[drtowfigh]

Pulsed Radio Frequency ablation treatment?

The nerves anteriorly in the groin are hard to pinpoint percutaneously. That is, they are hard to find with precision and to therefore ablate. Though some patients have improvement, I am told by Pain Management specialists that ablation (cryo or RF) can partially treat a nerve and so it is likely that more than one procedure is necessary. Also, partial treatment of a nerve problem can possibly cause pain, as it is basically an injury. Lastly, as with neurectomy (surgically cutting the nerve), the ablation can cause paradoxical nerve pain stimulation and make the pain worse. It is a risk with any of these operations or procedures.

[drtowfigh]

Diagnostic laparoscopy as the definitive means of hernia detection?

I only apply it to small hernias for now, as a proof of concept. Will know more as more patients choose to have me perform this type. So far, results have been excellent, but it’s too early to claim.

[drtowfigh]

Lowest risk surgery type to resolve groin pain?

Short answer, Chaunce123: No.

It’s like asking, which pair of Jeans will make a human being look better? It’s based on your body type, sex, height, weight, style you wish to portray, etc. Hernia repair is the same.

A. the best repair type varies per surgeon and their expertise and experience
B. the best repair type varies based on sex, lifestyle, body habitus (weight), risk factors for recurrence, etc.
C. each mesh type is different and may be better or worse for each patient (E.g., lightweight mesh may sound great, but I would argue it is not a good choice for the morbidly obese or larger build body types. Similarly, no-mesh repair sounds like a safe alternative, but if there is going to be an early recurrence, with tearing of the muscle, resulting in a larger hole and more complex redo surgery, then that would be a terrible outcome.)

[drtowfigh]

Can a hernia be caused/worsened by Varicocele embo

A- possibly you always had a hernia and that was cause of pain attributed to varicocele
B- possible that varicocele has recurred. 20-25% with embolization procedure
C- possible that small lump is a clot or coil from the embolization.

I reviewed these with prominent urologists in this field.
Hope it’s helpful.

[drtowfigh]

8 months of undiagnosed pain

Try Dr Brian Jacob.

[drtowfigh]

Another hernia 4 weeks after repair?

As soon or as late as you wish. Your prior surgery likely has not affected what surgery you may need on the symptomatic side.

[drtowfigh]

Diagnostic laparoscopy as the definitive means of hernia detection?

quote :

Thanks Dr. Szotek. I guess my question is, is the peritoneum vital to have intact? Once it is taken down, can it be placed back to where it was before, or does something else (mesh) have to be inserted in it’s place? This is assuming everything looks normal on close inspection, no hernia or lipoma. Also, is insurance covering this “experimental” robotic repair? Thank you

Yes, insurance covers robotic repair. It is not experimental. I choose to do it under research protocol so that I can prospectively follow my patient outcomes and report my results in a research paper.

Peritoneum does not provide strength to a hernia or muscle. No mesh is necessary if exploration shows no hernia.

[drtowfigh]

Recovery from second surgery

Hard to evaluate an operated groin with Ultrasound. My choice is straight to MRI.

In MA, check out Dr David Earle, Peter Lydon, Stephen Ferzoco, George Velmahos. And also check out the site http://americanherniasociety.org/find-a-hernia-specialist/

[drtowfigh]

Mesh After Removal

No

[drtowfigh]

Years of inconclusive groin pain on right side. Maybe swelling? Maybe Hernia?

Springsman,
Depends on the timing of your pain. Last surgery was 3-5 yrs ago. When did the symptoms start?
And yes, not all radiologists are cognizant of the subtleties in mesh findings on imaging and their clinical implications.

[drtowfigh]

8 months of undiagnosed pain

Yes. Your symptoms may be due to hernias. In women, hernias present differently than in men.

I’m happy to help you reach a diagnosis and treatment. Alternatively, let us know where you live and we can refer you to a specialist nearby.

[drtowfigh]

Hernia Doctors near Pittsburgh, Pa

You should not have to live with pain. Almost all pain is treatable and even curable.

In Pennsylvania, I recommend Dr Eric Pauli in Hershey. You can also try looking up a specialist that can help treat chronic pain after hernia repair by calling offices of doctors found at http://americanherniasociety.org/find-a-hernia-specialist/

[drtowfigh]

Pain after left Inquinal hernia surgery

A tight repair may imply a secure repair.

Alternatively, if the repair is too tight, just like an outfit that is too tight, it can rip and tear. This can cause pain but not necessarily a recurrence. It all depends on your body weight, circumstances of the repair, size of the mesh, etc.

Best is to reduce risks of pressure in the abdomen, which can be increased by constipation straining, coughing, weight gain, and certain activities.

[drtowfigh]

Do I Have a Hidden/Occult Hernia?

Where exactly is your pain? It sounds like you very well may have a hernia. Have you had surgery of the abdomen? If not, the areas where hernias may exist are either at your belly button, a finger breadth above your belly button, or halfway between your belly button and your lower sternum.

Did your doctors look at the films themselves? Or just read the reports?

In Houston you can see Dr Charles Butler or Dr Brian Dunkin. You can also find other interested surgeons on http://americanherniasociety.org/find-a-hernia-specialist/

I am also happy to review your studies and images and give you my opinion if you wish to do an online consultation.

[drtowfigh]

Another hernia 4 weeks after repair?

Depends on how your hernia was surveyed laparoscopically.
Some hernias are filled with fat and a survey from the inside will not reveal a hole (aka a TAPP or transabdominal laparoscopic survey) while there really is a hole/hernia.
If your surgeon took down that fat and actually looked at the muscle to see if there is a hole (aka TEP or extra peritoneal laparoscopic survey) then there is no better more sure way of ruling out a hernia.

[drtowfigh]

Mutiple Surgeries in a close proximity of time.

CindyBigg,
Dr Poulose is an excellent surgeon. You were in good hands.
The context of your operations seems to be important in evaluating the pain. It’s not normal to be in so much pain so far out from surgery. Mesh is likely not the cause of your pain but Dr P would be the appropriate specialist to help determine that. The cancer may be contributing. Your liver cancer surgeon should be surveying that with follow up scans etc. sometimes intestinal adhesions are also the problem.
In short, in your situation, you need a multidimensional evaluation of all factors in your history to help get you the treatment you need.

[drtowfigh]

Heria Diagnosis

Nope.

Hernia is a hole through the muscle. Muscle tear or pull has inflammation at the sight of the year, which is different than the area of the hernia. The examination findings are different. Also, ultrasound can show a hernia but it’s more difficult to show inflammation from a tear unless it’s a big one.

[drtowfigh]

Pain Diary

Yes. There is a new treatment as you mentioned.

RSD is more common in the extremities but for sure can be seen related to the groin.

Sounds like you are in good hands and moving in the right direction.

[drtowfigh]

Hernia ..

I hope you get the answers and support you need by reading and participating I the posts on HerniaTalk.

I can understand the fear. Knowledge is power. No need to be ashamed.

[drtowfigh]

Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

The canal fat or sure. If the cord lipoma is contiguous with that, then yes again.