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Agree.

Sounds like the first thing is a physical examination to determine if there is a recurrence.

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Good Intentions is very correct: TEP and TAPP place the mesh in the exact spot, between peritoneum and muscle. Getting to that spot is how they differ. Removing the mesh is no different if the original repair was TEP or TAPP. Removal is typically performed in TAPP fashion, but I have also been able to do it as a TEP in some cases. Robotically, all techniques are TAPP.

How was the hernia addressed after the mesh and tack removal? Also, was 100% of the mesh removed, or was some mesh left behind, especially on the spermatic cord?

Perhaps your pain is related to a) hernia recurrence or b) mesh on the spermatic cord. Scar tissue is usually not able to compress the spermatic cord.

A careful review of your symptoms and what was done during your operations will help determine the next plan of care. E.g., do you need your hernia repaired? Does the spermatic cord need to be released from its surroundings?

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To assure the readership and clarify: surgeons at meetings such as SAGES discuss the pros and cons of all sorts of mesh types. The titles of the talks for this year’s SAGES meeting, for example, are focused on different clinical scenarios, and so the surgeon will discuss the pros and cons of different mesh types and techniques as well as their risks and benefits for each clinical scenario. Choice of mesh is an integral part of what is discussed in each talk. The talks are not limited to a single mesh type.

In the past, SAGES has had a lot of talks addressing specific mesh types.

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Thanks guys.
Let me know if the problem is fixed now.
Mans thanks for your posts here.

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Hi guys. Working on this. Hope it’s working better…

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I just finagled with this. Let me know if you still get problems.

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Thanks for the heads-up. Let me see what’s going on…

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Hi there. Agree with Dr Procter. It’s a hernia most likely. It can be incisional or epigastric. Either way, it’s usually fat containing and not dangerous. Surgery helps with symptoms.
The ultrasound is usually diagnostic. CT scan can also be helpful.

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First: liposarcomas can occur. They are super rare and often larger than typical spermatic cord lipomas. They are also firm. And MRI (and less often CT scan) can show a difference between benign and malignant, but it’s not always so in smaller lipomas.

Second: a spermatic cord lipoma is treated as a Hernia if the fat communicates with the fat in the abdomen (prepreritoneal fat).

Regardless, it seems both CTscans show you have bilateral inguinal hernias. And you have symptoms that support that diagnosis. What is the hesitancy in offering you a surgical solution?

by the way, antibiotics have an anti-inflammatory effect, which may Be Why your symptoms are a better while on them.

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Thanks for question.

For small hernias, core strengthening exercises can mobilize the surrounding muscles to help effectively narrow the hernia opening. Symptoms may resolve. Surgery can therefore be avoided.

For medium sized hernias, the bulging may reduce with the same regimen.

Larger hernias, which spread into the scrotum area, cannot be addressed with such exercises.

Min all situations, risk factors for Hernia worsening should be prevented: constipation, straining, coughs, Weight gain.

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Most scar tissue problems resolve within the first year. If you have bulging or lumping, I agree with everyone else here: it may be something simple that a physical therapist can work on or you may need to have it re evaluated by your surgeon for either a suture issue, mesh issue, or recurrence.

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Hi there. Thanks for the post.

Sounds like you may have an umbilical Hernia. It may have become better with the appendix surgery if they went through your belly button for the laparoscopy and closed it as part of the operation. But then the suture dissolved and the Hernia returned.

It seems your urologist is working up a urachus. Is that right?

In any case, the CT scan should show a mini Hernia if you have it.

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Watchful waiting is a very safe option for most. That said, most young patients will eventually get their hernia repaired d but it may be decades before you get symptomatic enough to have it repaired. It’s really your choice.

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Jeanvic,

Can you share that article?
My research did not show that at all. And especially for occult inguinal hernias, CT scan is very poor. Ultrasound or MRI are much better.

https://jamanetwork.com/journals/jamasurgery/fullarticle/1893806

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Thanks for the post.

Very interesting clinical situation. I have high hopes that you will reach a cure.

– no, it is uncommon to have a hernia repair at the same time as an appendix operation. Usually, we do not like to mix the classifications of contaminated or dirty (ie appendicitis) surgery with clean (ie Hernia) surgery. The only time it would be considered routine would be if the hernia was involved with an appendix in it.

– what type of laparoscopic repair was performed? TEP or TAPP? Just curious.

– have you been evaluated for a possible low grade infection or contamination of the mesh? That can potentiallly cause some of the other vague symptoms you have. Were you ever started on antibiotics to see if your symptoms go away?

– my two cents about mesh removal and nerve stuff: please don’t dabble in it. Do not mess with the nerves unless you can prove that they are the problem. Nerve block may be part of that workup. Did your hernia repair use tacks? If not, then there is no way The ilioinguinal nerve can be injured.

– as for the mesh size. Tat is standard. It’s not overkill. Studies show that size is best for most patients and has been shown to have lowest recurrence rate.

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A huge hernia by itself may not necessarily damage organs.

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Direct Hernia’s are more likely to recur than indirect.

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Injections are typically performed by a pain management specialist. Sometimes orthopedic surgeons, sports medicine doctors, and general surgeons do them, but not as a routine.

Sorry, I don’t know of any in Az. Perhaps call your local sports medicine doctor or orthopedic surgeon and ask who they recommend.

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Perhaps. Some of the absorbable suture are effectively no longer holding at 3 weeks.

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Hi there,
Checking into see if you had any luck with a diagnosis.