DrBrown
Forum Replies Created
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If you review the literature from the 1980’s (before mesh), there are no articles about post operative pain following hernia repair. That is strong evidence that when surgeons were trained for pure tissue repairs then pain was not a post operative problem.
Also if you have pain after a mesh hernia repair it can be debilitating. If you have pain after a pure tissue repair it resolves with time and it is not debilitating.
Bill Brown MD
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Dear DailyMail22.
I agree with Good Intentions. If the hernia is not bothering you, then wait until symptoms develop.
If you travel to countries with poor health care, then consider repair.
You are thin and are at increased risk of pain from mesh. If you decide to have surgery, then select a pure tissue repair.
Regards
Bill Brown MD -
Dear Bekahjan
Endometriosis is missed on imaging. Laparoscopy is often the only way to make the diagnosis.
Laparoscopy can also identify if there is a hernia.
Dr. Cook is an endometriosis expert. You may want to contact him.
https://www.vitalhealth.com
Best wishes.
Bill Brown MD -
Dear Pinto.
Athletes with sports hernias want their injuries repaired so that they can return to sports.
I advise pure tissue repairs for all these athletes, because 10 to 15% of patients with mesh have pain and that would limit the athletes ability to compete.
All the surgeons who fix lots of sports hernias are doing pure tissue repairs.
Regards
Bill Brown MD -
Dear Pinto.
The anatomy does vary from patient to patient. The nerves are often in different places. In heavy patients the muscles are pushed so that they are orientated anterior to posterior rather than superior to inferior. During the repair knowing how far apart to place the sutures. How many knots. What to do to relieve tension. Where are the femoral vessels.
So it is important that the surgeon does the operation frequently.
Regards
Bill Brown MD -
Dear JJpugsley.
Chronic pain without a diagnosis is a terrible problem.
Do not hesitate to push your doctor. Endometriosis is often not seen on any imaging tests.
Small indirect and femoral hernia often do not show on imaging tests.
Adhesions will be missed on imaging tests.
Also see a GI doctor.
If everything is negative, then diagnostic laparoscopy is needed.
Regards.
Bill Brown MD -
Dear Diane1255.
If you are skinny, then a 1.8cm Umbilical Hernia can be closed without mesh.
So if you are comfortable with the second surgeon, pick him or her.
Regards
Bill Brown MD
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Dear UhOh!
If the hernia can be identified on physical examination, then there is no need for an imaging test.
Ultrasound results depend on the expertise of the technician.
Best wishes
Bill Brown MD -
Dear Chrisjohnson.
You most likely have a hernia. A standing ultrasound with valsalva maneuver should be able to confirm the diagnosis. I have taken care of many service men and women, and the air force will probably want you to have the hernia fixed.
But it should not keep you from being qualified.
Best wishes
Bill Brown MD -
Dear UhOh!
I did train in st louis, but unfortunately non of my colleagues moved to Chicago
You best bet to find a local surgeon is to find one about 60 years old. They would have been trained prior to the introduction of mesh.
You would also try one of the medical schools.
Be up front with the surgeon. Ask if they believe in the pure tissue repairs.
Best wishes.
Bill Brown MD -
Dear Jnomesh.
After mesh removal and the reconstruction of the inguinal floor, your abdominal will probably not be as strong as what God originally gave you. Continue to slowly increase your exercise regimen. But listen to your body.
Aerobic exercises are always safe.
If you messure intra abdominal pressures, Coughing, Constipation, BPH, Smoking are the worst offenders.
I think that your risk for a femoral hernia is small.
Best wishes.
Bill Brown MD -
Dear Scaredtodeath.
After a Prue tissue repair your should be able to return to sports about about 8 weeks.
There should be no long term restrictions.
Below is the link to the regimen I advise for most atletes.
Regards.
Bill Brown MDPost-Op Care & Rehabilitation – Sports Hernia Specialist
https://www.sportshernia.com
Sports hernia diagnosis and repair by sports hernia expert Dr. William H. Brown. -
Dear Clevelandhernia
Light exercise is usually helpful. But listen to your body. Avoid activities that cause any sharp pain.
You should also ask for a copy of your operative report and a copy of any photos taken during the operation.
Keep us updated about your progress.
Regards.
Bill Brown MD -
Dear Chaunce1234.
I charge $4000 for a simple hernia repair. That includes my fee, anesthesia fee, and the facility fee.Removing mesh is a difficult operation and the cost would have to be individualized. But for less than $8000 total.
regards.
Bill Brown MD -
Dear Pinto.
Even large hernias can be fixed with a pure tissue repair. For the large hernias it is especially important to get the patient in good shape prior to surgery.
Get the BMI down to normal. Stop smoking. No Constipation. No difficulty with urination. Good nutrition.
Regards.
Bill Brown MD -
Dear Jnomesh .
You are correct. A long standing indirect hernia can stretch the inguinal floor and result in weakness and/or a direct hernia.
The reverse does not occur.
When I used the term weakness, I usually mean that the inguinal floor is very thin and if it gets much thinner a direct hernia will result. This is also a very common finding in athletes with sports hernias. Athletes with sports hernia also have injuries to the medial attachment of the inguinal ligament, injuries to the origin of the adductor longus, and osteitis pubis.
Weakness of the inguinal floor often feels just like a direct hernia. Pain and weakness with exercise. Minimal symptoms at rest. But usually no bulge.
A indirect hernia will have a hernia sac that starts lateral to the inguinal floor and will travel inside the spermatic cord. This sac needs to be separated from the cord and either ligated or inverted into the peritoneum with a purse string suture. If the floor has been weakened from the indirect hernia then a Bassini, Shouldice, or Desarda can fix the weakness. But if the indirect hernia has not weakened the floor then the Marcy Operation is very effective.
A groin exploration will not increase the risk for a hernia in the future.
I hope I answered all your questions.
Regards.
Bill Brown MD -
Dear Chaunce1234,
Bassini was used to reinforce the inguinal floor. A Shouldice would also have been effective. If Dog had had a complete tear the same operation would have been effective.
Both the Bassini and the Shouldice sew the transversalis to the inguinal ligament. But a femoral hernia passes underneath the inguinal ligament and over cooper’s ligament. Thus neither a Bassini nor a Shouldice will fix a femoral hernia. The McVay sews the transversalis to Cooper’s ligament, so it will fix both a direct hernia and femoral hernia.
Regards.
Bill Brown MD -
Dear Clevelandhernia.
I would advise a couple of weeks of rest, heat, NSAIDS. Then slowly return to lower core exercises.
If you still have pain then see your surgeon.
He/she will check you for recurrent hernia, fibrosis of the mesh, strain.
Regards.
Bill Brown MD -
Dear Pinto.
Unless the hernia becomes huge, a pure tissue repair will be possible.
Wait to have your operation until you are more symptomatic and timing is good for you and work.
Regards.
Bill Brown MD -
Dear Jnomesh.
I would like to thank Dog for allowing us to share his photographs.Hernia Sac: this is the sac or balloon that is filled when the intestines pop out through the indirect hernia.
Hernia Sac Opened: In this photo, hernia sac has been cut open and at the very bottom is the hernia. As you can see, even though the hernia sac is large, the actual hernia is small. This is one reason the recurrence rate for indirect hernias is so low.
Floor Weakness and Anatomy: Dog had had his hernia for a long time. It had stretched the muscles medial to the indirect hernia. In the photo, notice that the inguinal floor is mostly fat. There is no bulge but there is also no strength. To reconstruct this weakness I will suture the transversalis to the inguinal ligament.
Reinforce Floor: The sutures have been placed between the transversalis and the inguinal ligament.
Repaired Floor: The area of weakness (fatty area) seen in the photo “Floor Weakness and Anatomy” has now been reinforced.I hope that clarifies some of your questions.
Regards.
Bill Brown MD
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