drtowfigh
Forum Replies Created
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Autoimmune Watch wait or fix
I disagree with the statement that tissue repair causes stiffness and loss of function.
It is not well documented at all that autoimmune disorders cause worse mesh reaction. I’ve seen it in my practice and I’ve researched the phenomenon, do I have a special interest in it. Read my chapter on it in the SAGES Manual of Groin Pain. I’m compiling my own data and perhaps the AHSQC database will be able to answer this question one day.
Pain from mesh is not a mesh rejection.
Polypropylene suture repair is different than polypropylene mesh implantation.
It’s not an immune system issue. It’s these diseases’ propensity toward heightened inflammatory response.
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Umbilical hernia + diastasis
This is a difficult problem. Hernias that occur within a diastasis (separation) of the Rectus muscle have a higher recurrence rate. In my practice, in the right type of patient, I robotically repair these and do a diastasis repair to protect the repair and reduce the risk of hernia recurrence. It’s a much much bigger operation, which is why I don’t perform it routinely for every patient.
At this stage, exercises you are doing will help reduce the chance the hernia will get bigger, but won’t cure it.
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Finding no-mesh inguinal hernia surgeons on west coast?
Chaunce 123 this is an excellent post. I’m going to move it up on the top. Agree 100%.
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Hernia – Newbie questions.
Patients with hernias undergo colonoscopy safely unless the hernias is super huge and includes a lump of colon.
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top hernia doctors in georgia or tn
Add to Tennessee: Guy Voeller, Ben Poulose
Florida: Edoardo Parra Davila, Jerrold Young -
Hidden Hernia questions from Ohio
1. Yes yes yes
2. Dr Ajita Prabhu at Cleveland Clinic
3. Constipation may be contributing to your herniaYou’re very smart and are right on with all of your assessments. I’m very impressed.
Read this article: http://www.ncbi.nlm.nih.gov/m/pubmed/25141884/
If you wish, I can re-read your films and review your history via online communication. Then I can give you a recommendation for care closer to home. You have such a classic presentation for a hidden hernia. You have many excellent hernia surgeons in Ohio. Go to http://www.beverlyhillsherniacenter.com for Online Consultation
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Chronic Mesh Pain and Weight Loss
We do. It tailor the size of the mesh to the weight of the patient. However, thinner patients are more likely to have sensation of the mesh so I prefer heavier weight mesh in the obese and lighter weight in the thin patients.
Losing weight down to a healthy weight without malnutrition is protective and preferred for hernias.
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Epigastric hernia repair — 2 weeks post-op
Abdominal pressure can increase risk of hernia recurrence.
That said, risk of hernia recurrence after repair of a 5mm hernia without mesh is expected to be very low.
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1 week post op… horrible nerve pain
In similar situations, I recommend activity and stretching of the area, I.e., slow hip extension. It’s possible the repair feels a little tight for you and every time you put it on pressure (sit, stand, orgasm), then it’s pulling along the groin crease where it’s sewn.
I agree with the comment by your surgeon.
The body usually adapts to the problem. Consider experimenting with a TENS unit.
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Exercising
UnderArmour crisscross compression shorts work well.
All core strengthening exercises are safe and effective.
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Pain after inguinal hernia repair using PHS.
1. CT scan does not degrade polypropylene.
2. Removal of the mesh and possible genitofemoral and/or ilioinguinal neurectomy may be necessary. In my practice, I start with a nerve block to determine how much of the psi is attributable to nerve impingement or entrapment.
3. Hernia repair should be a secondary issue. It depends on your findings and exam and the operation whether you should have another mesh repair or tissue repair. -
Which Mesh System
In my practice, I treat patients with known autoimmune disorder differently than others. These are patients with diagnoses such as lupus, rheumatoid arthritis, fibromyalgia. I have noticed that they respond with a heightened inflammatory repost we to injury (or surgery). Since mesh typically exerts an inflammatory response as part of the healing, I either perform a pure tissue repair or I implant mesh that has the lowest risk for inflammatory response. These include some biologic mesh, some new hybrid mesh products, and new PTFE or PVDF based mesh products.
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Diagnosing
I go by the strict definition of a sports hernia,which is a tear of the groin muscle(s) as opposed to a regular inguinal hernia which is an enlargement of a natural hole/canal or a weakening of the muscle.
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Options after open triple neurectomy + meshoma removal
It is unfortunately a known risk of neurectomy, that is neuroma formation or nerve-type pain after the transection.
If that is indeed the cause of chronic pain, then re-excision is an option. Other lesser options also exist, such as nerve stimulation and cryoablation/alcohol ablation.
The re-excision technique depends on the other needs you may have and may be performed in open or laparoscopic manner. There are risks with the laparoscopic technique including abdominal wall laxity and denervation. -
Pain Diary
21Tomlinson:
Im happy to see you if you can benefit from another set of eyes on your situation.
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Lingering problems after possible scar tissue break
As far as we know, exercise involving core strengthening and without rapid movements are safe for hernias.
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Pain after inguinal hernia repair using PHS.
Yes. Pretty much all imaging modalities may show it. MRI is most accurate
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Pain after inguinal hernia repair using PHS.
Dr Shah has offered to help you. Call his office and make an appointment. You will have to ask Dr Shah about his expertise once you meet him, he examines you, and he helps determine the cause of your pain.
Good luck.
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Inguinal Mesh Removal
LoriCx3:
You should not contemplate mesh removal if you’re not debilitated from the current problem. Mesh removal has a high success rate when performed by specialists and for meshoma or nerve entrapment due to mesh. That said, it must be of enough value to you to consider it. Not everyone chooses this pathway and that’s ok.If you send me your contact information, I can ask patients of mine to share their experiences with you.
Momof4: mesh removal for abdominal wall hernias is much more straight forward and with fewer complications. The reason should be very clear.
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Pain Diary
21Tomlinson:
Has anyone evaluated you for a simple cause for your pain: such as a hernia recurrence?