drtowfigh
Forum Replies Created
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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).
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Possible recurrent femoral/inguinal hernia for female
It’s possible that your CT dies in fact show the problem and it is misread, but after a hernia repair, the CT is a poor study to evaluate the groin and pelvis. The mesh does not look much different than the muscle adjacent to it on CT, but MRI is a much more sensitive study to evaluate your hernia and the pelvis.
I would ask that your physician request a peer-to-peer review of the authorization and not accept the insurance company’s denial. They go by a protocol and non-physicians are making these decisions. Once a physician speaks to a physician and explains your situation, the MRI should be approved. I have yet to have one denied for my patients. But it takes time for the doctor to get this done. You can also have your ordering physician quote or send my manuscript that described in detail how MRIs are superior to CT for detection of small hernias. In my study, 10 0f 11 negative CT scans were positive on MRI.
To help you best, I would need an MRI to read.
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parietex progrip removal, an exercise in futility?
Fascinating discussion
I agree with Dr Earle. I would have to see your imaging to confirm if you indeed had hernias. I wonder if you had small hernias that were treated and your surgeon’s comment about “prophylactically” repairing them intended to imply that you had not yet incarcerated or strangulated your (small) hernias and he was protecting you from this possibly occurring in “3-5 years.”
I don’t know. Just trying to make more logical sense of the situation.
Question:
– did the symptoms for which you presented to the ER resolve after the hernia repair? That is what is important. Just because your hernias were small does not mean they were not causing your symptoms. Symptoms are a more important reason to operate than size.As for mesh removal: it’s almost always feasible. It has risks. Injury to your spermatic cord or to nerves in the area are definitely risks with this operation and so I would not take recommend that procedure lightly. The question is why do you have your symptoms and direct the treatment toward that end.
If you are fit and you had three pieces of mesh, a tightness or stiffness of your abdomen and pelvis may be the cause. Also, the type of fixation you had may be the cause. Inflammation due to mesh should resolve Formosa Patients after the first couple of months. Thin patients and women are more likely to have this problem, as are those with fibromyalgia and inflammatory disorders. Dr Earle’s recommendations are right on for that problem.
If your mesh is too tight, Botox injections have been shown to help out with that problem. It’s a unique thought. It relaxes the muscles and therefore the repair. It is a temporary effect but many people have a long lasting result.
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Small Umbilical Hernia Repair Advice
The area of the hernia repair is naturally tighter than it used to be. If you have pain or soreness after a workout, use ice. It should help.
I agree with the assessment by your surgeon/nurse.
I recommend visiting your surgeon so you can be examined. Sometimes there is a pulling and tearing of the muscle (not the suture) and this will take a while to recover from. It does t necessarily mean you tore the hernia apart.
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mesh removal
Thank you for sharing your story.
I am curious why you went to the ER in the first place. What were your symptoms? And next, did any of those symptoms resolve since the operation irrespective of the new pain you now have.
I am happy to help. Certainly mesh removal can be done if that is the cause of your pain.
To determine that, I will need a copy of all your imaging CDs and operative report sent to me prior to your visit. Sheila can help arrange this.
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Dr. Towfigh – Neurectomy
Your problem is curable
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Training in Radiology
It’s reality.
Surgery and Medicine are not perfect sciences. I hope patients can appreciate that. This article is proof that any study (and therefore any operation) can be interpreted differently, and there is no one single correct answer (or in the case of surgery, no one correct way of doing any hernia repair).
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Dr. Towfigh – Neurectomy
I believe the study you are referring to is based on the open neurectomy. It is much easier and more effective to perform the genitofemoral neurectomy laparoscopically due to the nature of where the nerve lays.
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New website
Correct. The Facebook page is a closed group of hernia surgeons only.