[DrBrown]

@allenpagent
Dear AP.
There is no blood test for a hernia.
If you are skinny, then a good physical examination is all that is required to determine if you have a hernia.
The best imaging test is a standing ultrasound with valsalva.
Regards.
Bill Brown MD

[DrBrown]

@brunog
There is a good chance if the mesh is removed, that your autoimmune problems will improve.
As a general rule, most patients have 80% improvement after mesh removal.
Sexual function should not be affected by the operation.
Regards.
Bill Brown MD

[DrBrown]

@alephy
A Shouldice will give a good result, but it is overkill for a small indirect hernia.
Regards.
Bill Brown MD

[DrBrown]

@ontarioanswers
A careful history and physical examination is the next step. A thoughtful surgeon should be able to differentiate between a hernia and spermatic cord pain.
Also, Consider diagnostic injections. For example, if the spermatic cord is injected with a local anesthetic and you feel better for a few hours, then the cord is probably the source of your pain. In a similar manner, other structures can be injected with a local anesthetic.
Regards.
BIll Brown MD

[DrBrown]

@rsshook
Your pain should be slowly improving each day.
Contact your surgeon. If the hematoma has recurred, then it should be drained.
If you have a nerve entrapment, then a nerve block will be helpful.
If the spermatic cord is stuck to the mesh, then a cord block may be helpful.
Regards.
Bill Brown MD

[DrBrown]

With Crohn’s disease I would advise against a mesh repair because of the increased risk for infection and autoimmune problems.
If you will need prostate surgery, then avoid laparoscopic hernia repair because the mesh can make it more difficult.
Regards.
Bill Brown MD

[DrBrown]

I agree. The pure tissue repairs offer excellent results without the complications of mesh. There are multiple techniques that can be tailored to the individual needs.
https://www.sportshernia.com/no-mesh-hernia-repair/
Regards.
Bill Brown MD

[DrBrown]

@alephy
A complete history and physical examination are still the most important steps to determine the etiology of an athlete’s groin pain. 90% of the time, a diagnosis can be made with the history and physical examination alone. A rushed or inadequate physical examination is the most common cause of a missed diagnosis.

The British Hernia Society stated that an Athlete has a Sports Hernia if at least three out of the five clinical signs below are detectable:

Pinpoint tenderness over the pubic tubercle at the point of insertion of the conjoint tendon;
Palpable tenderness over the deep inguinal ring;
Pain and/or dilation of the external ring with no palpable hernia
Pain at the origin of the adductor longus tendon; and
Dull, diffused pain in the groin, often radiating to the perineum and inner thigh or across the midline.
MRI, CT scan, Ultrasound are used to try to image the tear in the oblique muscles. Unfortunately, the tests can be challenging to interpret, and there is a high false-negative rate. Imaging tests are mainly helpful in identifying other possible etiologies of the groin pain, for example, a hip injury
Regards.
Bill Brown MD

[DrBrown]

@surgery
If your pain is from nerves, then a nerve block with a steroid can be very beneficial. Sometimes neurontin can be helpful.
If your pain is from the cord being stuck to the mesh, a steroid injection can be helpful.
Try the injections before proceeding with surgery.
Regards.
Bill Brown MD

[DrBrown]

Dear Karthik.
Return to your surgeon and ask him/her to evaluate the swelling.
A seroma can be aspirated.
If you have a healing ridge, then that should resolve with time.
Regards.
Bill Brown MD

[DrBrown]

Each hernia repair needs to be tailored to the patient’s anatomy and needs. 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 with ringplasty 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 great technique, especially if the floor of the inguinal canal is just weak and not fully torn. The traversalis fascia is sewn to the shelf of the inguinal ligament. 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. Therefore, it is not a good option if the external oblique aponeurosis is torn or weak. Shouldice is an excellent operation. There little tension on the repair. The four-layer repair is solid. But it does rely on an intact inguinal ligament. Thus, there will be times when the Shouldice may not be possible.

The McVay repair involves the use of Cooper’s ligament instead of the inguinal ligament to repair the inguinal floor. It is an especially useful technique in situations in which the inguinal ligament is damaged, or there is an associated femoral hernia. The McVay hernia repair does have tension on the repair and may require more recovery time.

Your surgeon should know all of these techniques for hernia repair. And he or she will often find that a hybrid operation using the best ideas from each method are needed to achieve the best result.
Regards
Bill Brown MD

[DrBrown]

@dave-graham
Dear Dave.
Ask your surgeon to inject the mesh with some steroids. That will sometimes soften the mesh and help with the pain. A ilioinguinal and a iliohypogastric nerve block can be helpful.
Regards.
Bill Brown MD

[DrBrown]

@watchfulwaiting
Most hernia repairs can be done with local anesthesia and a little sedation.
But obese patients and complicated hernias usually require general anesthesia.
Laparoscopic repairs require general anesthesia.
Regards.
Bill Brown MD

[DrBrown]

@rosi
Most likely the fever is not a problem, but ask your surgeon to check you.
Regards.
Bill Brown MD

[DrBrown]

@alephy
Inguinal hernias and umbilical hernia can be repaired at the same time with either an open procedure or a laparscopic procedure.
I prefer the non mesh repair.
Bill Brown MD

[DrBrown]

@alephy
Dear Alephy.
A hernia is reducible if the intestines can be pushed back into the abdomen. Both direct and indirect hernias can be reducible.
If the intestines become stuck in the hernia, then the hernia is called incarcerated.
Regards.
Bill Brown MD

[DrBrown]

@jnomesh
It is sad that most surgeons who use mesh do not know how to treat the complications.
Bill Brown MD

[DrBrown]

@dh305
Your surgeons are correct that you probably do not have a recurrent hernia. But the most common cause of problems after mesh are scarring or damage to the local nerves. Neither or those problems will show up on imaging tests. So I use diagnostic injections. First I would inject the mesh. If you did not get better then I would block the local nerves.
Most surgeons do not know how to inject the mesh, so it will probably be difficult to ask them to do the procedure.
Regards.
Bill Brown MD

[DrBrown]

@colt
When the suture repair is done correctly, there is minimal tension.
On the other hand, remember that mesh will shrink 50%. So in 6 months a mesh repair becomes a tension repair.
Regards.
Bill Brown MD

[DrBrown]

@colt
Try to find an older surgeon. He/she would have been trained before mesh was available.
Regards.
Bill Brown MD