[drtowfigh]

You need to see a true hernia specialist. Your symptoms can absolutely be related to inguinal hernia or a sports tear. Also a specialist should know that a dynamic ultrasound is significantly more accurate than any CT scan also it’s incorrect to claim you will have more pain if intervention is considered

[drtowfigh]

Sorry about your experience.

For groin hernias, if they are symptomatic and for sure if you mom has had to go to the ER multiple times, it should be repaired.

There is no such thing as being too old to heal/form scar.

If she is healthy enough to undergo IV sedation (you don’t need general anesthesia) then repairing the hernia will improve her quality of life.

Also, if her problems are related to a femoral hernia, she should not delay surgery. Repair should be before she ends up in the hospital with a strangulation. It’s high risk.

[drtowfigh]

Definitely have your surgeon re-examine you. You may need imaging to confirm whether this is a persistent fluid collection or a hernia recurrence. I recommend CT scan with valsalva and oral contrast.

For those who need surgery after an abdominal wall hernia repair, it is important to let your surgeon know that you have had a hernia repair and/or use of mesh. Ideally, your surgeon should try their best not to go through the repair and instead use alternate routes for your operation.

[drtowfigh]

1. If anyone offers plug and patch, run. It’s the worst choice for hernia repair. There are so many better options.

2. Watchful waiting is considered safe if you have no or minimal symptoms with your groin hernia. 0.2%/yr risk of incarceration in study with 10-yr followup. And ⅔ chance you’ll end up with a hernia repair in the next 10 years, based on the same study.

[drtowfigh]

Going back in open, after prior open repair, is asking for trouble. There are nerves that risk being injured as they are already involved in scar tissue.

Laparoscopic repair would be safer and more effective. Not sure why laparoscopic surgery scares you. If done by a specialist, it would be the best option.

[drtowfigh]

– seek a specialist to figure out the cause of pain

– if it’s a hernia recurrence, wear a truss or compression underwear. Ice packs help.

[drtowfigh]

Yes. Ilioinguinal Neurectomy performed electively during open inguinal hernia repair is a commonly performed procedure claiming to reduce chronic postoperative pain.

I don’t like it. And I don’t do it. There are risks with neurectomy, including neuroma and chronic pain. Many don’t do the neurectomy correcfly. this practice ignores the many other reasons for chronic pain after open inguinal hernia repair besides ilioinguinal nerve injury.

If you really want to reduce chronic pain, a) make sure a hernia specialist performs your hernia repair and b) consider a preperitoneal (usually laparoscopic) repair.

That’s my thought on the issue.

[drtowfigh]

I recommend you travel to Hershey. dr Eric Pauli.

[drtowfigh]

– highly unlikely and unexpected to have any intraperitoneal injury with an open tissue repair

– even with laparoscopic repair, adhesions are uncommon

[drtowfigh]

You’re so right. We have little data for women.

We do know that women are more likely to have femoral hernias and watchful waiting is not safe for that type of hernia. So make sure you rule that out with the ultrasound evaluation.

As a power lifter, I would recommend laparoscopic repair with mesh. But of course you have options.

The prior surgery did not cause the hernia.

[drtowfigh]

Not sure if Dr Hari Kumar Ondiveeran could see you. He’s in Ontario, I believe.

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Congratulations on your successful repair. Thank you for sharing.

Also, a two layer repair is technically not a Shouldice. It may be a Bassini or another type of two layer tissue repair.

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Sounds like you had the best repairs possible based on the circumstances.

If they truly did a Shouldice repair, then that’s great and it doesn’t make sense that they said you had a temporary repair. Sometimes surgeons do a tissue repair and I correctly call it a Shouldice. Those pseudo-Shouldice repairs are not well studied and it’s unclear how many of them fail.

[drtowfigh]

Good to see your surgeon about this. Imaging may help. You may have a seroma or hematoma. Massaging the area may also help. In some situations, the new symptoms are a result of the mesh shrinkage taking into effect.

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Consider Dr Jan Kukleta in Switzerland. I’ll bring him on as a guest for HerniaTalk LIVE episode soon.

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all true hernia specialists should be able to treat a Spigelian hernia.

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The standard for most hernia repairs is not to touch or cut any nerves. With the modified Shouldice repair by the Shouldice Clinic, they have considered cremaster muscle resection (to reduce the hernia recurrence from the originally described Shouldice technique) and thus genital branch neurectomy as their common practice. With other open operations, many surgeons commonly cut the ilioinguinal nerve.

[drtowfigh]

yup. which is why I teach all my residents in the OR and also show up to the Morbidity and Mortality conference to educate the rest of the Department and remind them of the tissue repair options and how to best do them.

[drtowfigh]

I tailor my recommendations to the patient’s needs

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Most people with hernias don’t know they have it