Replies – Forums – drtowfigh – Page 92

drtowfigh

Moderator

January 4, 2016 at 2:24 am in reply to: Muscle atrophy

Muscle atrophy

Yes, one of the risks of laparoscopic or extended triple neurectomy is denervation of the abdominal muscles on that side. This problem is not seen with the open anterior approach triple neurectomy.
In a subset of patients, the muscle regains its strength and one has less bulging .
I am not aware of any treatment for this

drtowfigh

Moderator

January 4, 2016 at 2:18 am in reply to: Third Recurrence of Umbilical Hernia

Third Recurrence of Umbilical Hernia

Hernias do recur in a subset of patients. Typically, these patients either have a genetic predisposition to getting hernias, or there is an underlying issue that hasn’t been addressed, such as straining with Bowel movements, nicotine use, obesity, chronic cough, etc, that predisposes one to hernia recurrence. These must be addressed prior to considering a third operation
Also, many of us specialists resort to laparoscopic surgery for the redo hernia repair or to a different method of open mesh repair.
We would have to review your operative reports to understand what was done and why you had the recurrences.
Where do you live? Perhaps we can refer you to someone we know who can help with This process.

drtowfigh

Moderator

December 26, 2015 at 8:57 pm in reply to: Severe groin pain

Severe groin pain

Hi and thanks for posting.
If your symptoms are suggestive of a hernia, and you are tender at the ara when you touch it, then you should do as you are doing: try hard to get a definitive diagnosis before committing to any intervention or surgery.
If you are super-thin, you probably also have very little fat. It is usually the fat that is in the inguinal canal that causes the pain.
MRI is best done in these situations with valsalva or beardown views. I suggest you have the MRI re-read by a radiologist who specializes in this problem. Alternatively, I am happy to review it also. The process would be to either see me in consultation in person so that I can examine you or send your MRI and records to me via an online consultation (see http://www.beverlyhillsherniacenter.com).
Near you, I recommend Dr. Jerrold Young and Dr. Eduardo Parra-Davila.
Good luck! And don’t give up!

drtowfigh

Moderator

December 26, 2015 at 6:11 am in reply to: Dr. Towfigh – Neurectomy

Dr. Towfigh – Neurectomy

I don’t understand the objective of this question.

Radical orchiectomy is for cancer and so all potential sources of communication with the spread of the tumor are removed. The orchiectomy is done via inguinal approach and the cremasteric muscle is transected. That usually includes the genital branch of the genitofemoral nerve. It is typically not spared.

That is different from regular orchiectomy for benign causes, in which the minimal amount of removal is performed and a scrotal incision is made, this the genital nerve is not at risk.

drtowfigh

Moderator

December 25, 2015 at 9:40 pm in reply to: Mesh let loose

Mesh let loose

Sounds like you have a hernia recurrence.
Hernias, whether recurrent or otherwise, should be addressed if they are causing symptoms, especially if it affects one’s daily activities. However, having the mesh loose or any other type of recurrence, is not necessarily an emergent or urgent problem, especially if there is no associated pain or other symptoms.

drtowfigh

Moderator

December 25, 2015 at 9:38 pm in reply to: 6 mo post op reaccurrent hernia ?

6 mo post op reaccurrent hernia ?

No need to be scared.
All hernias have a small risk of recurrence. The key is to diagnose it and determine the appropriate treatment while reducing any preoperative risk factors which make you prone to recurrence.
The symptoms you are experiencing are suggestive of a hernia, however, examination and complete history are super important. Imaging is necessary if your examination is not diagnostic or obvious for a hernia recurrence.
There is no need to repeat MRIs if they are of high quality. In my experience, if symptoms are suggestive of a recurrence, and examination is not diagnostic of a recurrence, I choose an MRI with valsalva (bear-down) views. In our study, that has been shown to have the greatest impact on correctly diagnosing a recurrence. Also, it is important that the radiologic study by correctly read or interpreted. Also in our experience, up to Â¾ of studies are incorrectly interpreted as being normal.
You can consider having a radiologist with experience in this field review the MRI as a second opinion. Also, I offer this service, if you choose to send me the films after signing up for an online consultation (go to http://www.beverlyhillsherniacenter.com).
If symptoms are not severe, time will also help in the diagnosis, that is the hernia may get larger, and the diagnosis would be more obvious.

drtowfigh

Moderator

December 24, 2015 at 5:03 am in reply to: Hiatal/umbilical

Hiatal/umbilical

There is not slot of data regarding management of hernias and pregnancy.

Most of us specialists believe symptomatic hernias should be repaired prior to pregnancy and all others should be delayed until no further plans for pregnancy.

The risk of strangulation of most hernias during pregnancy is not zero but it is very very low.

drtowfigh

Moderator

December 22, 2015 at 6:35 am in reply to: Hiatal/umbilical

Hiatal/umbilical

Hernias that are reducible but not causing pain are safe to watch in most cases. Hernias that are painful, increasing in size, and/or are stuck and cannot be pushed in, should be repaired.

drtowfigh

Moderator

December 22, 2015 at 6:33 am in reply to: Possible recurrent hernia?

Possible recurrent hernia?

A single view of an ultrasound is not very helpful. Ultrasounds are dynamic so the entire video of what was performed is more informative.

That said, this ultrasound shows two layers of mesh in the plane of view. The mesh layers are both flat. There is no air bubble. The question is: what type of mesh was implanted? If a single mesh, then the mesh is folded, with hematoma in between. If it was a two layer mesh, such as the Prolene Hernia System, then this may be a normal image.

drtowfigh

Moderator

December 22, 2015 at 6:26 am in reply to: Swollen Groin after Mesh Removal

Swollen Groin after Mesh Removal

Great
You are in good hands with Dr Lydon. Please let him know about HerniaTalk.
The MRI will show if there is a hernia recurrence. Also a careful exam and possibly a nerve block will address possible genital nerve injury.

Best of luck.