[DrBrown]

Dear Chaunce1234
If you look at young males with indirect inguinal hernias, the recurrence rate is the same with a pure tissue repair when compared with mesh repair.
Thus, especially in young males, there is no need for mesh.

https://www.ncbi.nlm.nih.gov/pubmed/28391976

Also if you do a literature search for postoperative pain after inguinal hernia repair, it is difficult to find any articles about the post op pain before the introduction of mesh. Which suggests that pain complications were minimal before the introduction of mesh.
That is also my personal experience.

Regards.
Bill Brown MD

[DrBrown]

Dog has been very kind with his comments.
It was my pleasure to help in his care.
Regards.
Bill Brown MD

[DrBrown]

Dear VegasHernia.
The pain that you have is most likely related to a nerve.
Was your nerve cut at the time of the hernia repair? If so, neuromas occur about 6 months later and could explain your pain.
If you are lucky, the pain will resolve on its own. Try Capsaicin cream. A steroid injection often helps. Nerve ablation or neurectomy may be needed if conservative measure fail.
Regards.
Bill Brown MD

[DrBrown]

I wish it was not true, but some doctors think more about money than the patient.
Bill Brown MD

[DrBrown]

Dear BobbyO
Pain that occurs in multiple locations make diagnosis more difficult.
Pain on the inner thigh and scrotum is often related to the ilioinguinal nerve.
Pain on the outer thigh can be the lateral femoral cutaneous nerve.
When the nerves are involved, the skin often feels numb, burning, tingling.
Pain with walking could be the hip joint and sometimes the adductor.
So it is very important to identify what areas give you the most trouble.
Regards.
Bill Brown MD

[DrBrown]

Dear BobbyO
What type of hernia repair did you have?
Where is the pain? Inner thigh? Outer thigh?
​​​​​​Does the pain feel deep or in the skin?
Do you have a photo with marks on the skin that identify the sites of your pain?
Regards.
Bill Brown MD

[DrBrown]

Dear Chaunce1234.
The indirect hernia was treated by dissecting the hernia sac back into the retro peritoneal space and then inverting the sac and securing the reduction with a pursestring. The inguinal floor was weak secondary to the chronic indirect hernia. I reconstructed the floor with a limited Bassini This also had the effect of a ringplasty. The external oblique was imbricated over the floor to provide additional reinforcement.
If it is OK with Dog, I will post the surgical photos.
Regards.
Bill Brown MD

[DrBrown]

Dear Kevin b.
Please keep us updated about your recovery.
Work with your surgeon to determine the source of your pain. Your surgeon will want a good result for you and will first determine the cause of the pain and then put together a treatment plan.
Regards.
Bill Brown MD
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[DrBrown]

Dear Kevin B.
If the pain feels like it is in the skin, then it is probably the result of an injury to the ilioinguinal nerve.
If the pain is deep, then it could be related sutures placed in the bone or the spermatic cord.
Contact your surgeon.
Regards.
Bill Brown MD

[DrBrown]

Dog is very kind with his comments, but he made my job easy by working with me every step of the way. He did ask a few more questions than usual or maybe a lot more questions than usual, but I believe that the more the athlete understands the injury, the anatomy, the operation, and the recovery the better he/she does with surgery. So I am always ready to answer questions.
Dog did have an indirect hernia, but there was also weakness of the inguinal floor that also required repair.
Regards.
Bill Brown MD

[DrBrown]

Physical therapy can be beneficial, especially if combine with some soft tissue work.
Unfortunately, the results from injections can be variable. Sometimes the athlete will have get long term relief. Sometimes the relief is only for a few hours. But the injections are easy to perform with minimal risk, so I often use injections.
TENS units are occasionally helpful.
Capsaicin cream is occasionally helpful.
Regards.
Bill Brown MD

[DrBrown]

Dear Jnomesh
I agree with you. And there is too much money involved. Mesh is just a piece of plastic that probably costs a dollar to manufacture. And the mesh companies charge the patient hundreds and sometimes thousand of dollars for the mesh. There is a strong incentive to play down the problems with mesh. And some of the young surgeons have only been trained using mesh.
Bill Brown MD

[DrBrown]

Dear Alliej.
It is reasonable to see a surgeon. He/she will be able to tell you more about the hernia (direct or indirect). He/she should be gentle during the examination and thus not cause your mother any pain. If she decides to have the hernia repaired, then a open repair with local anesthesia and sedation is the safest method. I prefer a non mesh repair. The lap hernia repairs require general anesthesia, which should be avoided in a frail woman.
But again, if the hernia is not giving her any trouble, she does not need to have an operation.
Best wishes.
Bill Brown MD

[DrBrown]

Long term pain drags you down mentally and physically. You find yourself thinking will I be in pain for the rest of my life? Will I never be better? Will I ever have sex again. The pain is very hard on personal relationships. I prefer to try to get treatment started early. There are thought to be three main causes of chronic pain after hernia repair. One is a recurrent hernia. This should be identifiable on physical examination or with ultrasound.
Next is the body’s reaction to the mesh itself. Mesh becomes scarred and shrinks and becomes stiff. This is usually a pain that feels deep. Often gets worse with aggressive activity. Often gets worse with long periods of sitting. The pain will get better with rest.
Next one of the nerves has been damaged. This will often be a shooting or an electric pain that is more superficial. The skin will often be sensitive to light touch.
If you think that the mesh is the source of pain, then the mesh can be injected with marcaine and steroids. This will often provide relief.
If the nerves are the source of the pain, then a nerve block with marcaine and steroids can be very beneficial.
Removal the mesh and neurectomy are the last resort. The operation can be very difficult and sometimes the patient does not get improvement.
A very difficult problem.
Regards.
Bill Brown MD

[DrBrown]

Dear Alliej.
If your mother is not having any trouble from the hernia, then I would not advise an operation.
There is a slight chance for incarceration, but the risk is small.
If she has a chronic cough or constipation then these problems should be treated as they can make the hernia worse.
Regards.
Bill Brown MD

[DrBrown]

Dear Chaunce
A nerve block is the best method to determine whether or not a neurectomy will be beneficial.
If a nerve block is helpful then I advise a steroid injection first. Occasionally that is helpful.
A radiofrequency ablation can also be helpful. I advise neurectomy if conservative measures fail.
Occasionally a neuroma will occur after neurectomy, which can be a source of pain.
Regards.
Bill Brown MD

[DrBrown]

Dear Wasin TN.
You should see a general surgeon. He/she will be able to determine is you have a recurrent hernia or trouble from the mesh.
If necessary they can arrange for the appropriate imaging.
Regards.
Bill Brown MD

[DrBrown]

I agree completely. Without proper codes and documentation we do not know how often mesh has to be removed.
I have not found any articles in the medical literature that give a real number. Without information we can not calculate the cost in terms of dollars and pain and suffering.
Bill Brown MD

[DrBrown]

Dear AJM.
Usually, pain related to hernia surgery will improve for upto a year. After a year there is usually very little improvement.
If you are having pain in the testicle, a spermatic cord block with local anesthetic and steroid will often be very beneficial.
If you are having pain from the mesh, the mesh can also be injected with the hope of getting some relief.
If you have nerve involvement, then there is usual a change in skin sensation and there is some pain 100% of the time.
A nerve block can be very helpful.
Mesh usually shrinks with time, which is probably the source of the tightness you feel.
Best wishes.
Bill Brown MD

[DrBrown]

Dear Dill.
Mesh did not become popular until the late 1980’s. Try to find a local surgeon who is about 60 years old, he/she would have trained before mesh was available and he/she should be able to offer you a non-mesh hernia repair.
Regards.
Bill Brown MD