drtowfigh
Forum Replies Created
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Why there is no foolproof method?
This would be a great one for Dr Ramshaw to answer. His lifelong research interest is this problem.
He will tell you that it’s because hernias and our individual bodies are complex systems. A mesh repair in one patient will act differently in another patient even if performed exactly the same. Until we can approach it with this in mind and determine the best modality depending on the specifics of each patient (cancer treatment is finally moving in that direction), then the problems you present will remain.
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Desperate
1. Can you palmate the area of your pain? If so, is it tender to touch? If so, then follow below:
I am not clear as to where exactly your pain is in the left lower quadrant. Nevertheless, I would pursue the hernia question. Try dynamic Ultrasound of the groin and left lower quadrant first. If negative, follow up with MRI pelvis with Valsalva (see other posts for details). If still negative, make sure the films are being read correctly by seeing a hernia specialist.
If the pain is not from a hernia, then it should be from T11-L2 depending on where it is exactly where your pain is.
Read earlier posts and see if you relate to the symptoms listed for occult hernias. If do, then don’t give up til you find someone who can cure you.
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MRI with valsava for imaging & diagnosing hernia?
Here are details for best imaging for small or occult/hidden inguinal hernias:
– non-contrast MRI pelvis. Nothing to drink. No injections.
– 3Tesla machine is preferred. Some centers get good results with 1.5T but the tech must be very diligent there is minimal motion artifact, etc.
– no open MRI. Won’t give you enough clarity of picture
– Valsalva (bear down) is key to finding the very small ones.
– they should mark the area of your pain
– in my center, they also do dynamic video images. Doesn’t add much more to the Valsalva still images, frankly.
– in my center, they also do close ups of the hip, which helps rule out a hip problem as the cause of groin pain.RJ: your symptoms can absolutely be due to a femoral hernia. Usually these present as groin pain that radiates down the top of the thigh. Not sure why an MRI is necessary when ultrasound already shows the femoral hernia. With laparoscopic repair (now gold standard for femorals), any other inguinal would be found and repaired anyway. Lastly, all femoral hernias should be repaired. They have a high rate of strangulation, unlike other inguinal hernias.
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future of inguinal repair and PT
Fantastic discussion by all.
We really truly need a defined physical therapy regimen for pre- and post-hernia repair patients. I’m so glad do many of you have brought up this topic. At the Shouldice clinic in Toronto, where everyone has a 48 hour stay after their inguinal hernia repair, they are asked to ride stationary bikes those two days. There are bikes all over their campus. They also have pool tables, encouraging bending and other movements.
I strongly believe that all abdominal and inguinal operations, not just hernia repairs, should be followed by a strengthening regimen–just like orthopedic surgery. We just don’t have any hard evidence to support any specific regimen. It’s not been in the culture of general surgeons.
I would love to work with any therapist, patient, and surgeon who is interested in helping devise a regimen, and then test its efficacy.
WasInTN: very informative posts. Please name your surgeon here so that others may seek him for similar excellent care.
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Scar Tissue Healing
Scar tissue takes about a year to maximally reform itself to a more normal structure. Some advocate massaging it. There are topics creams over the counter which usually work within the first few months of a wound. Dermatologists have machines that can help reformulate scars after the one year mark has passed. If there is no pain, no drainage, then usually this is of little concern.
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Mesh removal after hernia repair
Great question.
In pathology, if the mesh is removed, the pathologist can view signs of acute vs chronic inflammation under a microscope.
In MRI, inflammation can be seen if it is quite a lot.
We do not have any sensitive laboratory values to show inflammation from mesh. Blood tests such as ESR may or may not be elevated.If the inflammation is causing pain, anti-inflammatory medications or steroids, in more extreme cases, may be helpful. For chronic pain due to inflammatory status from the mesh, there is little to help. Some may require mesh removal as a cure, and that is also for extreme cases.
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Pain after mesh repair
Please share this site with your physicians and surgeons.
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Pain after mesh repair
Troy,
I suggest you see another surgeon. For a second opinion. I do not personally know of anyone in Utah. Go to the American Hernia Society website to find someone. If not, you may have to travel.Pain 9 or more months after a hernia repair is often due to a new recurrence. It is often worse with increased activity or end of the day, better when lying flat. Nerve pain rarely starts so late unless it is related to impingement from a recurrence. I recommend MRI pelvis to assess the groin after a prior hernia repair. Ultrasound is often inaccurate as the mesh distorts the visible field. Also, the MRI is best performed with Valsalva (bear down) and dynamic images. Not all radiologic centers do this.
I hope this is helpful! -
Pain after mesh repair
Stacey,
Thanks for the update.
Re MRI for occult hernias:
– I don’t believe the situation is as sour for non-inguinal hernias. The reason is because the groin area is poorly evaluable with CT but the abdominal wall is pretty well seen. That said, all hernias are underreported in imaging. It’s not high on radiologists’ radar.
– Hernias from laparoscopic operations are very rare. I’ve also published on this. See the Bariatric Times article “to close or not to close port site hernias.”
– Upright MRIs are excellent alternatives to MRI with Valsalva. But open MRIs are not sensitive enough to show occult hernias.
– You can take your CD to any radiology group and ask for a second opinion or re-evaluation. You may have to pay cash for it. -
Inguinal hernia: 33 year old female patient- mesh?
I agree with Dr Goldstein. There have been no reports that I am aware with problems with pregnancy, delivery, or Csection after laparoscopic inguinal hernia repair. I would mention to the obstetrician that there is mesh there. And theoretically there can be problems (mesh infection). I review this with my female patients and still recommend it. Also, if thin female, I recommend lightweight mesh.
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Pain in thigh radiating through left leg too
Hernia-related pain can radiate from groin toward flank, hip, lower back, and front of thigh. Never behind the thigh or leg and never below the knee. Such symptoms are either from spine, or very possibly from a hip problem, such as a tear. I would evaluate your hip.
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hernia specialist in New Hampshire
Hernia-related pain does occur during intercourse and with orgasm in men and women. In my opinion, I do not believe inter course is actually doing more harm.
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Surgery with Chronic Fatigue Immune Dysfunction
These requests are all doable. We will assign you to an anesthesiologist to make sure all protocols are followed. I’ll have my office set that up for you.
No worries about Cedars-Sinai. With good communication, everything will be just fine. It’s a fantastic hospital with excellent nursing care.
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Trying to Get A Hernia Diagnosis
Yeah! Please spread the word to your doctor and your friends!
As for the Trocar site, it sounds like it may be a hernia. An exam by your surgeon should be all you need. And/or an ultrasound. Those are easy to fix.
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Could this be a hidden hernia ?
Dr Bruce Ramshaw is an amazingly knowledgeable and talented hernia specialist. He is in Daytona FL. He can help.
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hernia specialist in New Hampshire
1. Try Dr Gina Adrales at Dartmouth. She is a talented surgeon with interest in women with hernias.
2. MRI is recommended if Ultrasound is not diagnostic. If trappings shows hernia, no need to do further imaging. In fact, my research paper “role of imaging in the diagnosis of occult hernias” published on JAMA Surgery this week. Show this to any entity or person who refuses to order MRI to help you.
3. Abdominal core exercises may improve your muscle strength around the area of you hernia and improve
Hernia symptoms.
4. Yes! Your prior laparoscopic operations do not prevent you from having laparoscopic hernia repair.Talk to your surgeon. For thin petite women, I do not recommend mesh repair unless it’s done laparoscopically and with lightweight mesh. Other option is non-mesh open repair.
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What ?s should surgeons be asking their patients?
Hi all. Please welcome Dr Greenberg. He is a friend and colleague of mine and I respect all of his expertise.
So glad to have you on board, Jake! -
Hidden hernia or pudendal pain symptoms?
Thanks for your reply.
Which part of your leg does the pain radiate to? And which part of your back?
Numbness of the buttock is not caused by hernias. I would look into spinal issues.
Pudendal neuralgia is a very difficult diagnosis to make. Dr Michael Hibner in Arizona is a world expert on it. I recommend you go on his site and see if you relate to his information. -
Trying to Get A Hernia Diagnosis
Is the bulge at the incision? I can’t tell if the incision is there. If so, then yes, that’s a hernia at
The Trocar site. -
Surgery with Chronic Fatigue Immune Dysfunction
Of course.
So glad things are movingbalongvtowards a cure to your pain.
Looking forward to your operation.