[drtowfigh]

I don’t restrict, though I prefer they don’t start gym type exercises until 2 weeks postoperatively.

[drtowfigh]

Hi there,
Any update on how you are doing and diagnostically?

[drtowfigh]

Depends on the umbilical hernia size. Small size umbilical hernias would be most appropriate for non-mesh repairs.

The goal is to be symptom free. Sometimes weight loss and abdominal strengthening can get you there.

[drtowfigh]

In general, almost all abdominal exercises, including crunches, are considered safe. We don’t have enough studies to look at every single type of exercise, but situps have been studied, and there is no major increase in abdominal pressure.

[drtowfigh]

– Dr. Igor Belyansky in Anapolis
– Dr. Sharon Bachman in Fairfax, VA

[drtowfigh]

Hard to judge that. If it is obvious you have a hernia, the examination is pretty straightforward.

[drtowfigh]

Good question, Saro.

The hernia itself does not anatomically affect sexual desire or function.

If you have pain at the hernia, that may indirectly affect your desire to has sex and/or orgasm. But it does not specifically prevent it.

[drtowfigh]

The abdominal muscles do help with breathing. However, losing the force generated by the muscles, such as due to a giant ventral hernia, would not reduce lung volumes. I have not examined you, but most likely it is not related.

[drtowfigh]

Hi
See the post of yours to wish I just responded.
Best of luck!

[drtowfigh]

Thank you for your post. By the way you wrote it, it seems you have done a lot of your homework. Also, it seems much of the information you researched on HerniaTalk was helpful. I am glad.

Yes, your symptoms warrant a more in-depth look into whether an occult inguinal hernia may be the cause of your pain. I am interested that your gastroenterologist may have actually felt a hernia. Were you examined lying on the table or standing?

None of the ultrasound images you mentioned would look for a hernia unless hernia was actually mentioned as something to look for. A “hernia ultrasound” needs to be ordered specifically. That technique has you do many maneuvers and beardowns and there are specific to look at the abdominal wall itself, not deeper.

If your doctor was able to palpate a hernia, maybe, then a dynamic “hernia ultrasound” done by a talented technician or radiologist will give you the answer. If it is “normal” or there is no hernia, then I would consider following up with an MRI. The false negative rate for an ultrasound in the setting of an occult inguinal hernia can be as high as 50%.

Search for Florida in HerniaTalk and you may find some names of surgeons. Those who I know and respect as hernia specialists include:

– Dr. Eduardo Parra-Davila, MD, in Celebration
– Dr. Jerrold Young, in Miami
– Dr. David Edelman, in Miami
– Dr. Jonathan Yunis, in Sarasota

You can also search here for others near you: https://americanherniasociety.org/find-a-surgeon/

The nearest surgeon to you who has a special interest in women’s hernias is Dr. Sharon Bachman in Virginia.

Best of luck.

[drtowfigh]

Good questions.

Depends on the absorbable sutures used. Vicryl loses 50% of its strength at about 3 weeks. There are more slowly resorbable sutures.

I do not use absorbable sutures because I feel the recurrence rate is too high. But Dr. Ramshaw, who I very very highly respect, uses that technique and has had excellent results.

Ultimately, the best you can do is remain active, not gain weight, engage your abdominal muscles to keep them strong and supportive of the repair, prevent constipation, prevent coughing and clearing of your throat.

[drtowfigh]

Thanks for this post, HerniaHelper.

I just submitted my longterm outcomes data after applying robotic non-mesh tissue repair for inguinal hernias. There are for sure risks to it (nerve entrapment being the main one), but no recurrences to date.

I was only offering this to persons with small hernias in patients with low risk for hernia recurrence. Now, I feel it is warranted to increase the inclusion criteria to a wider population. I now routinely offer this after any mesh removal surgery, especially if the mesh removal is due to mesh properties themselves.

[drtowfigh]

Good Intentions:

That was a fascinating response. Rings very true. It is an uphill battle for us surgeons to treat our patients and have the insurance companies agree there is a problem that needs treatment.

[drtowfigh]

:rolleyes:

[drtowfigh]

Hernia repairs are performed based on symptoms.

Not all inguinal hernias require surgery, regardless of direct or indirect status.

Femoral hernias are the only hernias where we recommend surgery instead of watchful waiting, due to higher than average risk of incarceration, need for emergency surgery, etc.

[drtowfigh]

Mesenteric lymphadenitis does not present with any lumps that you can feel.

A hernia may be the cause of her symptoms.

The constipation must be treated more aggressively.

CT scan may be misread or perhaps there was no lump at the time of the CT scan.

[drtowfigh]

Completely agree with Good Intentions.

There is usually no problem going in laparoscopically on the other side for a repair. If you haven’t had any problems from the repair on one side, likely the same will be true for the other side.

[drtowfigh]

Phasix is a new and very expensive product. Final clinical trials outcomes have not been shared yet.

It’s an interesting idea, but there is no proof yet that scar tissue left behind is enough to prevent a recurrence. It may just delay the time at which you gain a recurrence. We will know more in 1-2 years.

TIGR mesh has had some success in Europe. It is not widely available in the US.

[drtowfigh]

1. Please search on this Forum for keyword Alabama. I encourage you to chat with another fellow patient from Alabama.
2. I am sorry there is no surgeon colleague I am aware of who practices in Alabama. Certainly there are very few of us in the nation who are familiar with the diagnosis of hidden hernias.
3. Consider searching the American Hernia Surgeon Find a Surgeon tab to seek a surgeon near you for an initial consultation. https://americanherniasociety.org/find-a-surgeon/

[drtowfigh]

Dear Jnomesh,

Some thoughts about your post:

The outcome from femoral hernia repair is poor for non-mesh tissue repairs. The reason is because, unlike the common inguinal hernias, the femoral hernia is not flanked by muscle. It is flanked by thick taut ligaments. They have “no give.” Tissue repair used to be done, and history has taught us that the ouctomes are poor and chronic pain is a very real problem with it.

It think Dr. Shouldice described the best tissue repair for femoral hernias. I have performed it, and it works well for thin and small build patients (usually women). Simple suture repair does not work in most situations and can result in a lot of pain in the area. Being in such a particular anatomic region, even open mesh repair is no longer considered efficacious enough for femoral hernias. The gold standard is now laparoscopic mesh repair, based on a large study focused on this type of rare hernia.

Though rare for both sexes, femoral hernias are more common in women and can be seen among men. The question is: did you have a true femoral hernia (deep with content) or did you have a wide femoral space notable only on exploration?

With regard to exercise: all studies show that the majority of exercises are protective of hernias, do not increase abdominal pressure, and in some cases can reduce the size and/or symptoms of hernias. Since femoral hernias are not lined by muscle, exercise does not affect its progression or symptomatology.

Lastly, you asked about the mesh left on your vessels. It is common practice to do so, for safety reasons. If your mesh was removed because you had a true mesh reaction, then I do not leave any mesh at all, because even the slight amount may cause pain. Symptoms down your leg may be due to a) femoral hernia, b) nerve pain, and/or c) retained mesh. Your surgeon is very qualified to assess the pain for you and help you figure out why you have the pain down your leg.

You may notice that this forum will have contradicting information. Do not be afraid of this. It is something we are very used to in medicine, as it is not a black and white field and information is always in flux. Also, with surgery, outcome and experience can be different from surgeon to surgeon.