[drtowfigh]

Based on your symptoms, I think it would be worthwhile to have imaging to check the mesh placement and see if it has folded or balled up. I usually order MRI pelvis.

[drtowfigh]

Stick with Dr Sheen.

If the ultrasound shows a hernia and your symptoms support such a diagnosis, lack of examination findings is not as important. You may have an occult or hidden hernia.

[drtowfigh]

Trusses are helpful if you have pain from a protruding inguinal hernia. Wear it while lying flat in your back and after pushing the hernia back in.
There is no need or benefit to wear a truss if you don’t have pain or feeling of heaviness.
Wearing a truss does not cause any problems.

[drtowfigh]

Fix the prostate problem first. You should reach a state where you are not straining to empty your bladder and not straining to improve the stream of your urine.

Then, if your hernias remain symptomatic, consider repair. The CT findings and your symptoms are basically that of a traditional inguinal hernia. Nothing nefarious. Risk of incarceration while watchfully waiting is low—0.18% per year.

And please do exercise and move around. Minimal movement is not necessary nor is it helpful.

[drtowfigh]

I agree with you. An enlarging inguinal hernia is a good reason to undergo repair, as larger hernias have higher risk for recurrence after repair than smaller hernias.

Large hernia means scrotal extension of the hernia.

[drtowfigh]

Sorry to hear, as it sounds like you had a great repair.

In general, these symptoms will abate with time. Stretching out the hip with slow extension exercises may help.

Things to consider if the symptoms don’t resolve: MRI pelvis to evaluate for a hernia recurrence and position of the mesh. Some of your symptoms sound like ilioinguinal nerve but usually with ProGrip no tacks are used and so the nerve is not at risk. Check your operative report to see if any tacks or fixation we’re added.

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Few of us treat a lot of chronic pain patients. We are those that perform (or evaluate appropriateness for) surgical neurectomy.

Mostly:
me, Shirin Towfigh
David Chen
Brian Jacob
Igor Belyansky

also, David Krpata’s practice is growing in this realm.

[drtowfigh]

Take your time to figure out exactly why you have pain and therefore what is the best next step. There is no rush to remove mesh.

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[USER=”2758″]Dill[/USER] : your comment about “I would like nothing to be cut” needs clarification.”

Are you referring to nerves?

Because the open non-mesh repair involves the most amount of muscle and fascia cutting.

[drtowfigh]

Most open operations can be performed with IV sedation only and a lot of local anesthesia. That is my practice. It’s also referred to as conscious sedation. The anesthetic recovery is simpler and quite nice.

[drtowfigh]

Thank you for your contributions!

[drtowfigh]

For some perspective:

The Shouldice hospital reports a 1% or lower recurrence rate. They highly select their patients and no one has been able to reproduce their results.

The average expected recurrence from a non mesh mesh performed in the US is 10-15%. Most experts have a rate in the 3-10% range.

Compare that to the average national recurrence rate with open mesh as being in the 5% range and under 1% with experts.

[drtowfigh]

The mesh typically goes no higher than the level between the two protruding pelvic bones in your left and right.

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Interesting that you had a recurrent hernia repaired in anterior open fashion after laparoscopic surgery (that is standard) BUT they chose a repair technique that involved the same posterior space as the laparoscopic repair (not as standard, but I’ve seen it done).

[drtowfigh]

Consider Dr Aali Sheen in manchester.

[drtowfigh]

Hernia is not uncommon after emergency surgery and after colorectal surgery. The repair is mesh based and tissue based repairs are more likely to cause pain and disability, because of tightness and tearing that may occur after the repair.

Let’s not conflate chronic pain after inguinal hernia repair with that of incisional abdominal hernia repair. Two different animals with two different outcomes.

I would recommend mesh based repair if she is symptomatic or if the hernia is growing in size.

Remember that not all mesh are the same. There is a wide variety of mesh options and surgical techniques, each with their own risk for recurrence and pain.

A hernia specialist can help walk your mother through her options and with realistic outcomes.

[drtowfigh]

I have not.
Peritoneum regrows.

[drtowfigh]

Can’t say for sure. Possible.

[drtowfigh]

All surgery incurs scar tissue.

Same

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If the pin is due to the mesh balled up (meshoma), there is no good pain relief short of surgical removing the mass.