drtowfigh
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Most studies show that risk factors for postoperative chronic pain after open inguinal hernia repair with mesh include: women, younger patients, thin patients.
The definition of chronic pain is ANY symptom that continues after 3 months postoperatively. The data is around 12% risk (range is very wide based on which study you look at). These symptoms may include a twinge of pain or chronic debilitating pain. The serious pain risk is around 3%.
The data is all over the place for hernias. In general, laparoscopic repair has less chronic pain than open. Also, most recent study shows no difference between non-mesh open and open mesh repairs in terms of chronic pain. Also, a recent study shows lightweight mesh causes more chronic pain than heavy weight mesh. Like I said… the data is all over the place.
It’s best if your surgeon expert helps you digest the data as it pertains to your specific situation and needs.
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sorry, don’t know Dr. Tiru.
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[USER=”2661″]mackerel[/USER] There are a lot of causes of groin pain. Hernia is a common one.
I am happy to see you in consultation. If too far for you to travel, I do offer online consultation to at least review your images and make sure they were correctly interpreted, and also to review your symptoms (I can’t examine you online, he he). That way, I can offer some direction for you and you can seek the specialty care you need closer to your home.
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Sounds like a hernia to me.
We have a lot written about “hidden hernias” or “occult hernias” on this site. Search them.
Dr. Martindale has retired. Seek consultation with Dr. Orenstein. He can help you in Oregon.
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1. The standard approach for a recurrence after laparoscopic inguinal hernia repair with mesh is the open approach.
2. There should be little to no discussion about mesh removal as a primary plan of care if you have no actual primary mesh-related problem (such as mesh infection or mesh-related pain).
Less is more.
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All great options, understanding that there is no one correct answer. The most commonly performed operation with the best longterm outcomes for large scrotal hernias is a mesh repair. That said, non-mesh repairs, especially those with time-proven outcomes, are alternative options, with varyingly higher recurrence rates based on each patient’s risk factors.
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Interesting discussion regarding robotic surgery.
Here is my take on it:
– Robotic surgery is an advancement in surgical technology. Because of the shorter learning curve than laparoscopic surgery for many complex operations, it has allowed more surgeons to offer minimally invasive surgery to their patients. In the majority of operations, minimally invasive approach options result in less infection rate, less postoperative pain, and shorter recovery and faster return to work. For those of us that already use laparoscopic techniques, the robotic-assisted technology allows us to perform operations that we would not be able to perform laparoscopically. In some situations, such as mesh removal, my data has shown that robotic-assisted mesh removal is safer and with better outcomes than laparoscopic removal. The paper is due to be published soon.
– Robotic surgery has made a lot of advances since its original introduction decades ago. It is continuing to do so.
– The choice of instruments depends on the type of tissue handling planned. There are varying grip strengths. E.g., you would typically not use the same instrument to grasp mesh as you would to handle intestine. The reverse is okay.
– Arcing can occur with any electrical instrument, whether open, lap, or robotic. Robotic instruments have the most safety precautions, of the three techniques, for arcing. They all have a gel-type cover to minimize exposure of electrical current to only the tip. The videos shown are of extremely old instruments with tear in the gel safety cover. I am not sure what year and in which country that was filmed. It is clearly below the standard.
– The instruments typically have a 10-use lifespan. This is also another safety precaution.
– There are a lot of reasons for the robot not being used in pediatrics: the instruments are wider than many laparoscopic instruments (3-5 mm vs 5-8 mm) and most operations in children are not performed laparoscopically to begin with. That said, the robot is superior to the laparoscope in “tight” areas, such as the pelvis, hence its prevalence in urology, colorectal surgery, gynecology, head and neck surgery.
– The only ones who make money from the robot are the investors/owners of Intuitive Surgical. It is a very expensive tool. Insurance companies do not pay any more than laparoscopic or open operations for the operations performed by the robot. Hospitals typically lose money on the robot, to the point where many have decided not to buy it. This is also another reason why most European (and other) countries have chosen not to get on the robotic bandwagon, as socialized medicine cannot afford a $2M toy.
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Toronto, for the Shouldice Clinic is another alternative near you.
That said, if you’re going to travel by plane, not sure it matters the distance. We have a lot of names listed here for tissue repair, including my own. Use the Search option on this site.
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Thank you!! I try.
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Awaiting the 18 month results from the All-Comers trial. The next major meeting is in October. I wonder if they will present it there. If they do, I’ll post it here.
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[USER=”2335″]Ddot14[/USER] unfortunately there is a black hole. You are right.
You’d have to travel. Closest would be Ohio, Michigan, Indiana.
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See the other posts in response to your question. Most of us offer discounted cash rates for those without insurance coverage. I’ve provided letters for Canadians to fight their insurance to help reimburse but I don’t think anyone has been successful.
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Dr Eric Pauli is an excellent surgeon and super intelligent. He is among our go-to hernia specialists. I do recommend you see him in consultation.
Sounds like there is a combination of feeling the mesh and nerve pain. If it’s early after the surgery, the goal is to tame the inflammatory response to the mesh and allow time to heal. Ibuprofen and sometimes steroids can help. Nerve blocks and local anesthetic can also help.
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I’m sorry to say that that statement is no longer true. The famous brains of Mayo have mostly retired.
In our experience, we treat and cure a lot of patients who have sought help at the Mayo and were unable to get the help they need. One patient even lived there for a month!
Their Hernia and Abdominal Wall expertise is not strong.
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Happy to see any patients who travel to me for surgery. Also, I offer Online consultation to those who need guidance for diagnosis and treatment plans as the first step.
I see many many patients from Canada. In my experience, their medical doctors were very reluctant to approve their care in the US. I’m not sure if there is a disincentive to them to refer outside the Canadian system.
In addition to the Canadian surgeon names above, consider Dr Hari Kumar Ondiveeran. You can search HerniaTalk to see his contact information.
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[USER=”2029″]Good intentions[/USER] this is an important discussion to have.
Chronic pain comes in various flavors. There is mesh-related chronic pain, but there is also non-mesh related chronic pain.
We know that there is risk fo chronic pain with any operation, regardless of technique. We also know that each patient will have their own risk of chronic pain, different than their neighbor. We haven’t figured out why that is. It’s the billion dollar question no one has been able to figure out yet.
The most recent study published this past year put mesh and non-mesh repairs head-to-head and showed the risk of chronic pain is similar. It’s important to not that historically, tissue repairs were very painful and patients had to miss work and some were maimed by the repair. That is why a tension-free mesh repair was developed. For the first time, an inguinal hernia repair could be done as an outpatient and didn’t require a 3-day hospital stay. People tend to forget these details.
The reality is there is no one ideal repair. Some will do best with non-mesh repair. Others with mesh repair.
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[USER=”2705″]dbernard[/USER] de NDA on the type of tacks used. If absorbable type, no imaging can show them. Have to find them surgically (they are colored blue/purple usually) based on where your pain is. The permanent tacks can be seen on X-ray or CT scan. Just because the CT report says normal doesn’t mean that is accurate. Your surgeon needs to review it him/herself.
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I’d like to provide some alternative thoughts:
– a complete hernia ultrasound should be a dynamic study. That means pushing or bearing down and in many cases, asking the patient to stand, bend, rotate hips, etc. it’s not done so in most places in the US, which is why the false negative rate of ultrasounds here are so high (about 50% in our published study).
– type specific tissue repairs were historically what were done. Marcy is an example. We learned a century ago that type specific tissue repairs are not ideal and result in an adjacent Hernia occurring. The Shouldice is a more modern version of the tissue repairs, where both direct and indirect hernias are addressed. Dr Shouldice has also reported his femora hernia repair technique, which can be added to the typical Shouldice repair. This non-specific repair is perhaps one reason why it has the best outcomes among the different tissue repairs.
– I wish to hear and read more about the outcomes from various newer tissue repairs, including the Desarda, in peer reviewed journals and at our Hernia surgical conferences. It’s a major deficit that I see.
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It means different things to different people. The classic “darning” is using suture to recreate a hernia mesh effect. It is also possible that they just means suture repair.
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[USER=”2686″]tenreasy[/USER] Dr Toyama is an excellent surgeon.
Also, though I agree with what has been written about national chronic pain rates, those studies were for open repair with mesh. Those risks have been shown to be significantly lower with laparoscopic repair.
Finally, the risk of urinary retention is a combination of anesthesia and enlarged prostate. It is at higher risk with most pelvic surgery, which includes all inguinal hernias.