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Preferred type of surgery?

There is no one best hernia repair. You are right to figure that out. The repair should be based on your needs.

Pros of open:
– can be done under sedation without general anesthesia
– may be cosmetically a better scar
– non-mesh alternatives available
– low recurrence of done by an expert

Pros of lap:
– less chronic pain risk
– shorter recovery time
– lower recurrence if done by an expert
– best for bilateral inguinal hernias
– lower infection risk

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top hwrnia in wisvonsin

Wisconsin:

– Jacob Greenberg
– Matthew Goldblatt

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4 weeks post op inguinal hernia surgery

I agree with Drs Earle and Goldstein.

Sounds like you had an onlay mesh repair with Parietex self grip mesh.

Pain in legs/feet are not hernia-related. More likely a local problem (any swelling?) or a spine issue.

What is your body type? Thin, overweight, normal?

Stationary cycling is a good thing. Helps with the recovery.

Belyansky is an excellent choice. Please let us know what he thinks.

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Something weird after workout: bulge seemed to recess

Working out has not been associated with increased abdominal pressure, for the most part. In fact, when performed correctly, it engages the abdomen and supports the core abdominal muscles.

Yes, it’s possible that the hernia bulging receded with exercise. You are effectively strengthening and supporting the muscles on the periphery of the hernia.

Exercises that have been shown to increase abdominal include squats and jumping.

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Diagnostic laparoscopy as the definitive means of hernia detection?

Wes,

It’s not uncommon to perform a laparoscopy and miss a hernia. If the hernia is plugged with extraperitoneal fat, then a typical intraperitoneal exploration will not show the hernia hole. A complete exploration in the right setting should include taking down the peritoneum and looking right at the muscle itself, without anything obstructing the view.

I do not recommend placing mesh if there is no hernia. That can cause mesh-related complications and treating that is complicated and frought with risks, as Jgens points out.

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Finding no-mesh inguinal hernia surgeons on west coast?

I promote the use of tissue repair for inguinal hernia only in those who are
– super thin
– women
– have an inflammatory disorder
– infected

I for sure do not recommend it for:
– obese
– large build
– recurrent hernias

The American Hernia Society has a quality collaborative (www.ahsqc.org). It will soon be helping surgeons track their outcome for inguinal hernias and will help be the database nationally. Please ask your surgeon to sign up and add their patients to this.

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4 years of hip/groin pain. Help!

Thanks for your post.

Groin pain and hip pain overlap and can mimic each other with similar symptoms. Symptoms of pain with prolonged sitting, prolonged standing, bending, and any activity-related pain can be due to inguinal hernias.

It seems the MRI did diagnose fat-containing hernias and so it’s odd that subsequent studies are “normal.” These can be the cause of your pain. The story, exam, and radiologic findings need to correlate. I wonder if re-review of the films would show otherwise.

In any case, the best option is
1. have your MRI re-reviewed. I can do that as an online consultation (go to my website http://www.beverlyhillsherniacenter.com or email me).
2. if the imaging supports your symptoms, then I agree with Dr. Earle that laparoscopy is the best and least invasive option to explore your groin. If there is no hernia there, then little harm is done.

Hope this is helpful.

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Alternatives to mesh

The short answer is: yes. Phasix mesh lasts longer than Tigre, which lasts longer than BioA. Surgimend and other Biologics start absorbing around 3 months and are gone around 8. Phasix is supposed to be absorbed by 18 months.

At this time, I am not convinced that any of these mesh products are superior to synthetic mesh (which doesn’t absorb). I feel perhaps recurrences are just being delayed with them. The Gore study with BioA is promising, but longer term followup may prove my point. Phasix data will be out in a year or two.

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How long did you wait?

There is a great paper published in 2006 in the New England Journal of Medicine, with a followup 5 yrs later. They had Veterans commit to surgery vs watchful waiting. They all had groin hernias with no more than minimal pain and discomfort.

They all did fine waiting. No major complications. A quarter of them were frustrated from waiting as they didn’t like the bulge and having to adjust it, and deal with the twinges.

Some wait a lifetime and never get their her I fixed. Some have it fixed within days. There is no right answer for simple hernias. But they all get bigger with time.

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Have I messed up my hernia surgery?

Work on App in progress

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Pain Diary

Again, surgery is not your friend in these situations. There are great Pain Management specialists near you to handle centralization of pain. It does not involve surgery. Talk to your own Pain specialist and follow their lead if they’re comfortable treating that problem. You’re not treating a single neuralgia anymore. Those who I work with and have had great results are:
Dr Samimi, Lalani group
Dr Payam Vahedifar
Dr Tim Davis

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Pain Diary

This is why it is important that you don’t jump from operation to operation.

There is treatment for centralization of pain. Are you being treated by a Pain Management Specialist?

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Too small to be “real hernia” …. ultrasound vs MRI?

I see a lot of women and they tend to have very very small but symptomatic hernias. Hernia repair cures their pain. We presented our data in Milan about this at the World Hernia Congress, to prove that 87% of these patients with hidden/occult hernias are cured of their pain.

In my world, with the right exam and history, yes, a 4mm piece of fat can cause hernia pain.

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Have I messed up my hernia surgery?

Hi there,

I agree with comments by Dr. Earle. And the mesh repair is intended to cover all future hernias, too, so a femoral space on the opposite side is already covered by the mesh with the hope that a future femoral hernia does not occur.

If the pain continues, which it seems like it is, perhaps it is best to get that MRI pelvis, with valsalva preferably if they can do it. Send it to me and I will evaluate it. It will take some guessing out of the picture.

Good luck!

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Pain Diary

21tomlinson: I’d have to physically se you and review all that’s been done to figure it out. You’re quite complicated and seemed to have undergone all the right procedures.

But there is always hope: a missed nerve, a new neuroma, a hernia recurrence, etc. there are also localities we can try to address your pain besides surgery if it’s none of the above and more of a nerve system issue.

I am happy to see you and help you. But you have to be patient with me and allow me to figure it out. Another surgery may not be your answer. You remember I was concerned that you have been having a lot of back to back operations, with potential of compounding your problems and not curing them.

Jgens: every patient is different. Anatomy can be different with aberrant nerves and branches. Some are more likely than others to develop scar tissue, neuromas, and so on, which in essence results in recurrence of the same neuropathic pain. In others it’s a completely different probem that is being missed. And there are complications with each procedure. For example, Higher neurectomy in some cases can denervate the abdominal wall causing potentially irreversible abdominal protrusion on one side.

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Day 3 – post bilateral inguinal hernia surgery

Anti-inflammatories work better than narcotics for pain after hernia repair. These include Aleve, Motrin, naproxen, ibuprofen. If no contraindications, these over the counter medications can be taken at double the recommended dose. They may irritate the stomach lining and cause stomach ulcers so make sure take it with food and also take an anti-ulcer medication such as Pepcid to protect the stomach.

Ice is another good anti inflammatory. So are some homeopathic supplements such as Arnica, Alpha Lipoic acid,, ginger, turmeric.

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Alternatives to mesh

At this point, there is too high of a hernia recurrence with dissolvable mesh. The studies that show good numbers with dissolvable mesh all end before the recurrences present themselves (i.e., need longer term followup).

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New diagnosis

100% agree with your assessment and understanding.

I’m happy to see you. For other excellent laparoscopic surgeons I also recommend Drs Namir Katkhouda at USC, David Chen at UCLA, Garth Jacobsen at UC San Diego.

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Infection question?

1. Majority of infections from surgery present within first two weeks. After that it’s very rare but can still happen.
2. It’s anatomical.
3. Hard to answer. Depends on the complexity of the repair and each individual patient. In general, with a simple repair, should be getting better after 3 days to two weeks.

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Encouraging percentages from Docs please!

Botox is very new concept. Initiated by some smart surgeons in Mexico. If the hernia surgeon is not comfortable with it, sometimes pain management doctors will do the injection.