drtowfigh
Forum Replies Created
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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.
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Post-vasectomy Pain – Neurectomy Options
Wow. Sounds like you’ve been through a lot and had a lot done by you. I suspect you’ve already seen the national experts on this.
My concern is that the actual symptoms have not been carefully evaluated and instead you are undergoing so many procedures to see which one works.
Cryo, RFA, denrvation, and the like all have complications of their own, so it’s important that you have treatment targeted to your actual problem. Also, I believe nerves such as the genitofemoral are best addressed surgically, as they are small and hard to get to percutaneously.
Where was the vasectomy done (on your body). Was it scrotal, inguinal, where was your original incision?
Where is you pain exactly? Drawing may be helpful. Does the pain radiate?
Who have you seen about this? Dr Paul Turek is the national leader in this field.
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Do I have a hiatus hernia
most likely this is a diastasis of your rectus muscles. hernia also possible.
If there is pain or discomfort, an evaluation by your primary physician should be helpful. -
parietex progrip removal, an exercise in futility?
Dear Marcello,
Regarding the nicotine: it prevents adequate collagen deposition and this is the reason why we feel it affects healing of incisions and increased hernia recurrence. I am not aware of vasodilation as the reason for the nicotine effect. At this point, we do not have the scientific evidence for any of this.
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abdominal pain
Hernia pain is typically related to the area of the pain itself. In other words, if you have a sizable hernia above your belly button, and that is the cause of your abdominal pain, it would be most common if that pain is at the site of the hernia bulge.
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Female pelvic pain, hernia?
I am not an advocate of surgical options prior to exhausting non-surgical means of gathering a diagnosis. That said, there have been situations in which my patient has been in so much pain, and studies have been normal or at least non-diagnostic, and thus I have offered exploratory laparoscopy.
The important question to ask if whether your surgeon is laparoscopically skilled in hernia repair. If a hernia is noted, is the plan to repair it laparoscopically or to convert to an open repair. If an open repair, does your surgeon plan of placing mesh or not? All of these are valid options, but you should know the plan of care ahead of time.
Also, as has been mentioned many times on this discussion board: if exploratory laparoscopy does not show an obvious hernia, and there is clinical suspicion for a hernia, then it is imperative that the peritoneum (lining of the abdomen) be taken off the muscle and the muscle of the abdominal wall be directly visualized to truly and completely rule out an occult/hidden inguinal hernia. This phenomenon is more commonly seen among women, which is why I am stressing it for you. The plan must be to take down the peritoneum along with the associated fat and visualize the hernia orifices (holes) as fat may cover the holes and small hernias (which can cause pain) may be missed.
There is low risk of injury to nerves with laparoscopic exploration, though there is risk. There is also low risk for adhesions from laparoscopic exploration.
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Chronic RUQ pain
Dear Aman,
You need to be seen and evaluated by a specialist in hernia complications. This may be a general surgeon or a urologist. Where do you live, and we can help assist in referring you to a colleague of ours that is knowledgeable in this realm.
The question is whether you have a complication from the hernia repair, the mesh, nerve injury, injury to your spermatic cord (which leads to your testicle), hernia recurrence, etc. Many of these problems can be managed with local nerve injections, for example. However, some do require reoperation. A surgeon with expertise in evaluation and treatment of these problems can help you get back to normal and enjoy an active life. -
Hiatal/umbilical
You will be in good hands with Dr. Schwaitzberg.
My take on this is that you have a diastasis recti (from pregnancy with a large baby), umbilical hernia (also can be from the pregnancy, and/or genetic), hiatal hernia (is this proven? can be from increased abdominal pressure due to pregnancy, abdominal weight, genetics, or other issues). I am not sure why you still suffer from the perineal tear during childbirth, as it has been 3 years.
You have so many abdominal wall and pelvic floor abnormalities, I wonder if a) your nutrition is up to par. Has anyone checked for your albumin, nutrition status, zinc levels, etc? and b) if you have a genetic predisposition toward lower collagen level. Any family members with hernias? Are you hyper mobile at the joints or do you have hyper extensibility?
Given all of these findings, choosing no mesh may not be in your best interest, as sewing tissue that is naturally weak and low in collagen is likely to fail and recur, causing more pain. I defer to your surgeon to help determine a) what are your main areas of pain, and b) what are the best surgical options.
If you are overweight, then weight loss will dramatically improve your symptoms, as any reduction in abdominal pressure will help reduce symptoms from hiatal hernia, umbilical hernia, and diastasis recti.
A tummy tuck is the most obvious choice for patients with very large diastases, with or without umbilical hernia, with possible mesh placement. However, this may worsen any symptoms related to a hiatal hernia, so once again it is important that a surgeon, of the caliber of Dr. Schwaitzberg, evaluate all of these issues together.
Best of luck! Keep us updated as to what the plan of care is proposed for you. There are a lot of great doctors near where you live, so also don’t be afraid to get second and third opinions.
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Chronic RUQ pain
Very difficult problem because no mechanical problem to “repair.”
Some ideas:
– dry needling.
– Botox injection in the area -
Ventral incisional hernia
Consider Dr David Johnson in Palm Springs, Dr David Jones in Pasadena, and Dr Howard Kaufman in Pasadena.
In Los Angeles, I am happy to see you. Also, I recommend Dr David Chen at UcLa.
For recurrent flank hernias off the Pelvic bone, I recommend an open mesh sandwich repair or a laparoscopic/robotic mesh repair.
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Female pelvic pain, hernia?
Clitoral pain is not usually hernia-related. It is more consistent with pudendal neuralgia, which is a very difficult diagnosis to make and treat as there are very few specialists in the nation. Michael Hibner in Arizona is the nation’s leading expert.
Alternatively, labial burning without clitoral involvement can be due to a small hernia. This is due to irritation of the ilioinguinal nerve by the small hernia. A hernia specialist, especially one who is aware of the concept of occult inguinal hernias, can help rule this out. MRI pelvis with valsalva or a well done hernia ultrasound will help rule this out.
Reach out to Dr Matt Morgan in Pella, Iowa. Also Dr Luis Jose Garcia at University of Iowa. They are both savvy hernia specialists that may help you.
Gynecologist a who specialize in vulvodynia may also be helpful to determine causes.
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to be or not to be a hernia?
Thank you for your post!
Some thoughts:
1. Just because you have imaging finding of labral tear/FAI does not mean your symptoms are due to it.
2. It sounds like you very well can have an inguinal hernia. I have great trust in Dr. Zoland, who has seen many of my patients and very thoroughly and astutely diagnosed them with inguinal hernias, when others had not. Dr. Brian Jacob is also a hernia specialist and skilled in laparoscopy and a member of HerniaTalk.
3. I do not recommend further consultations for more opinions. Please see Drs. Zoland or Jacob as you will be in excellent hands. -
Possible recurrent femoral/inguinal hernia for female
Here is the link to the article on imaging standards for small hernias (and women).