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So glad you finally got that darn bothering suture out! Usually, we just take out the suture and don’t do anything else. There may be a hernia recurrence in the future, but odds are you will do just fine.

If you have a small fluid collection in the area of the operation, that usually resolves on its own.

Congratulations!!

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I see this most often for inguinal hernias. The way I explain it is: the stool is taking up space and thus pressure in the pelvis. This increases pain in the groin hernia, as abdominal pressure is increased. Once it is expelled, the area has lower pressure, and hernia-related pain is gone.

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Biologic mesh is a good alternative (benefit) in select patient populations, but the risk with it is that recurrence rate is higher than non-absorbing synthetic mesh. Have you seen your surgeon yet? Would love to know the next step for you.

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I agree with Herniator.

Unfortunately, science is a bit behind and we do not have the best of answers for you. The Europeans do a much better job than the Americans in maintaining a national registry that can better answer some of the clinical questions.

– Mesh shrinkage has been determined to be multifactorial. It may contribute to pain if the mesh is already placed in a taut manner. Lighter weight synthetic mesh shrinks less than the denser mesh products. Biologic products tend to have the reverse problem. Mesh degradation is usually not an issue and not related to any mesh-related problems.

– The real % of patients that have true mesh-related problems (immunologic reactions, rejections, allergies) is considered to be very uncommon but is also unknown. It seems to be a greater concern in the US than outside the US. That said, I believe our mesh usage is also higher.

– If you have no symptoms in the first few weeks to months after mesh implantation, the risk of mesh-related reaction is close to nil.

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Pelvic pain is very complicated. It can be directly related to your repair or it can come from the hip, back, etc.

I use imaging a lot to help me differentiate among the different pathologies. I am not sure how liberally imaging is used in the UK.

I recommend seeking consultation with Dr. Aali Sheen. See his bio under “Hernia Surgeons” tab on this site for information on how to contact him.

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If not mesh in the space, there is no major difference between closing and not closing the peritoneum. Urologists routinely do not close the peritoneum when performing prostatectomy. The body eventually closes or regrows peritoneum to cover the area.

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If you have a recurrence from an anterior approach, then a posterior approach is indicated as the next way to repair it, for the reasons you mentioned (less scar tissue, so less risk of injury.)

In the US, this is usually done laparoscopically. That said, an open posterior approach is also an option, though with longer recovery time, usually.

Dr. Sheen can perhaps help you find someone in London or perhaps it is worth traveling.

By the way, erectile dysfunction is not directly affected by any hernia-related problems or complications. Any ED you may have is secondary (e.g., there is pain, so erection is painful and therefore difficult). Do not fear that ED will be maimed by a hernia repair.

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Thanks, Paul.

As far as I know, Dr. Brian Jacob also has performed this procedure. I am not sure if others have yet, but perhaps with time that may increase.

With my technique, I do not include all muscle layers, as there is a risk of trapping the nerves anteriorly.

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Welcome to our Forum, Dr. Kang!!

Lovely to hear more about your procedure.

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Yeah! Thanks for appreciating this forum!

There are excellent hernia specialists in NY. These include many who have been named on this forum, including Dr. Brian Jacob, Dr. George Ferzli, Dr. Steven Goldstein.

The type of repair is a highly personal choice. There are risks and benefits for each type of repair. Also, each surgeon has his/her own best outcome from repairs they may recommend. In general, both laparoscopic and open mesh repairs are considered standard options.

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Hi, Ashah2574,

Thanks for posting.
I would look into carefully determining why you had the recurrence? Do you have risk factors for hernia recurrence that should be addressed first, such as straining, nicotine use, overweight, etc.?
Then, I would review the technique used by your surgeon to determine how that affected your recurrence.

In Maryland, there are many excellent hernia surgeons. Dr. Igor Belyansky and Dr. Sharon Bachman are two of them. Perhaps you can search on this site for more.

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– There is a real risk of direct nerve injury with tissue repairs. Mostly, due to direct injury (cut, burn) or entrapment in the sutures. With mesh repair, there is the added risk of mesh-related injury to the nerve, such as erosion, entrapment, yet most surgeons don’t manipulate the nerves as much during a mesh repair, as it is not necessary. To think that there is no risk of nerve injury with non-mesh repair is not factual.

– Similar to open procedure, the risk of nerve injury from laparoscopic repair is due to direct injury (cutting, burning) or mesh-related injury. That said, the risk of mesh-related nerve injury is limited to direct mesh impingement or erosion, which are quite rare.

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First, constipation is a risk factor for hernia exacerbation. So… patients should prevent constipation and straining at all times.

Whether the straining you had at one time resulted in a hernia recurrence is unknown unless a) you have imaging and/or b) you wait to see if you develop a bulging or recurrence of your prior hernia symptoms. I do not recommend jumping the gun too early, as most patients do not get a hernia recurrence from one episode of straining. Any symptoms they may have may be related to muscle strain and pulling of sutures, etc., and time heals that aspect without any need for intervention.

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This is a discussion best made with your surgeon, who examines you, understands your daily activities, bases the risk assessment and surgicalrecommendations on your needs.

I agree that tissue repair may not be the best choice for athletic, muscular patients (e.g. Weightlifter, football player). But thin athletes who need maximal flexibility (e.g., ballerina, Yoga instructor) may benefit from tissue repair only. The size of the hernia and other risk factors also help determine best suitability for mesh use.

Watchful waiting is also a safe decision for men. We don’t have data for women but think the same is true.

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Most patients are candidates for a non-mesh inguinal hernia repair, as long as they are aware of the associated risks.

A hernia recurrence is the is the most common risk. It shouldn’t be taken lightly. A redo hernia repair will always provide a worse outcome than a primary repair. Also, often the recurrence can be larger than the first hernia, as it is due to a tear, and so repair will be more difficult and in the setting of less healthy tissue.

Nerve injury is another risk. When sewing the tissue repair, all three nerves are at risk of injury and/or entrapment, resulting in neuropathic pain. That can be tricky to treat.

Chronic pain has always been a risk for tissue repair. It was not as well studied back in the day, as we are doing now, because recurrence was a bigger problem. That said, it’s false to believe that chronic pain is not a risk with non-mesh tissue repair. The chronic pain is due to tight repair (it is not a tension free repair), nerve entrapment, and possible pubic bone related pain.

As with any repair, the more the experience of your surgeon with that type of repair, the lower the risk of these complications.

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If your symptoms started 9 years after your hernia surgery, then a hernia recurrence is top on the list of why you are having symptoms.

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I would still consider looking at some sort of dynamic imaging to rule out recurrence. That would be the most definitive route.

Ventral hernias can be repaired with all sorts of weights of mesh. The larger the defect, the higher the recommended weight/density of the mesh.

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I don’t personally know of any surgeons in Colorado. Those listed on the AHS website have an interest in hernias. They are not necessarily hernia specialists, but the majority of them have enough of an interest to have good experience in hernias and seek to educate themselves in hernia-related topics and procedures.

Good luck!

If you wish to seek consultation in surrounding states, we can offer you some recommendations.

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Sounds very plausible.
The tacks are dissolvable but it takes longer than we think for them to dissolve. Hopefully will feel better soon!

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Sounds like a hernia recurrence, which is expected if pure biologic tissue is used, especially for flank hernias.

I would recommend against any further operation until you have lost a significant amount of weight. A physician-supervised diet would be my first recommendation. You may even want to consider surgical weight loss.