drtowfigh
Forum Replies Created
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Chronic Pain after Hernia Surgery in April 2011
Great. Please keep us updated. And if you’re happy with your surgeon, please provide names so other locals can also get help.
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Trying to Get A Hernia Diagnosis
Yes. A letter is the best way to share your experience with that doctor.
So glad to hear of the successful operation. -
Clinical Data on Small Abdominal Wall Hernias
I believe most surgeons would perform a simple primary suture repair for such a small epigastric hernia. If it can be reached from the umbilicus (belly button), then the incision can be hidden in there.
Most surgeons place mesh for most umbilical or epigastric hernias, nationally. And studies show that mesh repair is always superior to non-mesh for this problem, in terms of recurrence. However, the smaller the hernia, the less the superiority of mesh in reducing recurrence. In my practice, I do not routinely place mesh if these hernias are under 2cm.
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Clinical Data on Small Abdominal Wall Hernias
First, let me assure you that almost all databases that I am aware of and publications that I have seen and those that I also perform include patient demographics, e.g., gender, height/weight. The height/weight are often reported as body mass index (kg/m2). That is pretty standard.
That said, you are correct: there is no formula where you can plug in your own info and it will spit out the risks and benefits tailored to your needs. Medicine is not a perfect science by any means. You may find me the same exact findings in a different patient and perform the same exact operation and the outcome may be different. Every patient is truly different. Now, statistically, the risk/benefit may be the same, but the outcome per patient will be different.
Dr. Bruce Ramshaw is a whiz in this concept of “complex systems” and has been able to show that implanting the same mesh in two different people, for example, can have drastically different outcomes at the mesh and cellular level.
Hopefully, one day, we can tailor each patient’s care to their own specific needs and body’s interactions, maybe even by genetic evaluation. Today, we cannot do that. Most of us who are interested in this topic, however, do have our own database and do publish. Also, if you go to the americanherniasociety.org website, they have a database that many surgeons also participate in, called the AHSQC. You can find out which surgeons near you participate. Lastly, there are other national databased with the American College of Surgeons, NSQIP, etc., that some surgeons participate in.
With regard to your 4mm hernia: if you are symptomatic, then I recommend repair. I also do not recommend mesh implantation for such a small hernia.
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Trying to Get A Hernia Diagnosis
Aha! You are now addressing one of my life goals: raising awareness of hernias among women.
My gut feeling is you are absolutely right. Though, nationally, 7 male groin hernias are repaired for every 1 female hernia, my impression is that many more women have groin hernias than are being diagnosed and treated. It reminds me of the situation of heart disease among women.In my experience, inguinal hernias are under diagnosed among women because:
1. Many doctors don’t believe women can get inguinal hernias
2. Hernias tend to be smaller in women so they are not easy to find on examination (ie, hidden hernias)
3. Hernia symptoms are different among women than men. Women get pain with their menses, it may radiate to their back or into their vagina or down their leg.
4. Many cannot imagine that a small hernia can cause so much pain.
5. Women’s pelvic anatomy is complicated by presence of ovaries, uterus, possible endometriosis.
6. There is virtually no prospective clinical trial research done on inguinal hernias that includes women.I am working hard to publish my results and educate the world about women and the concept of hidden hernias. Just this past Monday, I turned in another research publication sharing the specific questions and exam findings that can diagnose a hidden hernia, mostly seen among women. For the first time in its history, with my prodding, the American Hernia Society began a panel discussion on hernias among women last year.
I really do appreciate your posts on this forum, too, as many patients and doctors will also be able to read and learn from it.
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Trying to Get A Hernia Diagnosis
Fantastic. Best of luck. And thanks for sharing your story. I hope it can help others
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Trying to Get A Hernia Diagnosis
Sounds like a “hidden hernia.” I just presented my results on re value of Ultrasound vs CT vs MRI for hidden hernias and hopefully the journal will accept my manuscript. CTs are typically falsely negative. Ultrasound and MRI are much better options. Also, many films can be incorrectly interpreted anyway.
I would find a surgeon that would provide laparoscopic exploration and hernia repair.
If the ultrasound proves hernias, not sure why a CT scan is necessary. -
Chronic Pain after Hernia Surgery in April 2011
Sounds like it could be a hernia. A surgeon skilled in laparoscopy can do an extra peritoneal exploration and repair any hernias. Sounds like hernias can be the cause of pain. Not sure why you’re not being offered a repair. Cystitis is a different problem.
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Chronic Pain after Hernia Surgery in April 2011
Hi there.
Sorry to hear about your Mom. You had a legitimate concern to consider hernia as a cause of her pain.
I wonder what was found in the OR and also exactly what technique was used to address it.
Pelvic Congestion Syndrome is a real entity and is usually diagnosed by MRI or venogram. Was that performed prior to the coiling?
And does her pain radiate down her leg, around her back, into her vagina?
These will help figure out your Mom’s problems and hopefully work toward a cure. -
Recovery After Mesh Removal
That question is not as simple to answer as you may think. Each patient will have a different recovery based on their history, exam findings, and type of repair they undergo. Also, the recovery varies among surgeons.
In general, a small umbilical hernia repair with mesh should have a short recovery, back to work within a week. However, yes, in a subset off patients, they may suffer from pain and it may be chronic. Those are outliers, as no surgeon operates on a patient with the intention to inflict a lifetime of suffering. -
hernia vs muscle spasm????
CT scan should show an abdominal her now, though it’s not as good for groin hernias. Your symptoms sound very much like a hernia. Curious what CT showed and what plan of care has been.
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Umbilical Hernia and Diastasis Recti
PVP mesh is an Ethicon product intended to repair a hernia using an underlay or sublay technique. Other companies also make similar patches. It is recommended that the surgeon primarily close the hernia defect on top of the mesh. If they do, then it is no longer a bridged repair.
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Umbilical Hernia and Diastasis Recti
No. Diastasis recti is a very specific term which describes spatial separation of the rectus muscles without a hernia in between. The fascia (or strength layer) of the muscle is still intact. It is not a hernia. It is not related to hernia development. There is no medical risk to have a diastasis.
That said, some patients have a hernia repaired and the repair is bridged, not closed. The result can be a diastasis (or separation).