drtowfigh
Forum Replies Created
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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. -
Laparoscopic or Open Approach
– in thin patients and in the average female, I do not recommend mesh repair, unless perhaps it’s lightweight and placed laparoscopically. The risk if mesh-related pain in this subset is higher than average. A tissue repair done in open fashion should be considered
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exhausted-struggling to find diagnosis.
Your symptoms and the area of pain are all consistent with a possible inguinal hernia. For sure, you should seek the diagnosis first from your medical doctor, and then from a general surgeon. If your general surgeon is not convinced or if your doctor says its a strain or it’s all in your head, then move on to another surgeon. Your imaging may or may not show a hernia: much of it is based on interpretation, so I do not recommend you get more studies until a hernia specialists or an expert radiologist confirms you have no hernia on your scans.
Hernia specialists are not common. If there are none near you and you cannot get a radiologist specialist to re-read your scans, then I recommend an MRI with valsalva to demonstrate a small hidden hernia. It is more common among women.
Let us know how it goes. You are going through the same struggles as everyone else on this discussion board.
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Laparoscopic or Open Approach
The American Hernia Society website is a great first start. Ask the offices you call about the doctor’s experience and interest in hernias, especially hidden hernias among women. If they are not aware of it, then perhaps you should move on. If they have done over 500 or so inguinal hernias laparoscopically, that is a good start for you.
As for the ultrasound, there are no cystic lesions that typically occur in the inguinal region. More commonly, these are hernias. A specialist can examine you and help determine the cause of your pain and provide treatment. Your symptoms are very much consistent with a hernia. Another possibility could be a hip problem, such as a labral tear. That gives the pain with external rotation.
Lastly, an open repair is a perfectly sound option, as long as they also look for a femoral hernia and can repair a femoral hernia via open fashion. I would shy away from any mesh, unless it is a lightweight mesh or you are a heavy built person.
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Frustrated – trying to get proper diagnosis
That sounds like a very unfortunate consultation.
As you may have read on other posts and also online, a hidden hernia is a phenomenon that is well described and known for decades. It is most common among women. Surgery is a cure for the pain associated with it.
That said, it seems yours is not truly a hidden hernia because you actually see and feel a bulge, though only after your workout. This is not uncommon among healthy, young patients with strong abdominal core muscles: they have a hernia, which is a hole in the muscle or fascia, but the hole is maintained and supported by strong surrounding muscles. I.e., you do not have a gaping hole with contents flowing out easily. Your abdominal muscles are trying to keep the hole as closed as possible.
An ultrasound, done correctly with multiple maneuverings, should be able to prove your hernia, though, if the surgeon can feel the hernia or see the bulge, I do not recommend imaging.
Perhaps you can try other surgeons at the same facility. I recommend Dr. Michael Alexander, who is a very talented surgeon at the Shouldice Hospital.
That said, the Shouldice technique would be a great choice for you to repair your hernia, and the Shouldice Hospital in Toronto has published the best results from this technique. Other options are to cross the border or go to Montreal, where I also know reputable hernia specialists, such as Dr. Melina Vassiliou.
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Laparoscopic or Open Approach
I’ve mentioned these before in these posts, and I hope this discussion board can be a tool to spread this information to others, including your physicians:
1. If you have a bulge on exam already, then imaging is not necessary. You have a diagnosis. Imaging rarely offers anything more than confuse the sutuation, such a as the radiologist saying it’s negative.
2. If a CT scan is negative for a hernia, and there is clinical evidence for a hernia (suggestive by story and by exam), then either a) the CT scan is misinterpreted (commonly), or b) you must seek a more sensitive test, such as MRI. In JAMA Surgery, my paper will be out soon that discusses the different imaging modalities and their use to determine hernias.
3. Laparoscopic surgery should only be performed by a specialist who has at least 250 (and some say 500-750) laparoscopic inguinal hernias in their experience. Otherwise, the recurrence rate and complications may be too high. So, do not choose laparoscopic surgery just because It sounds better; in some cases and with most surgeons, open repair is safer and with better outcomes.
4. If no hernia is found, do not undergo hernia repair or mesh placement. You cannot become better. And you may be subjecting yourself to risks. (Perhaps you misunderstood your surgeon: if on one side a hernia is noted, mesh is always placed to cover that hernia and those around it on the same side. That is standard.)
5. If you have a hernia and hernia-related pain, then repair will cure you. In women, the hernia may be small and the findings minimal. However, the associated pain may be severe and repair will help you. Most do not yet appreciate this among women.
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Femoral Hernia
😉
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Possible femoral hernia
It was nice seeing you today! It just occurred to me that you are from this post!
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Inguinal Hernia when Pregnant
Not necessarily.
Bed rest helps all inguinal hernias when they are very symptomatic. I.e., laying flat helps relieve inguinal hernia-related pain.
However, it is not recommended that you have bed rest during your pregnancy to prevent hernia-related pain.
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Lumbar Hernia – Mesh Patch
That is a tough one. Lumbar hernias are very rare. It is possible that you had a tight repair, with mesh, plus… mesh shrinks, so it is possible that the tight repair became even tighter with time. Also, mesh does not stretch, so it may feel even tighter.
The technique and operative findings should be reviewed, based on your operative report. I doubt there is any direct relation to your lungs, diaphragm, and breathing. It may just be a bit too tight.
Removal of the mesh is complicated and should only be done by a surgeon with experience in doing so, after determining that that is the problem.
If anyone else has experience with lumbar hernias, please offer your advice on this site.
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Can an Inguinal Hernia repair reoccurred?
Hernias tend to be genetic. Thus, if you have one hernia, you may have or develop more hernias, but not in the same place. That would be considered a recurrence.
All repairs of hernias have a rate at which they may reoccur. No one can claim a 0% recurrence rate. The recurrence rate varies based on technique and surgeon.
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Recommendations
Hi and thanks for your post.
Our paper will be coming out soon, as it is published in JAMA Surgery. So, then you can share it with your general surgeon.
MRI pelvis with valsalva would be the most sensitive study. Ultrasound may also be helpful if done by a skilled radiologist, with a lot of maneuvering, pushing in and out, etc. CT scan is less likely than all of these to provide an answer. But perhaps it will show…!Unfortunately, the concept of hidden hernias is not widely known.
I do not know of any surgeons in Mississippi who are hernia specialists. If you find one, and you are happy with their performance, please share on this discussion board. Nearby, you can try nearby states:
Tennessee: Drs. Ben Poulose, Greg Mancini, Guy Voeller.
Louisiana: Karl LeBlanc, David Treen, Charles BelllowsGood luck, and please let us know how you do.
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Possible femoral hernia
Glad your orthopedist found something that is treatable.
I also agree that it’s best to have a hernia specialist review the MRI, as a hernia is typically under-called by radiologists. In fact, in my practice? Less than ¼ of images are accurately diagnosed for hernia.And, yes, I have seen patients with both problems, but it is rare.