drtowfigh
Forum Replies Created
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Inguinal Hernia Surgery
Yes!
No coughing! It transmits a very high amount of pressure onto your hernia repair.
Make sure you take whatever steps are necessary to stop the cough: cough drops, inhalers, antibiotics, cough syrup, etc. Talk to your medical doctor to stop the cough.
When coughing, first engage your abdominal muscles (tuck in your belly), then cough. That will help reduce the pressure transmitted to the hernia.
It is not 100% that it will undo your repair, and in fact we do not know what % risk there is with coughing, but it is among the most common causes for hernia recurrence. Others include chronic constipation requiring straining to have a bowel movement, large prostate requiring straining to urinate, and nicotine use. -
Post-vasectomy Pain – Neurectomy Options
Hi
Did Dr Paul Turek contact you?
He’s a fantastic resource for vasectomy-related pain.
He wanted me to evaluate you for hernia and also other neuropathic pain.
Let me know your thoughts. -
Can Incisional Hernias Cause Genital Pain in Women?
about the Cesarean section:
the ilioinguinal nerve or, more typically, the iliohypogastric nerve, can be injured at the time of Cesarean section or get involved in scar tissue as you are healing from it. It is not a common problem.
this will cause burning sensation along the inner lower abdomen/groin (iliohypogastric nerve) or into the labia/sometimes vagina (ilioinguinal nerve).Local anesthetic block of this nerve at the hip level can be diagnostic and therapeutic. Your pain management specialist should be able to perform this.
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Dr. Towfigh – Neurectomy
This is a fantastic discussion among true pioneers and experts in hernia surgery.
That said, we try not to injure or sacrifice the genital nerve with the Shouldice repair.
I hope you get treated, so that the nerve pain you have does not continue to spread to affect you with other parts of your body.
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Can Incisional Hernias Cause Genital Pain in Women?
In women, small hernias may cause vaginal pain, but not clitoral pain. It is described most commonly as a burning or sharp pain. Rarely dull. The pain can also radiate around the back or down the front of the leg.
Also, random acts of increasing the abdominal pressure may cause symptoms if you have a hernia.
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Question
Hi there and thanks for the posts. Both are excellent scenarios.
– You should look into getting a Gastroenterologist to evaluate you for SIBO (small intestine bacterial overgrowth). After surgery, if antibiotics were given to you (e.g., for your laparoscopic surgery, even one dose of antibiotic will do), it is possible that this caused an imbalance in the bacteria in your intestines, and thus you now have SIBO. The classic symptoms are bloating, especially worse with eating, and no change in diet works, but probiotics may have a small improvement. A hydrogen breath test is the study to diagnose this. A specific type of antibiotic and diet will help treat this.
– Ultrasound and CT scans may be negative for small inguinal hernias or small recurrences in the groin. However, they are excellent tools for evaluation of epigastric hernias. If there is not hernia, then usually that is a true finding, unless the study was misinterpreted. Perhaps you have a suture reaction, such as to the knot in the suture(s) placed, and that is the cause of the bump under the skin. That is easily treated with either time (allow months), or local exploration, even in the surgeon’s office.
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Dr. Towfigh – Neurectomy
We don’t know as much about the human body as we would like to. Nerve damage is an especially ambiguous part of medicine as it can act on many other parts of the body without any direct scientific or anatomical relationship. I cannot explain your headache, but I also cannot say it isn’t related to the nerve damage. We doctors just don’t know enough about these things (yet).
As for the Shouldice technique: yes, the cremasteric muscle is cut as part of the original description of the repair. The genitofemoral nerve, however, is spared.
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Update: hernia repair
So awesome to hear!
Continue to spread the word about our forum.
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Soreness after working out
There is no consensus as to the length of time, if any, that is appropriate to limit weight lifting and other gym activities after laparoscopic inguinal hernia repair. Many specialists, including myself, do not place a limit.
Also, weight lifting and other gym type activities typically do not increase your abdominal pressure, if performed correctly.
That said, it is hard to know why patients get pain in the mesh area. One possibility is that the repair is tight and so there is a little pulling. If tacks were used, there may be pulling at the tack. It is rarely due to a recurrence.
In most cases, the pain resolves and the pain is not a sign of anything bad. Infrequently, tacks may need to be removed. If it persists or gets worse, then I would evaluate it for a hernia recurrence.
Dr Earle recommends use of Aspercreme or Myoflex cream over the area. You can also use muscle relaxant compounded creams prescribed by your doctor.
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Swollen Groin after Mesh Removal
Then you need to evaluate the groin further. You may have a recurrence since the mesh removal so essentially you are feeling another hernia.
You really need to have a full evaluation of your operative report, symptoms, imaging, and eventually an exam.
Where do you live? Perhaps we can find you a hernia specialist nearby.
Alternatively, you can sign up for an online consultation with me. Go to http://www.beverlyhillsherniacenter.com
I recommend a valsalva CT scan or valsalva MRI
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Post-vasectomy Pain – Neurectomy Options
I’m going to have to do some research on this.
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How long will this post op fluid bulge last?
It will take a couple of months for your own body to completely resort the fluid.
Massage it daily and that may help expedite the process.
It usually goes away on its own. -
Female with right groin pain, finally ultrasound
At UC Davis, consider Dr Jonsthan Pierce and Dr Kathrrine Troppman.
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Possible recurrent hernia?
Redo surgeon again in the open fashion is not recommended. This would result in higher recurrence and higher risk of nerve and spermatic cord damage, due to reoperation in a scarred field.
The imaging with bear down views will help confirm the diagnosis of recurrence.
Adding stitches will not help. A new repair needs to be done. Synthetic mesh works by causing inflammation and having muscle thereby grow into it. The stitches are secondary. So restitching alone does not help -
Dr. Towfigh – Neurectomy
Wow. That’s unfortunate. Not sure why nerve damage would be brushed off as incurable. Dr Chen, I, and others have written pretty vastly about the treatment of nerve damage. However, unfortunately, there is not much cross-training and so urologists are mostly not aware of what general surgeons practice, and vice versa. So if these are urologists telling you there is nothing to do, it usually means there is nothing they can do. Other specialists can help.
As for your questions:
– orchiectomy does not typically include genital nerve resection.
– the genital nerve is not intentionally transected with any hernia repair
– if you’re having pain from that nerve, you won’t miss it too much when its resected. -
Possible hernia in 4 year old after trama?
Thanks for posting.
There are a lot of reasons for abdominal pain after a fall. Depending on how she fell and on what, she may have had a bruising of her intestine. That can cause such symptoms. Sometimes it’s more than bruising and there is a crushing of the intestine. Other internal organs are also at risk for crushing, such as the pancreas, liver, spleen, kidney.
It all depends on the type of fall.
A CT scan would evaluate this nicely.
Hidden hernias are uncommon outside the groin area. If she has any belly button hernia, or abdominal wall hernia, she should have point tenderness over the area if you palpate it.
I would seek a pediatric surgeon’s opinion. -
inguinal hernia advice!
I wished we had strong scientific evidence for everything you ask, but we can extrapolate from what we know so far:
– sucking in abdomen does not increase abdominal pressure. Pooching it out does.
– pretty much all machine exercises do not increase abdominal pressure when you engage your abs and therefore your core while doing them.
– recurrence and chronic pain is very surgeon-dependent. All things being equal, laparoscopy has a lower chronic pain rate than open and a lower recurrence rate if performed in the hands of experts in laparoscopic hernia repair. There is no gold standard b -
Possible recurrent hernia?
You are correct on all accounts.
First you should seek consultation with a surgeon that is familiar with revisional hernia surgery. Their ability to get an accurate history and exam is key in your diagnosis. They know what to ask and what to feel for.
A CT scan with valsalva or MRI pelvis with valsalva will help diagnose your recurrence, especially if there is no palpable bulge.
In LA, I am happy to see you. Also, Dr David Chen at UCLA. I also recommend Dr Namir Katkhouda at USC or Dr Edward Phillips at Cedars-Sinai. In the OC, I recommend Dr Mercedeh Baghai in Torrance.
Please let them know you were referred via HerniaTalk.
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Chronic RUQ pain
Aman,
There are a lot of great surgeons in India for hernia problems.
Try:
Rajesh Mohan Khattar
Sumeet ShahPlease let them know you were referred by HerniaTalk
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Female with right groin pain, finally ultrasound
Thanks for reaching out on this site. It is exactly what we are here for. Is like to hear what other surgeons have to say, but here are my two cents about it (and there are varying thoughts about this question so there is no one true answer):
1. Congrats. You now have a diagnosis
2. Most small female inguinal hernias are not “dangerous,” that is, the risk of intestinal involvement is low because the hernia is small and plugged with fat. Thus, repair is not urgent and I typically recommend repair if there is pain that affects daily life. Otherwise, it is usually safe to delay repair as long as the patient wishes. The only exception is for femoral hernias. Those must be repaired.
3. The type of repair that is best is the one that your surgeon is best at doing, most comfortable to offer, and so on. Open inguinal hernia repair with mesh is standard and the most commonly performed type of inguinal hernia repair. My personal preference for women, especially those of normal to low weight, is laparoscopic repair with mesh or open repair without mesh. Women as a whole have been shown to have more mesh-related pain with open repair with mesh, though the data is not concrete.That is my take on it. I tailor the repair to what are the needs of the patient.