drtowfigh
Forum Replies Created
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Chronic pain and recurring Hernias
First of all, if you are in chronic pain and debilitated, then every effort should be taken to help relieve that.
If it is from the tacks, they can be removed. It is not like finding a needle in a haystack as they can be seen on X-ray if they cannot be seen upon initial laparoscopic exploration. If it is from the sutures, those can be removed, too. If it is from the mesh, the mesh can also be removed.
If performed by a skilled surgeon who has done this in the past (ask them specifically), then you will be in good hands and any risks would be diminished.
Dr. Peterson of the UW Hernia Clinic is an excellent resource. Please let her know that you have been posting on HerniaTalk and ask her to join the discussion group as one of our surgeons!
Let us know what she recommends.
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Could this be a hernia?
Yes! Pain with opening heavy door: Classic. Female in the family with hernia: strong link. Pain at labia: absolutely. These are all symptoms which are typically seen sming my patient’s with hernias.
I recommend you start with a dynamic hernia ultrasound. If it’s “negative “, then MRI with valsalva.
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Occult or hidden hernia?
– MRI is much better than CT to detect abnormalities in the muscle and soft tissue. I recommend it.
– injection therapy may be helpful as a diagnostic and possibly therapeutic modality. Be careful that any steroid injection, if performed too superficially, may cause fat necrosis and a permanent deformity of your skin. Discuss this with your Pain specialist. -
Could this be a hidden hernia ?
No no no. You are not crazy. Your pain is real. You do not have to live with it.
In fact, your story is a textbook case of a hernia. It’s been a long time since I have heard a story that points to a hernia from every single aspect.
First, examination must be done standing.
Second, your story is perfect for a hernia.
Third, CT scan is very poor and inaccurate for smaller occult hidden hernias. We just published this data last month. Look up “Role of Imaging in Occult Hernias” in JAMA Surgery. MRI with valsalva is next step. And of course a skilled radiologist or surgeon specialist should interpret it.
Do not give up. Find a surgeon who is a “believer”, as I call them, get your hernia(s) repaired, and move on with your joyous pain free life.
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Chronic pain and recurring Hernias
Curious to know what your CT shows. A rock in the abdomen is not normal. It can be a recurrence or a ball of mesh. And you should not accept chronic pain as something you have to life with.
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Surgery with Chronic Fatigue Immune Dysfunction
Such a pleasure to have seen you today. Hope to be able to help you.
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Mesh and Surgery Concerns
Yes to all. The recurrence rate of tissue repair is highly variable from surgeon to surgeon and depends in the patient’s risk factors, tissue quality as well.
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Pain after mesh repair
Great question.
Interpreting an imaging study can be like looking at a work of art. It’s really an interpretation. However, if the symptoms are real, there are examination findings that are real, and the imaging does not support any of those, then it must be re-read or another imaging must be sought. I don’t think it’s fair to have patients suffer from pain. -
Occult or hidden hernia?
Hi there.
Please let us know how your appointment went with the doctrine in Indianapolis.
Your pain may be due to a tear in the muscle or fascia with or without nerve injury. Treatment is usually nonsurgical. Nerve blocks should help. If severe and debilitating, local exploration and repair of a tear or cutting the nerve may be helpful. In the meantime, wear no compressive belt etc over the area.
MRI with Valsalva (pushing belly out) is most sensitive study to detect such a tear.
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Surgery with Chronic Fatigue Immune Dysfunction
Thank you for your post and details and links provided.
Chronic fatigue and fibromyalgia are certainly under appreciated as an important syndrome that should be treated with caution and quite differently than other diseases. The possibility of imparting chronic pain on such a patient after an operation is very high.
I am experienced with this and so I am keenly aware. We can discuss your possible diagnosis and treatment plan when we meet. I look forward to seeing you.
In the meantime, I hope others can get information from your post to help them with their peri operative care.
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Mesh and Surgery Concerns
I absolutely agree with your pain management doctor. Multiple studies looking at chronic pain after open hernia repair with mesh show the incidence is highest among the young an among women. See below for links.
In my practice, for super thin women, I offer open tissue repair (no mesh). For thin women I also recommend laparoscopic repair with lightweight mesh. Open mesh repair, especially with normal heavyweight mesh runs a high risk of chronic mesh-related pain among women and I do not recommend it
Some links:
http://m.generalsurgerynews.com/Article.aspx?d=In+the+News&d_id=69&i=May+2012&i_id=837&a_id=20819 -
Laproscopic without catheter or open with mesh
Some may disagree with my opinion, but I have specifically asked urologists this same question and also seen complications related to the bladder. So here it is:
1. I do not ever recommend any laparoscopic pelvic surgery (appendix, inguinal hernias, lower abdominal incisional hernias) to be performed without decompressing the bladder with a catheter. Why?
– there is a risk of injuring the bladder
– even with urinating prior to surgery, some people may not completely empty their bladder, thus injury to the bladder.
– I have seen multiple complications, such as tacking the mesh to the bladder, or laying the mesh onto the bladder thus resulting in bladder spasms, pain with filling of the bladder, and resultant urinary frequency.I do combined procedures with prominent urologists in our town. They are very concerned that it is common practice for general surgeons to perform laparoscopic inguinal hernia repair without catheter.
2. Open repair is a valid option, as urinating prior to repair and restricting IV fluids is typically enough to prevent need for catheterization.
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Hernia Repair -abdominal and umbilical
I’ve reached out to my pediatric surgery colleagues for more information. .
My inclination is to perform primary repairs on all of them (suture, no mesh). I would do them open through the minimum number of incisions as any laparoscopic procedure would require 3 incisions anyway.
I would place mesh only after (if) they recur. -
Occult or hidden hernia?
Please explain the exact blunt force trauma. Your story may be suggestive of a hernia. Where exactly is your pinching pain?
Also, a physical exam which shows point tenderness in your groin where a hernia would be is a great start. If your surgeon can feel a hernia, or even elicit tenderness in the area, I would have your scans re-read. Or do a dynamic study where you are pushing out (ultrasound or MRI).
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Trying to Get A Hernia Diagnosis
Sounds like a straightforward Trocar site incisional hernia. This can occur if she had an infection at that site, if the fascia was stretched to remove the appendix through it, and/or if the fascia was not closed at the end of the operation. It seems your daughter also has a propensity toward herniation.
I recommend an open repair with mesh insertion. And recreation of her belly button to make it look like a nice innie.
Please submit a picture so others can see what a small Trocar site hernia looks like. And thanks for spreading the word about this discussion board.
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Sports Hernia
I don’t recommend a repeat MRI. The athletic portico I presume involved a dynamic views, Valsalva (pressing out). That should show it. Youaybwant to consider it be re-read looking specifically for a femoral hernia. It is easier to have your physician request that.
I am sorry I cannot reach out and examine you to provide more help.
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Post-hernia surgery, burning pain down left leg
Two main nerves are at risk for injury at the time of laparoscopic hernia repair: lateral femoral cutaneous nerve and genitofemoral nerve.
You had no injury at the time of your hernia repair, because your symptoms did not occur until 9 weeks later. This timing suggests a) early hernia recurrence and/or b) folding of the mesh or balling of the mesh. The mesh ball/fold can impinge on a nerve. The most likely nerve to impinge is the genital nerve which causes symptoms down the upper inner thigh. Secondly, since you had a direct hernia, the ilioinguinal nerve can be tickled, causing scrotal sensitivity. Lastly, testicular pain can occur if the spermatic cord is affected by the mesh. Also, mesh folding can result in a hernia recurrence by exposing the hernia defect it was patching.
MRI pelvis with Valsalva can rule out these most likely causes of your symptoms. Then the question is how to address it!
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Sports Hernia
Your situation is a bit complicated, as your symptoms may be due to an inguinal or femoral hernia, yet I trust that you had a bonafide, high quality hernia repair each time.
Here are some thoughts:
– is it possible you have had a femoral hernia that has been missed with both operations? Read your operative report from the laparoscopy to see if your surgeon looked for and confirmed/denied the presence of a femoral hernia.
– not sure what to make of the sports hernia diagnosis. This term is often misused. A true sports hernia doesn’t occur in most women, unless you’re a bodybuilder or professional athlete. It is a tear where the muscle actually pulls off a piece of bone/periosteum. You may have had a tear in your rectus muscle, but that would typically require some sort of trauma and it is not a true hernia. They usually heal without an operation. What second operation was actually performed?My gut feeling says you have a missed femoral hernia/inguinal hernia recurrence. That would be an easy fix. Alternatively, if it’s a pure nerve issue, your story does not fit, because it would not be similar to your preoperative pain.
I would recommend imaging of the pelvis (MRI pelvis soft tissue with Valsalva) and evaluation of your operative reports as part of the detective work to see exactly what was seen and what was done.
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Laparoscopic or Open Approach
Awesome post. I hope others can relate.
Your symptoms may be due to a hidden hernia. It is more common among women and can be debilitating. It is not uncommon for the examination to be less than expected among men with hernias. However, your imaging should show the hernia.
I am happy to review your films. You would have to submit an online consultation via my website http://www.beverlyhillsherniacenter.com
Once you have a diagnosis via imaging, then perhaps you can use that as armamentarium to seek surgical cure.
That said, lateral thigh pain is typically not a symptom related to an inguinal hernia.
I hope I can help.
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Hip tightness post-hernia repair
Stretching is good. Ab workouts focusing on the core are also good. Your body is always remodeling scar tissue. You can also help it remodel with your activities.
As far as we know, crunches and leg lifts are okay.