, especially if the floor of the inguinal canal is just weak and not fully torn. But there may more tension on the repair than the other techniques. The Desarda also provides excellent results. There is very little tension on the repair. But the Desarda repair does require a strong external oblique aponeurosis to serve as a patch to cover the inguinal floor. Therefore, it is not a good option if the external oblique aponeurosis is torn or weak. The Shouldice is an excellent operation. There little tension on the repair. The four-layer repair is very strong. But it does rely on an intact inguinal ligament and good tissue in the inguinal floor. Thus, there will be times when the Shouldice may not be possible.

Regards.
Bill Brown MD

[DrBrown]

[USER=”2482″]katiebarns[/USER]
The shear stress occurs because your tissues are more flexible and stretch more than the mesh.
So when you bend and the mesh does not that is a source of pain.
See your doctor to be sure that you do not have a recurrent hernia.
If the pain is from the mesh then a steroid injection into the mesh may help.
regards.
Bill Brown MD

[DrBrown]

[USER=”2983″]slicedanddiced[/USER]
I am sorry that you are having so much trouble.
Your situation is more complicated than usual.
You need to work with your surgeon and infectious disease doctor to determine if you have some persistent infection,
if you have an immune deficiency, if you have adhesions to the intestines.
Do not hesitate to call you doctors until you get your problems resolved.
Regards
Bill Brown MD

[DrBrown]

[USER=”2967″]MeshMangledMerritt[/USER]
The most common reason for pain is the mesh or scarring of the nerves.
Ask your doctor to inject the mesh with lidocaine. If you feel better that will be strong evidence that removing the mesh will help.
If injecting the mesh does not help, then inject the ilioinguinal and the iliohypogastric nerves with lidocaine. If that helps then the nerves are a component of your pain.
Regards.
Bill Brown MD

[DrBrown]

Best wishes.
Bill Brown MD

[DrBrown]

[USER=”1391″]UhOh![/USER]
In infants, simple ligation of the sac is all that is required.
In adults, the sac has usually dilated in the internal ring and the ring needs to be tightened (sometimes called a ringplasty).
Regards
Bill Brown MD

[DrBrown]

[USER=”2966″]Tino_7[/USER]
Dear Tino.
Be sure that the robotic operation does not create too much scar tissue to have prostate surgery later.
An open pure tissue will not interfere with any prostate surgery in the future.
Both operations can make urination difficult. Consider Flomax before surgery.

Regards.
Bill Brown MD

[DrBrown]

[USER=”2862″]kaspa[/USER]
Thank you for the history lesson.
For infants, simple ligation of the hernia sac is all that is required.
This would be similar to the operation the Pope had.
Regards.
Bill Brown MD

[DrBrown]

[USER=”2758″]Dill[/USER]
The rule of thumb is at three weeks you will have about 70% of the final strength of your repair.
That is plenty to start aerobic exercises.
At six weeks you will have about 95% of your final strength, so at that point, you can start pushing yourself harder.
External support (abdominal binder, compression shorts) often helps.
Topical poultices may make everything feel better, but they will not help the healing.
I would support you if you decide to write about the benefits of pure tissue repair.
The recurrence rate you quoted is too high.
Regards.
Bill Brown MD

[DrBrown]

[USER=”2921″]Hiway40blues[/USER]
I pray that your surgery and recovery go smoothly.
Bill Brown MD

[DrBrown]

[USER=”2777″]Mariel[/USER]
I agree that most patients do not have as many problems as you describe.
Imaging tests such as MRI, CT, Ultrasounds can be helpful.
MRI is good for muscles and ultrasound provides a dynamic image.
None of the tests are good for nerves.
A careful physical exam and history are probably the most important test.
Diagnostic injections can be helpful.
Regards.
Bill Brown MD
​​​

[DrBrown]

[USER=”2777″]Mariel[/USER]
After surgery, your pain should slowly decrease and you should slowly get your function back.
If your surgeon is satisfied with your healing, then waiting is reasonable.
Compressions shorts are sometimes helpful
Injecting the mesh with marcaine and steroids will often help.
And nerve blocks will often help.
Do not hesitate to keep asking your surgeon questions. It is his/her responsibility to help you through the post operative recovery.
Regards.
Bill Brown MD

[DrBrown]

[USER=”2012″]saro[/USER]
A few patients have a bulky cremasteric muscle that can make the repair of the inguinal floor difficult, in those patient I sometimes remove the cremastic muscle. If the cremasteric muscle is excise the testicle does not retract in response to cold and during intercourse.
If there is a lipoma of the spermatic cord or an indirect hernia, the cremasteric muscle can be split to get access to those structures. The cremasteric does not have to be excised.
I do not routinely cut the nerves. Once cut there is no way to be sure that it will grow back.
Regards
Bill Brown MD

​​​

[DrBrown]

[USER=”2957″]kjm018[/USER]
The ultrasound is a simple and safe procedure.
It would be reasonable to have that done.
Regards
Bill Brown MD

[DrBrown]

[USER=”2482″]katiebarns[/USER]
That sound more muscular than nerve pain.
What was your original injury?
Any imaging tests?
Bill Brown MD

[DrBrown]

None of the nerves have to be cut during the repair.
Bill Brown MD