drtowfigh
Forum Replies Created
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Sounds like a good plan.
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All of these are great suggestions. It is uncommon to have nerve damage with lap TEP, but it can happen. Did you have tacks? Why did you have 2 meshes on one side?
I wonder if the needle from the steroid injection caused bleeding. And thus your symptoms and signs were related to a small bleeding episode.
Imaging and details of your history need to be reviewed carefully.
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This sounds like it is likely the Bard Perfix plug and patch, in size medium.
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Thanks to all who participated. Stephanie Prendergast, MPT, did an amazing job answering all your questions about PT, pelvic floor disorders, pelvic pain, and how they relate to hernias. We discussed different exercises and when they are safe to perform them.
If you missed it, WATCH and SHARE from Youtube here: https://youtu.be/88aRacf_rQM
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If the mesh was placed laparoscopically, then the mesh removal should be done lap or robotically.
I do both sides at the same time. The scars are the same. The OR time is longer but less than double the time of only doing one side. Extra anesthesia time in an otherwise healthy patient is not an issue. The recovery is better with both sides done.
If open: that’s a lot more recovery per side. So, I stage those. Usually do one side first.
Make sure your surgeon does a lot of these, and successfully.
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@richarda When I see patients with postoperative chronic pain after hernia repair, the evaluation is quite complete so that at the end you have a better idea of what exactly is causing your pain and what is the plan of care. The details of your symptoms are important in determining this as well as results from imaging, examination, and possibly nerve blocks.
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There is a treatment. You just need a thoughtful surgeon to figure out exactly what you need and not overtreat you. Fortunately, you are in Cleveland and both Dr. Grishkan and the Cleveland Clinic can help you. Horror stories tend to arise from situations where patients are note being treated by specialists. But even we specialists cannot guarantee nothing is cut/permanent damage is not done.
Testicle loss should not be a worry. In the right hands, it should happen very very very rarely.
Nerve transection is a real possibility with any groin mesh removal procedure.
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Peripheral nerve blocks are usually done well either using anatomic markers or ultrasound guidance. MRI-direct nerve blocks are best suited for difficult to reach or assess areas. Nerve blocks only work if the nerve is the reason for your pain.
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Sorry you are having this interaction. I would be direct but respectful with your surgeon and see if you can get a bit more help. If not, be your own advocate and seek a second surgeon to help you.
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The questions were awesome tonight. Dr. Nikolian is an expert in TeleHealth and is using his expertise to optimize access to healthcare for patients.
We also had an interesting discussion about gaslighting by physicians.
Plus a trickle of discussion about abdominal wall reconstruction.
To watch and share, go here: https://youtu.be/ERdrrB4OK6E
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I highly recommend viewing the HerniaTalk LIVE Q&A I had with Dr Ramshaw: https://youtu.be/cvmLowkvg3Y
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Interesting discussion.
Laparoscopic and robotic approaches are fundamentally the same. The taking down of the peritoneum, for example, is the same when done laparoscopically or robotically.
What is different between the two is how the surgeon commands the robot. For example, with laparoscopy, one is at the bedside and maneuvers the instruments. The surgeon directly controls how much the abdominal wall is impacted by their instruments. With robotic surgery, the instruments are manipulated by the surgeon at a separate console. If the surgeon is early in their learning curve or not aware of what is happening at the patient’s side, the arms may be moving more than is necessary, which can cause more pressure or pulling on the abdominal wall by the robotic arms.
When comparing to open surgery, laparoscopic and robotic surgery is considered less invasive for two reasons: 1) less incisions and scars on the abdominal wall, 2) less manipulation of the tissues, resulting in less scarring and adhesions inside. However, from a practical standpoint, the same operation is done on the inside.
Everyone has a different trajectory of recovery from open, laparoscopic, and robotic approaches. The skill and tissue manipulation of the surgeon can also play a factor in your recovery.
I hope this is helpful.
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@mitchtom6 thanks for bringing up Dr Belyansky’s situation. When surgeons choose to perform higher risk operations that no one else offers, it is stressful when patients don’t have the best outcomes. Then, to get sued for it is even more stressful. As a result, you have highly talented surgeons that will no longer be offering their skills. And now hundreds and thousands of patients are negatively affected.
Regarding Cognitive Brain Therapy: Dr Ramshaw has shown that CBT prior to surgery can improve outcomes after surgery. It’s incorrect to assume that he was offering CBT because he thinks your pain is all in your head. What his research has shown is that if you can control how you perceive pain, after months and years of being exposed to chronic pain, then your revisional hernia surgery will be performed with less pain and you are more likely to remain pain free from the surgery. Think of it as physical therapy of the brain. You would never guffaw at your orthopedic surgeon if he/she offered you physical therapy prior to your hip surgery, would you?
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Thanks for all who participated tonight. We had so many questions for Dr. Sbayi tonight, but were only able to answer about ½ of them in the hour! We talked a lot about Shouldice options in addition to pros and cons of mesh removal options, reconstruction, and neurectomy.
If you missed it, you can watch and share on YouTube here: https://youtu.be/SnyI5qgYFEY
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What a great post!
And yes, I’m proud of that blog post.
But this is the plight of all of medicine. We are in a constant state of motion, learning new things and looking back on past successes and failures and learning from them.
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Just know that tissue based repairs have their own risks, including chronic pain. Head to head comparison studies showed the same rate of chronic pain after inguinal hernia repair with and without mesh. Just the reason for the chronic pain is different with tissue repair. I have plenty of patients that I treat for chronic pain after tissue repair.
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HerniaTalk celebrated its 1-year anniversary tonight, on the 50th episode.
Thanks to everyone for participating with non-stop Q&A. I also shared details of what pitfalls I see in surgery when I repair hernia complications.
If you missed it, you can watch it on my YouTube channel here: https://youtu.be/AsEjxnZ7VC4
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Most likely this is a fluid collection from the surgery, seroma or hematoma, and not a hernia recurrence. A simple ultrasound can diagnose this. It is extremely rare to have such an early recurrence.
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If 100% of the pain is from the nerve, there is no need for mesh removal, usually.