[DrBrown]

The body treats mesh as a foreign body and inflammatory tissue will form around the mesh. The mesh then becomes stiff and shrinks. The process usually takes about six months. That explains why pain related to the mesh usually occurs about six months after surgery. Pain related to damage to the nerves usually occurs very quickly after surgery.
Regards.
Bill Brown MD

[DrBrown]

I agree with Dr Towfigh.
Bill Brown MD

[DrBrown]

Dear Ark93.
It is important to determine the etiology of your pain before proceeding with surgery so that you know what needs to be treated.
If the pain is in the skin that it is probably nerve in origin. The pain is deep inside then it is probably related to the mesh. Pain in the testicle and pain during sex is usually related to the spermatic cord becoming adhesive to the mesh.
regards.
Bill Brown MD

[DrBrown]

The nerves should be preserved during hernia repair. The nerves need to be identified and treated with care.
Neurolysis will traumatize and should not be done.
Bill Brown MD

[DrBrown]

Dear Damien10
I would advise you to have the spermatic cord injected with local anesthetic and steroid.
That might free up the cord from the mesh and give you some relief.
You can also have your testosterone levels checked.
Regards.
Bill Brown MD

[DrBrown]

Dear PeterC
You need a surgeon that will take the time to examine you and review your history.
I also have found that diagnostic injections are helpful.
Athletes often present with a long history of pain and multiple previous operations. This makes determining the exact source of the pain difficult. I often use trigger point injections to try to localize the pain. For example, assume an athlete presents with pain that is near the origin of the adductor longus tendon. If that tendon is injected with lidocaine (a local anesthetic) and the pain gets better, then that would be strong evidence that the adductor longus is the source of the pain. In a similar manner, other structures can be injected such as the ilioinguinal nerve, the genital nerve, the spermatic cord, the symphysis pubis, etc With sequential trigger point injection, the etiology of chronic pain can often be identified then the appropriate treatment can be started.
regards.
Bill Brown MD

[DrBrown]

Dear Sambuka.
You can email me directly or give the office a call.
DrBrown@
Hernia-Surgeon.com
Regards.
Bill Brown MD

[DrBrown]

Dear Sambuka.
You are welcome to email me directly at:
DrBrown@Hernia-Surgeon.com
If you include your cell number I will give you a call to help you make decisions on how to proceed.
Regards.
Bill Brown MD

[DrBrown]

Dear Damien10.
If you had a mesh repair, then your cord is probably scarred to the mesh. Your surgeon can inject the mesh and the cord with steroids. That might help.
Regards
Bill Brown MD

[DrBrown]

Dear Txman.
More important than the Cpt code is to be sure that the radiologist and the XRay technician know what you are looking for. A marker can be placed on the skin over the site of your pain so that extra images can be taken at that site.
Regards.
Bill Brown MD

[DrBrown]

Dear Saro.
Preventive neurectomy only started after mesh was introduced. Sometimes after hernia repair the nerve can become scarred to the mesh resulting in pain.
There are three major nerves in the inguinal area. The iliohypogastric nerve, the ilioinguinal nerve, and the genital nerve. The iliohypogastric nerve provides sensation to the pubic hair area and the upper part of the scrotum or Mons. The ilioinguinal nerve provides sensation along the inguinal ligament, on the inside of the upper thigh, and on the outside of the scrotum or Mons. The genital nerve provides innervation to the cremasteric muscles and sensation to the testicle or labia majora.

Damage to any of these nerves can cause chronic pain after the surgery. Some surgeons advise routine transection of these nerves to avoid postoperative pain. But cutting the nerves causes the skin to be numb. And if the nerve tries to grow back and a neroma forms, then that can be a source of cause chronic pain. It is best to carefully identify the nerves during the operation. And then take care not to damage the nerves while the hernia is being repaired.

The iliohypogastric nerve can usually be identified running parallel to the inguinal ligament about a centimeter above the level of internal ring and deep to the external oblique aponeurosis. It will emerge through a hole in the external oblique aponeurosis just above the external inguinal ring and continue its journey to the skin.

The ilioinguinal nerve joins the spermatic cord (or round ligament in women) at the internal inguinal ring and then runs along the anterior superior aspect the spermatic cord (or round ligament).

The genital nerve usually joins the spermatic cord (or round ligament) at the internal inguinal ring and then runs along the posterior aspect of the spermatic cord (or the round ligament). Of the three nerves, the course of genital nerve is the most variable. Instead of traveling with the spermatic cord (or round ligament), it can be found near the inguinal ligament or running along the floor of the inguinal canal.
Regards.
Bill Brown MD

[DrBrown]

Dear Victim73
Consider having a spermatic cord block, that might help the pain and avoid more surgery.
The spermatic cord could be adhered to the mesh again.
Skeletonization of the spermatic cord would be the next operation if the spermatic cord block helps.
Regards.
Bill Brown MD
​​

[DrBrown]

Dear Stonehood
The site of your pain could be the mesh or a nerve.
Ask your surgeon to inject the mesh with a local anesthetic and if you feel better I would then advise a steroid or PRP injection.
Then try a nerve block if injecting the mesh is not helpful.
Regards
Bill Brown MD
​

[DrBrown]

Dear mitchtom6.
The operative note is incomplete, but it appears that you had a TEP hernia repair.
Regards.
Bill Brown MD

[DrBrown]

To treat pain after mesh hernia repair it is important to try to determine the exact cause of the pain. Check for a recurrent hernia. A nerve block will help determine if the nerves are involved. The mesh can also be injected with local anesthesia to help determine if the mesh is the source of the trouble. Other structures that can be also be injected such as the inguinal ligament, the spermatic cord, etc. Once the etiology of the pain is identified the appropriate plans can be made.
Mesh pain is a difficult problem and is the source of my gray hair.
Regards.
Bill Brown MD

[DrBrown]

Dear Victum73.
Occasionally a spermatic cord block with local anesthetic and steroids can provide some relief. It is a safe procedure and should not make things worse.
Do you still have any mesh?
Best wishes.
Bill Brown MD

[DrBrown]

Dear Stonehood.
I believe that your best chance for pain relief is to have the mesh removed.
I know that is a big decision, but you need to get your life back.
Best wishes.
Bill Brown MD

[DrBrown]

Dear Stonehood.
I do not understand the exact site of your pain. Would you feel comfortable posting a photo of yourself with marks on the skin that identify the sites of your pain.
Regards
Bill Brown MD

[DrBrown]

Dear Runner.
It is possible to remove Umbilical Hernia mesh. There are often adhesions between the mesh and the intestines, so the removal needs to been done very carefully.
​​​So I would advise trying non operative methods to control your symptoms before proceeding with surgery.
Regards
Bill Brown MD

[DrBrown]

I agree with Dog. If a surgeon uses mesh, then he/she should be prepared to take care of all the complications of the mesh.
Bill Brown MD