drtowfigh
Forum Replies Created
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Can be suture pain. Local anesthetic needs to be targeted to the actual suture knot area. I use ultrasound guidance to help.
Also, can be ACNES, which is basically a nerve entrapment at that level. Nerve block should help if given exactly at the level of the anterior or posterior cutaneous nerve. Neurectomy can help if blocks don’t provide longterm help.
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We just turned in our manuscript that demonstrates the social media effect on mesh perception and how it affects our surgical care. It will be an interesting read for you.
At this time, mesh-based inguinal hernia repair is considered the standard of care (some refer to it as the gold standard) in the US.
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Re mesh removal:
– if preperitoneal mesh (eg laparoscopic it open Kugel patch and some plugs), then Removal is best done laparoscopically.
– if anterior mesh (eg open) then mesh removal can only be done open.Re tissue repairs:
– I do perform robotic tissue based inguinal hernia repair. It is best for those with small indirect hernias. I do combine it in patients who get laparoscopic mesh removal and still need a repair.Re Progrip
– though polyester mesh has been known to cause more inflammation than polypropylene because it’s braided, we do not see more complications or chronic pain with Progrip mesh. -
Allow me to provide some of my own perspective, as a surgeon who ha does mostly chronic pain and revisional hernia repair and thus also performs neurectomies as needed:
– neurectomy should not be taken lightly and the nerves should be preserved as much as is possible.
– though the ilioinguinal and iliohypogastric nerves have both motor and sensory components upon its origin, they lose their motor component as they extend anteriorly in the groin. Thus, anterior neurectomy of these nerves has sensory side effects in most patients (ie numbness), but should not provide any motor dysfunction. This is why I am not an advocate of laparoscopic radical neurectomy except in extreme situations.
– the genital nerve branch does have motor function to the cremaster muscle in addition to sensory function.
– Neurolysis is an option in an i damaged nerve entrapped in, eg, scar tissue.
– in the case of a neuroma, there is no option other than neurectomy.
– neurosurgeons have little to no experience in how to handle peripheral nerves. At my institution, I am referred the peripheral (small) nerve pain, including meralgia paresthetica, as our neurosurgeons do not handle these. -
Also @deeoeraclea we have multiple patients on this site who have gone to @drkang. You can search the site for their posts.
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For tissue repair in the US, there are few of us that do it on a regular basis. Dr Brown and I are two on the West Coast.
In the MidWest, I’m not familiar with any.
On the East, perhaps Dr Jacob.
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Sounds like a great recovery. Congratulations.
Dr Belyansky is lovely and technically among the most skilled of my colleagues. He has helped a lot of patients.
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In Europe:
Koch
Lorenz
Conze
Bittner
Muysoms
Reinpold
SheenA lot more options, frankly, than in the US.
I do not know of Dr Weise.
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Hernias can cause lower back pain on the same side.
Hernia repair should not cause any back pain. If you have isolated back pain after hernia repair, either the hernia has recurred or you have a different reason for the pain.
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Plus the results are only applicable to men.
Nevertheless, the rate of chronic pain predicted by the App is concerningly higher than expected.
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Thanks for tagging me.
A spermatic cord lipoma May or may not be painful. We remove them as part of a complete hernia repair. Sometimes they can be missed or difficult to remove from laparoscopic approach.
They can present as a groin bulge.
It would be uncommon to have a huge symptomatic lipoma without an associated hernia. Most lipomas are actually linked to the preperitoneal fat. The one exception is if there is a hernia repair and the fat is missed. In that case, what used to be a mobile, non painful lipoma is now trapped in the inguinal canal by the mesh upstream. This can cause pressure and thus pain. The treatment is to remove the lipoma and that is a fairly straightforward procedure done open.
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The Muschaweck procedure, aka minimal repair, has not been validated outside her clinic. Nevertheless, she is highly respected within our hernia specialist community.
I do not recommend the procedure for moderate to large direct hernias, as the tissue repair becomes too tight. Since it is a local repair, it does not benefit from the laxity of nearby tissues to offset local tension.
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Should be an exciting meeting. I’m chair-ing the session on chronic pain.
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Yes. Very sad. He was supposed to be in Hamburg for the EHS and could not make it.
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Yes
We have multiple posts that can be searched about these. -
Thank you for all of this.
Will work on them and continue to improve. -
Chronic pain risk is same with all procedures, just the mesh can’t be blamed for the non mesh operations.
We don’t have hard data. I would say 3cm would be a hard upper limit for robotic tissue repair.
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Yes. If there is a hernia recurrence.
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IV sedation with Propofol and local anesthetic.
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It’s dependent on surgeon practice and your risk factors.
I do most open inguinal hernias under IV sedation only.