drtowfigh
Forum Replies Created
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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.
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Pain after mesh repair
Imaging is a great road map.
It is also important that the radiologist/surgeon accurately read the imaging study and not misinterpret it. In our study, for very delicate situations such as yours, a study may be misinterpreted up to 75% of the time.
A repeat study is not indicated if one was done a year ago. It’s important that that one from a year ago be accurately and precisely interpreted.
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pain after hernia surgery
There is no science behind my answers. Each surgeon, technique and patient will have a different outcome and recovery pattern.
For the average patient (complex operations and patients with known chronic pain disorders excepted), it is expected that hernia recovery be simple, quick. Most laparoscopic inguinal hernia repairs require 1-3 days of recovery, and open inguinal hernias about 1 week. For abdominal wall hernias, small umbilical hernia repairs take 3-5 days, and larger repairs of laparoscopic and open hernias require about 2 weeks. These are in best circumstances, without any complexities, underlying problems.
In terms of postoperative activity restriction, most experts agree that there is no evidence to support any restrictions in activity. In fact, activity may improve results from repair. Lifting restrictions are arbitrary as well. For most straightforward inguinal hernia repairs, I do not restrict my patients’ activities at all. I do restrict activities that are known risk factors for hernia recurrence: coughing, straining to have a bowel movement/urinate, nicotine use). For abdominal wall hernia repairs, restrictions are usually placed in patients with large hernias, tenuous repairs, unhealthy tissue. Otherwise, still many of us experts cannot scientifically claim that restrictions in activity or lifting will prevent hernia recurrence.
We need more research on this topic.
For sure, most of is specialists do not recommend weeks and months of limited activities. That will likely cause weight gain, muscle weakness, and even prevent optimal healing.
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Hernia surgery prior to pregnancy?
Very important question.
My answer to you is not based on any scientific data, because there is none. But it is a very important topic that is a bit difficult to study.
Short answer: most pregnancies have no problems after hernia surgery nor without hernia surgery.
– in my practice, I do not recommend any hernia surgery unless you are symptomatic or it is growing larger, unless you have a femoral (low groin) hernia, which should be repaired regardless.
– for inguinal (groin) hernia, repair prior to pregnancy has generally not caused any problems with pregnancy nor complicated the need for C-section. Pregnancy while still having an inguinal hernia is generally safe, with low risk of complications.
– for umbilical or abdominal wall hernias, I do not recommend repair until after all pregnancies are done unless you are very symptomatic from the hernia. The chance of a complication during pregnancy (from having a hernia) is generally low. If you do have a very symptomatic hernia and it is a small one (2 cm), I recommend no mesh placement. However, if mesh is placed, there is a risk if localized pain as your belly enlarges.
– need for immediate surgery while pregnant is generally safe and can be done without general anesthesia.
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electric shock in right lower pelvic area
Let us know how it goes
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Unexplained abdominal pain
Hernias can cause groin pain, radiating around to the back. Lying flat makes it better. So many of your symptoms may be suggestive of a hernia.
When ordering an ultrasound, it must be a specifici hernia ultrasound. The technician or radiologist should have you stand up, bend forward and back, push your belly in and out, and basically have you do maneuvers to exacerbate a small hernia and make it more likely to visualize a hernia. If that is not diagnostic, then I recommend MRI pelvis with Valsalva. Based on our research, a CT is likely to be nondiagnostic with small hernias.
If all are negative and you still have symptoms highly suggestive of a hernia, then you should have the ultrasound/MRI re-read. I read my own images and there are a lot of “negative” interpretations because radiologists are not in time with what constitutes a small hernia. Especially in women.
These are my suggestions.
Hip problems can also manifest as groin pain. Just another thing to think about.
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electric shock in right lower pelvic area
Thanks for the great post. As I am sure you have read, many others who have contributed here have similar symptoms.
Hernias can cause pelvic pain–sometimes debilitating. These can include vaginal pain, pain with intercourse, pain worse with sitting upright or bending. It may shoot into the vagina, down the leg, and/or a round the back.
See a general surgeon. If they dismiss you, see another one. Pick one from the Americas Hernia Society website.
Start with a dynamic dedicated hernia ultrasound. If that doesn’t show anything, get a non-contrast MRI pelvis with valsalva.
Let us know how you do.
Best wishes!
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Laparoscopic or Open Approach
Dr Goodyear is great and he should be able to discuss the benefits of open tissue repair vs mesh repair.
Others in NE include Dr Gina Adrales in NH and add Sharon Bachman in MD. Both also have an interest in female surgery.Whichever surgeon you see, please let them know about herniatalk.
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Laparoscopic or Open Approach
You are in excellent hands with Dr Belyansky.
Please let us know what he finds in your operation and what he ends up doing.