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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.

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Hernia or Psoas?

Great! So happy that this forum led to your correct diagnosis. It is the main goal of why we do this.

As to your questions:
– can you explain why small hernias are often more painful than large ones? I BELIEVE THAT SMALLER HERNIAS ARE MORE LIKELY TO HAVE THEIR CONTENT PINCHED, THUS THE GREATER PAIN.
– are small hernias any easier to repair? Is there a greater chance that a mesh would not be required (I am thin and so am wary of the mesh). YES. PERHAPS.
– are painful hernias trickier to repair because nerves are involved? NO.
– does the fact that the hernia is ‘occult’ mean that it is literally deeper in the groin and therefore more difficult (riskier) to repair? NO
– if left untreated, what is the likelihood of it getting bigger? 100%. BUT UNCLEAR OVER WHAT PERIOD OF TIME.
– is there an advantage to getting it repaired sooner (while I am still relatively young at 55) rather than later? ONLY IF YOUR ARE SYMPTOMATIC.

As long as your surgeon is skilled in the hernia repair procedure planned for you, and he/she confirms you have a hernia, then the experience with women’s hernia is not as necessary. Really, diagnosis is much more difficult in women than the operation itself.

We have had posts here about the Shouldice Clinic not accepting patients with hernias who do not have an obvious hernia on examination. I have personally reached out to the Shouldice Clinic Chief Surgeon to discuss this. They have strong historical data that in their experience, if they cannot feel for a hernia on examination, the patients are less likely to have as good an outcome. Not sure why that is. I do not have the same experience.

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Inguinal hernia recurrence

Great news!

If you are happy with your outcome after surgery, please share your surgeon’s name and location so others nearby can have similar success.

Please also share HerniaTalk with your surgeon and invite him to join us.

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Fascia Tightening ??

Try Dr. Sam Ahn in Los Angeles. He is very good at thinking outside the box and trying innovative things.
Also, can try Dr. Hugh Gelabert.
Both are vascular surgeons.

Good luck!

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Dr. Towfigh – Neurectomy

Please do or just send email via Contact Us section. Mention HerniaTalk forum.

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Dr. Towfigh – Neurectomy

I’d have to confirm there is no hernia.

I would also submit you to repeat injections. If you had short term relief with injections, that is a good thing. In my practice, I would inject every two weeks until your pain is decreased.

If you fail that, then you may benefit from a surgical neurectomy. That can be done laparoscopically.

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Dr. Towfigh – Neurectomy

Based on your description, you may have a genitofemoral and/or ilioinguinal nerve injury.

Did you get local anesthetic injection by your pain doctor? This should help. It’s a bit difficult to do for that nerve in particular. If your pain doc can’t do it, seek one who can.

You may also have an occult inguinal hernia. Dynamic ultrasound or MRI pelvis should help discuss this.

I can help you if you wish to drive up a couple of hours. Dr Chen is also an excellent resource, also in Los Angeles.

I don’t recommend re operation unless you have no long term improvement in your symptoms or if you have an inguinal hernia as the cause of your symptoms.

Btw, did your original preoperatice pain ever get better?

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Is this a Hernia? In desperate need of help!

Any update?

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Inguinal hernia recurrence

Would love to hear an update.

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Chronic pain that will not go away

Based on your description, you may have a genitofemoral and/or ilioinguinal nerve injury.

Did you get local anesthetic injection by your pain doctor? This should help. It’s a bit difficult to do for that nerve in particular. If your pain doc can’t do it, seek one who can.

You may also have an occult inguinal hernia. Dynamic ultrasound or MRI pelvis should help discuss this.

I can help you if you wish to drive up a couple of hours. Dr Chen is also an excellent resource, also in Los Angeles.

I don’t recommend re operation unless you have no long term improvement in your symptoms or if you have an inguinal hernia as the cause of your symptoms.

Btw, did your original preoperatice pain ever get better?

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Fascia Tightening ??

I am so sorry about your situation.

There is a hand transplant surgeon I reviewed this with as well as another vascular surgeon and two hand surgeons.

All felt that there is nothing to do in terms of fascial tightening. All agreed that you should evaluate for proximal venous obstruction at the neck and upper extremity.

Note that after fascial release, the compartment will eventually scar down. And re-tightening the fascia will only re-exacerbate your issue.

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Inguial Hernia? Next Step? Bay Area? Dr. Towfigh?

Thanks so much for your post.

It’s so amazing the number of women I see with hernias that have undergone hysterectomy or oophorectomy when their pain was due to the groin hernia.

Your symptoms are am certainly suggestive of a hernia. You need to be seen by a surgeon with interest in hernias who is able to listen to you, evaluate you with an open mind, examine you carefully. That surgeon specialist needs to review your films to make sure the interpretation is correct.

In the Bay Area, there are several great surgeons. Go to the America Hernia Society website and plug in CA as your state and you can see all who are interested in hernia. Try Dr Hobart Harris. At Kaiser, try Dr Rock Liu.

Unfortunately, there aren’t that many who particularly specialize in hernias or even women’s hernias.

If it doesn’t work out for you up North, I am happy to see you in consultation. Sheila is my office manager and she can help you with accommodations. Most patients can fly or drive back home the next day after surgery.

I invite others on this forum who have had surgery out of their local area to report their experience.

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Training in Radiology

This is a timely article relevant to this discussion.

Based on my research, the results are even worse for radiologic evaluation of inguinal groin hernias.

http://archsurg.jamanetwork.com/Mobile/article.aspx?articleID=2442536&utm_source=Silverchair+Information+Systems&utm_medium=email&utm_campaign=ArchivesofSurgery%3AOnlineFirst09%2F23%2F2015