drtowfigh
Forum Replies Created
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Pain with toy
It would be rare for me to explore for a hernia if I have not already exhausted all non-invasive forms of doing so.
That said, to answer your question: yes, if no hernia, then just close up, so to speak.
I am not sure that you have a hernia from your actions. That said, you may have a simple occult inguinal hernia, and a workup to prove that may be helpful.
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Femoral or Inguinial Hernia under Lymph Node
It is not necessary to have IV gadolinium contrast with your MRI if the purpose is for hernias. So, therefore, it would be okay to nurse immediately if you are not given contrast.
Watchful waiting is appropriate for most “minimally symptomatic” or “asymptomatic” inguinal hernias, with one exception: femoral hernias should be repaired. The timing is based on your needs, but it should not just be watched, in general.
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Weight loss and mesh
In general, weight loss reduces any tension on a hernia repair and any tension on a hernia. Thus, weight loss usually results in less pain related to a hernia or hernia repair.
Perhaps something else is going on.
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painful masturbation
6 months post-operatively, the area of the hernia repair should usually not hurt. Also, the wound itself should not hurt.
I recommend evaluation by your medical doctor, and possibly your surgeon.
It is not related to your activity.
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Is this normal or should I see my doctor?
I would seek a visit to your surgeon if the pain/symptoms are affecting your daily activities.
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inferior epigastric
The inferior epigastric vessels may need to be tied off or clipped during either open or laparoscopic surgery. Usually, this is done because it is in the way of the hernia repair or because a branch was bleeding as part of the dissection in the area.
There is no side effect to this process. Bleeding may occur if a vessel injury is not addressed. It is usually not the cause of poor bladder filling.
The inferior epigastric vessels may be used as part of a breast reconstruction in cases of mastectomy for cancer. It is not a procedure that is commonly used. The plastic surgeons are usually aware of any operations in the area that may affect the vessels, and often the vessels are ultra sounded to determine their caliber in those situations.
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Mesh-Free Tissue Tissue Repair Techniques
The Shouldice technique is tried and true. Many of us use it as our go-to repair technique for non-mesh open inguinal hernia repairs. The Shouldice Clinic in Toronto has the most experience in it and has published the best outcomes.
The Bassini is another technique. It is basically half of a Shouldice (2 layers instead of 4 layers). I resort to this if the Shouldice seems too tight for the patient.
There are 100s of other techniques that have been validated over the past century or so. Nowadays, most surgeons do not have enough experience and volume with open non-mesh repair, and few are trained in it during their residency. I predict it will make a comeback when we see more mesh-related complications.
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Undetermined Lower Pelvic
Springsman,
Pudendal neuralgia is a nerve issue. The nerve runs from the lower back (sacrum) toward the very front, and follows the contour of the pelvis. It may be directly injured or entrapped by spasmodic muscles of the pelvic floor and hip girdle.
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Re: mesh or no mesh surgery
Your experience is very important, as is the information that you share.
But to provide balance to your statements: femoral hernia repair without mesh can be very very painful and has a much higher recurrence rate, requiring even more surgery. Laparoscopic surgery is the gold standard for femoral hernia repair, and that includes mesh, because the outcomes (pain and recurrence) are so poor with non-mesh options and also with the open option.
You have the fortune of not having had the open non-mesh femoral hernia repair, and perhaps now the grass seems greener at this point. I am here to attest to you that it is not. Be confident that you had the best option for repair, with the lowest risk for pain and complications. I would practically never offer a non-mesh repair for a femoral hernia. Been there, done that, won’t go back to it.
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Is this normal or should I see my doctor?
Small twinges, catches, or even pain may continue after some hernia repairs. This is usually within the normal. It is why there is this quote of 20% “chronic pain” after hernia repair. It includes these types of symptoms.
With time, they reduce, but in some patients we see that they never go away. -
recurrent inguinal hernia
Sorry, I have asked around and we are not aware of any colleagues in hernia surgery in Jamaica.
I do know there are great surgeons in Jamaica, so do your due diligence and seek help. If not, you may have to travel to nearby countries. Mexico is a great resource for hernias.
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Undetermined Lower Pelvic
This is why examination is so important.
You may have a rectocele or obturator hernia.
A general surgeon or colorectal surgeon may be able to provide you with some guidance.
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Femoral hernia, still searching?
yes.
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Surgeon in Cleveland area
Consider Dr. Ajita Prabhu at Cleveland Clinic
Occult inguinal hernias can be symptomatic. Pain is not “in your head.” It takes a skilled physician to determine if the small hernia noted correlates with the symptoms you are experiencing.
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Surgeon challenging Radiologist’s CT scan
1. Hydroceles may be associated with a small inguinal hernia. Most often they are two separate entities, but they can coexist.
2. Unpredictable if fat or intestinal content hernia is painful. Everyone is different.
3. Likely not referred pain from the other side. The rest are complex situations which require a physical examination and complete history. -
Developing bumps after lap. hernia surgery
Yes. Seromas and hematomas can cause pain pressure or mimic hernia symptoms. They typically resolve on their own.
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Mesh sandwich / sandwiched fascia
1st surgeon seems on the right track. Recurrence after open inguinal hernia is typically best performed via laparoscopic approach. If the hernia recurrence is from the plug repair, and the plug is in the way of a good laparoscopic repair, then it can be trimmed at the time of laparoscopy.
I have no idea what the second surgeon is describing. I do not agree with the concerns presented. We don’t see that in clinical practice. The best practice standard is to approach the hernia recurrence from an open repair via laparoscopic approach. That approach provides lower risk of hernia recurrence, less risk for chronic pain, best long term and short term outcome.
MRI is best imaging to evaluate recurrence after mesh has already been implanted. CT scan cannot clearly differentiate between mesh and muscle. If MRI is denied, which many insurances attempt, then your surgeon needs to seek peer to peer review to get approval. I had to do that with two patients today. Such a waste of my time but I had to do it to get my patients evaluated the best I can.
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Developing bumps after lap. hernia surgery
This is usually normal (having not examined you). Massage it.
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Recurrent femoral hernia & Iatrogenic sports herni
I thank you for reaching out!
I assume you mean genitofemoral nerve? In the right setting, this may need to be performed. I try to spare nerves as much as possible. In some cases if non-surgical portions fail at addressing nerve related pain then we can discuss this procedure. Non-surgical options include nerve blocks, usually done serially to gauge the outcome.
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Surgeon challenging Radiologist’s CT scan
Agree with Ct reading.
How did your appointment with Dr Goodyear go?