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Thank you for all of your posts.

It seems you don’t even have a diagnosis yet. In Arizona, there are few surgeons who handle complications after hernia repair. Also, Medicaid is very limiting as few specialists are available to you outside of major County-based training programs.

Have you considered seeing someone at U of Arizona or Mayo Scottsdale?

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Just confirmed with Dr Ramaswamy of U Minnesota: no one local that is specialist in tissue repair of inguinal Hernia.

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[USER=”2534″]marty[/USER]
– your friend should not make changes to steroids unless supervised by his doctor
– Sjögren’s disease may or may not get worse with hernia mesh. It’s kind of an unknown.
– Desarda is for inguinal hernias

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This is the most recent contact I have for Dr David Johnson:

1180 N. Indian Canyon Dr.
Suite E421
Palm Springs CA 92262
United States
‭(760) 424-8224‬

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University of Minnesota has a hernia center under Dr Archana Ramaswamy. Try that.

Not aure if they offer tissue repair.

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Your symptoms are suggestive of inguinal Hernia: radiates to inner thigh, upper thigh, hip, around to lower back, GI symptoms, one-sided, better with ice, worse with menses.

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You are correct. In my discussion with the Shouldice hospital, they refuse to see patients of mine with imaging documented hernias that don’t have a bulge on examination.

If your bulge is prominent when standing, that’s enough to be treated by them.

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The original Shouldice repair was described with stainless steel suture. Most of us do not use that anymore. At the Shouldice hospital, they still use stainless steel because it’s cheaper—that’s what they told me. They make their own sutures in the back room. I saw their technicians do so. They have a limited stipend provided by the government Lee patient so they have a lot of cost cutting steps. Suture is one of them.

The reason why tissue repairs fail is often because of the quality of the tissue being sewn. Most with inguinal hernias have a collagen deficit. Sewing collagen deficient tissue together is less sturdy than healthy tissue.

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Time to seek a specialist. This kind of cycle can keep repeating and you may end up with a larger hole each time.
Also, you need to be evaluated for risk factors for Hernia recurrence and get those addressed: nicotine use, cough, constipation, enlarged prostate, obesity…

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[USER=”2683″]Jen74[/USER]

1. Adenomyosis typically does not require attention unless it’s associated with pain and heavy bleeding.
2. Imaging would show most hidden hernias. Just because the report says no Hernia doesn’t mean there isn’t a hernia. If your symptoms suggest hernia, a negative imaging study should be re read.
3. Exploratory laparoscopy alone will not necessarily show all hernias. Hidden hernias require that your general surgeon take down the peritoneum and preperitoneal fat and inspect the muscle itself for a defect.
4. You can ask that your surgeon not perform a mesh repair at the time of laparoscopy and either just take some pictures and have you go to a surgeon later who can do tissue repair or convert to an open tissue repair of your inguinal hernia at the same time as your laparoscopy.

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Thanks for your questions. There is no correct single answer. The type of repair options for revisional surgery vary depending on each patient’s needs. For example, type of prior repair, reason for recurrence, risk factors for recurrence, size of recurrence, lifestyle, etc. We usually don’t place mesh directly over mesh.

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This is a good forum to get your questions and concerns answered.

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Most recurrences from laparoscopic surgery are best addressed with open approach the second time.

That said, in the hands of an expert surgeon, a redo laparoscopic or robotic procedure may be feasible in some patients.

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[USER=”2672″]muzik[/USER] Thanks for your post

sounds like you have a mesh infection. There is no reason to have recurrent infections in the same place unless there is a foreign body that has seeded with bacteria and so the infection keeps recurring.

The UHS mesh is a good one. It’s considered lightweight, even ultra lightweight. Thy tend to be more resistant to infection than heavier weight mesh products.

If the mesh is infected, it must be removed in its entirety.

Unfortunately, I don’t know of anyone nearby to TX who can handle this problem.

I am happy to help you if you’d like to travel to CA. These are pretty straightforward operations. I don’t recommend biologic or anything else put in. I recommend a staged procedure: get rid of all foreign body and have the area scar in and be infection free. Then we can discuss hernia repair at a future date if you still have a hernia. The intense inflammation and scar from infection often seals the area and hernia recurrence is less likely.

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Also Dr Conze.

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Thanks for your post. Some answers for you:

– umbilical hernias greater than 1cm have been shown to have Lower recurrence rates when mesh is used. That may be why mesh was implanted, which is standard.

– most of your symptoms seem to be relatable to the umbilical hernia repair. Infection is rare. Other causes can include recurrence, mesh folding, and foreign body sensation, and foreign body reaction. Evaluation by a surgeon who is used to evaluating patients such as yourself would be helpful.

– hair loss has anecdotally been associated with mesh reaction in few patients. Most likely it is not related. It has not been associated with mesh infection.

I would recommend addressing the belly button and delay addressing the groin mesh in a staged process.

How do you know you have titanium tacks? If that’s what it said in the operative report, then for sure they are not absorbable. But that’s ok. I prefer those tacks actually.

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All the surgeons noted are excellent options for you. Dr.Eric Pauli in Hershey PA also an option.

Your story is complex. Occult hernias do not improve with local nerve blocks. Endometriomas would have cyclical pain and bulging.

The MRI should show a hernia or endometrioma.

Soonds like hysterectomy is not the right plan.

I’m happy to review your story and images if you’d like to request an online consultation via my office. 310-358-5020. Alternatively, travel to see one of the great surgeons noted that are closer to you.

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Interesting post. Just to add some clarity:

– sometimes indirect bs direct can be diagnosed in physical examination. That is not always accurate.
– direct hernias are more of a weakness of the transversalos fascia. Indirect hernias are an enlarging if a natural hole
– the type of repair (direct vs indirect) does not always determine the repair type (open vs lap vs non-mesh). I do tailor the approach to the needs of the patient (Eg, size of hernia, size of patient, their lifestyle, their medical history, etc).
– it is not a good idea to treat one hernia and not the other. Eg, if you have an indirect hernia, we also include the direct space in your repair. The reverse is also true, especially in adult men. The reason is because the entire myopectineal orifice is at risk, so repairing only on May result in having a recurrence in the other, and redo surgery to address the other has higher risk than repairing both direct and indirect spaces at the same time.
– ultrasound is preferred over CT scan. In the US, you are right that a good Hernia ultrasound is not as easy to get.

Hope thats helpful.

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Yes, inguinal hernia related pain can be activity related. That’s a common finding. Not every hernia causes pain. Those that do are worse with standing, sitting, bending, and best when lying flat.

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Biologic mesh has a role, but not typically for recurrent hernias. I used to use them for some patients at risk for mesh-rated allergy or chronic pain who couldn’t be closed with just non-mesh repair. I’ve moved to the hybrid meshes.