drtowfigh
Forum Replies Created
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Painful ejaculate post open hernia repair
Your surgery involves mesh placement and suturing onto the pelvis muscles. Strong contractions of any kind early after surgery, such as with orgasm or certain exercises, may cause pain and even stress the repair in rare cases. Also, the mesh is typically adjacent to or wrapped around the spermatic cord, which includes the vas deferens, which carries sperm from the testicle to the prostate. There are nerves along this. Any extra tension or pressure in this area, which includes orgasm, may be perceived as painful because the area of the cord is already swollen from the recent repair, as evidenced by the swollen scrotum.
Perhaps reduce any stressors on the repair until the area is less swollen, which can be gauged by the scrital and incisional swelling. -
Inguinal hernia recurrence
Definitely would use mesh for a recurrence. That is pretty much the gold standard.
When repairing a hernia in open fashion after a recurrence from a laparoscopic repair, you are basically performing an anterior repair after failure of a posterior repair. That is the standard approach and what is recommended for most patients. Therefore, an open anterior mesh repair should be chosen. Mesh repairs with the plug and patch or the Prolene Hernia System involve a posterior dissection as part of the anterior approach and that can be tricky. I would not recommend complicating the situation in that manner. A simple anterior onlay mesh repair (Ã la Lichtenstein technique) is probably your best and safest bet.
Once again, it is your surgeon’s discretion. A lot of the decision making is based on the type of recurrence, what is happening with the laparoscopic mesh, what your body habitus is and other risk factors.
Check the AHS website for surgeons skilled in revisional surgery in Arkansas and nearby. There are plenty that you can tap into I’m sure. http://Www.americanherniasociety.org. Tennessee is a great next door state for hernia specialists.
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Graves disease and Hernia connection?
There is no known direct relationship between Grave’s disease or other acquired hypothyroidism and hernia formation.
Patients with hypothyroidism may be constipated. Straining for constipation is a risk factor for developing hernias.
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Spigelian hernia?
Abdominal wall hernias and groin hernias can cause back pain. When they are fixed, the back pain can go away if it was due to the hernia.
A Spigelian hernia is a very specific type of hernia. Most general surgeons are knowledgeable about what it is, though they may not readily diagnose it as it is a rare type of hernia. At Kaiser in San Diego, seek consultation with Dr Jaclyn Parker. She is a general surgeon with excellent laparoscopic and hernia experience that trained with us prior to moving to San Diego.
Films, including MRIs, can be misread, especially for hernias. It is important to see all the images and in high definition in order correctly identify the findings you mention.
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Possible Hidden Hernia?
On the AHS website (www.americanherniasociety.org) you can just click on your state and a full list will show you member surgeons.
In San Francisco, Try Dr Hobart Harris. He is a senior surgeon and should be able to help diagnose and treat an obturator hernia. Let him know you were referred by HerniaTalk.com. I’m also happy to see you down in Los Angeles.
I have not seen reports of hernia after trans-obturator tape sling.
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Mesh Removal
Laparoscopically placed mesh can be removed off the transversus abdominis. Some muscle will be injured as part of the removal, as the muscle has grown into the mesh. Surgeon technique and surgical technique can help reduce the injury. It is usually not a major problem. There is minimal muscle tissue that is removed with the mesh and it typically does not affect abdominal wall strength.
I recommend that laparoscopically-placed mesh be removed laparoscopically. To do so via an open laparotomy, in my opinion, is causing too much extra damage and instability to the abdominal wall, cutting through the abdomen full thickness to get to the mesh. The recovery is also much longer. That said, there are not that many surgeons who routinely perform mesh removal laparoscopically. Mesh removal itself has risks of vessel (external iliac artery/vein), bladder, spermatic cord, and nerve (genitofemoral or lateral femorocutaneous) injury regardless of technique.
I have switched to performing all of these with robotic assistance, and have found the results to be much better, with less injury.
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Small Umbilical Hernia Repair Advice
Dr Earle: perfect answer. I 100% agree. :silly:
If less than 1cm defect I would err on no mesh and place mesh only if it recurs (very low chance, less than 1%). -
Muscle tore away from Mesh
Dynamic Imaging such as MRI pelvis with vslsalva will help determine if you have a recurrence. Your symptoms are similar to that noted from inguinal hernias.
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Advice needed!
In Washington state, try Dr Andrew Wright at the University of Washington. Tell him you were referred from HerniaTalk.com. He’s a very smart surgeon.
Occult hernias in women present atypically: pain several fingerbreadths above the groin crease, pulling or tugging, radiates down leg, into vagina, into labia, upper inner thigh, around the back, up to the umbilicus. Associated with bloating. Worse with abdominal pressure increases such as straining for bowel movements. I often hear the pain lingers after the bowel movement. Pain with sex.
The urinary frequency may be related to pelvic floor spasm due to inguinal hernia. Pelvic floor physical therapy causes more pain.
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Inguinal hernia recurrence
Pain after laparoscopic hernia repair can be due to a hernia recurrence and/or the mesh interacting with the contents trying to recur and push their way through the recurrence. Your surgeon is correct: most commonly, the most lateral edge of the mesh folds in, partially exposing the indirect inguinal hernia. It seems, based on your symptoms of pain with activity and relief with sitting and certain maneuvers, that these hernia contents are moving in and out through the area of the recurrence.
Once the open and laparoscopic hernia options have both been performed, then it is up to the discretion of the surgeon and the specific situation at hand whether the next hernia repair should be performed open vs laparoscopically. If your first repair was performed with mesh, then perhaps redoing it would be risky, with risk of spermatic cord and nerve injury. This is because the mesh is already stuck to these contents. However, if there is no mesh anteriorly, it is my opinion that revisional surgery is less risky in the open repair. You may have to have nerves cut. That is your surgeons discretion. Not all surgeons do that for every revision. It is done to reduce risk of postoperative nerve injury and pain.
I recommend imaging such as MRI pelvis to view the mesh repair, see if the mesh has shifted or is folded or balled up, and confirm recurrence. If the mesh itself is not the major issue, then open repair is safe and effective, and mesh should be implanted. Revisional laparoscopic repair is performed safely by only few surgeons who are laparoscopically experienced. If that route is chosen, make sure the surgeon performs these regularly.
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Hernia site pain during menstration?
In this situation I would consider looking into the possibility that your hernia may have recurred. The hernia pain is worsened at the time of one’s period. I see that commonly. Hernia pain is also worse with bending, which you also describe.
I recommend you see a general surgeon, preferably the one who repaired your hernias. CT scan would be part of the workup of the examination is suggestive of a hernia recurrence.
If you are looking for a new surgeon, let us know your location and we can recommend colleagues who we believe can provide you with expert consultation.
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Is this a Hernia? In desperate need of help!
The spots marked seem a bit low and medial for a Petit’s hernia but a physical examination by a knowledgeable surgeon will help figure that out.
The MRI scan you provided is of her spine, so most views will not catch this area, but it seems they did do a pelvis MRI so a review of the MRI as Dr Earle mentioned should help figure out what this is.
If it’s as simple as a lipoma, that is an easy fix.
In the Kaiser system, go see Dr Talar Tejirian in the Hollywood Kaiser on Sunset. She specializes in hernias in the Kaiser system. I’ll let her know to expect you. -
Hernia site pain during menstration?
Pain in general is worse during periods than the rest of the month. It has to do with the hormonal surges. However, the question is why do you have the pain?
If the pain is only during your period, then I agree with Dr Goldstein: you should look into endometriosis as the cause of your pain. Endometriosis is due to uterine lining cells escaping the uterus. They can implant anywhere in your body. The pain is not necessarily at your uterus. In fact it almost never is uterine pain.
Did you have mesh implanted at the time of a hysterectomy? Did you have pain between the time of your original operation and now? If so, of what nature? Do you have pain when you are not on your period?
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best exercises and ones to avoid after surgery
I can’t say that I know much about Desarsda-specific recommendations in terms of postoperative recovery and exercises. If anyone has any experience performing the Desarda technique and has a routine for their patients, ease share.
It seems to me the technique is a very specific and tenuous tissue repair technique so I would err on the side of caution. Do not perform any rapid movements, fast changes in direction, or activities that increase abdominal pressure. I do not recommend jumping activities, Crossfit type exercises, hiking (especially downhill), squats. Pilates and Yoga are excellent core strengthening exercises and I recommend it for my patients. They usually do not involve any activities that strain the groin or increase abdominal pressure. Most tolerate Pilates more than Yoga. Cycling is also good.
I would ask your surgeon if he/she has any specific recommendations. And please share with us.
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Scar Tissue – One year after IH Surgery
Most scar tissue remodels maximally by 1 year but continues to remodel (that means, become softer and softer and flatter) for the rest of your life. A keloid is very specific. It is a lumpy growth on top of your skin. That doesn’t sound like what you have. Most likely you have a soft linear scar tissue feeling along the length of your wound.
It will continue to become softer after one year. It’s a slow process.
You can expedite it with certain injections. Creams won’t work anymore at this stage. They work for the skin and earlier on.
If it bothers you, a good dermatologist and some plastic surgeons can inject, use lasers, or have other new technologies to soften up the scar.If it’s not causing pain, the hard scar will not cause any damage and is not hurting anything.
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pain lower right quad for 14 months
Sorry. Typo. Dr. Clint Streetman. He practices in Baptist East Hospital in Montgomery.
Please let him know you were referred by HerniaTalk.com!
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Survey! Re: Consultations with your Surgeon
Anyone else with ideas or thoughts on how to improve your understanding and consultation with the surgeon?
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Could this be a hidden hernia ?
Your hernias are small and have fat not intestine so cramps are not “dangerous” signs. Usually, we would be concerned that cramping implies a hernia is causing intestines to be trapped if there is a cramping going on, especially if it is unrelenting, and with bloating, nausea, or other signs of intestinal involvement.
Any signs of worsening include redness, warmth in the area, severe tenderness to touch. You need emergency attention at that time.
I look forward to seeing you. Driving or flight ok. Whatever works for you. I had a lovely couple drive 5 days from Canada!
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Is this a Hernia? In desperate need of help!
There are rare lumbar hernias that can cause pain and a bulge. Some are more common among women.
Look up Petit’s hernia (inferior lumbar hernia, just above the pelvic bone in the back, more often in men and on left side) and Grynfeltt’s hernia (just below the ribs in the back, typically among athletes, such as thin female marathon runners). Sounds like hers may be a Petit’s hernia.
Can you draw a picture and send it to us as to exactly where it is or attach a picture and mark it on her back?
Also, perhaps attach her MRI file if you can? If you can feel it the MRI should show it. If they said “negative” then it was either misread or the MRI was a spine MRI which doesn’t look at that area at all (it is cut out). -
Alternatives to mesh
Fantastic post!
I’m going to give my opinion here, sprinkled with some evidence based data from accepted literature. I urge the surgeons on this Board to give their take, too, as the answers to this post are very subjective.
Hernia surgery and the mesh question has not yet become a science. We just don’t know enough to be able to match the perfect technique or mesh implant to the perfect patient. There is an art to it. We can extrapolate from our experience and from research done on patient populations that are typically heterogeneous in some respects and homogeneous (ie, controlled) in other respects.
First, the “30% chronic pain” data is an exaggeration and should be understood in context. There is a 20% chronic pain incidence after open inguinal hernia repair with mesh for all-comers. There are papers that have shown lower numbers and other studies that have shown higher numbers. Most surgeons accept this 20% number. “Chronic pain” is defined as any pain or sensation noted after 3 months after surgery. This includes tugging, pulling, twinges, catching, fleeting pains. Almost all of these pains are rated to be low level, non-debilitating, and short-lived (ie, many can last a few seconds and then they are gone when they happen). The incidence decreases when the data is followed to 12 months, and so on. There is a 3% risk of chronic debilitating pain. This is the really important number. This is pain that seriously affects the patient’s life, they cannot perform normal daily activities, cannot work, and/or the pain level is greater than a 5 or 6 out of 10.
Also note that the numbers quotes are for open inguinal hernia repair with normal weight mesh. Patients undergoing the same operation with lighter weight mesh have been shown to have lower rate of chronic pain in many studies, though some studies show no difference.
Depending on the surgeon, laparoscopic surgery is also expected to result in a significantly lower risk of chronic pain. The outcomes from this technique of operation, which includes implantation of mesh, is highly dependent on the expertise of the surgeon, moreso than with open procedures. One study showed a significant difference in recurrence rate and complications after 250 operations. Many of us believe at least 500 operations must be performed before the learning curve is surpassed. It is considered one of the main reasons why laparoscopy for hernia repairs has not become more common than open surgery (unlike gallbladder surgery).
With regard to your comments about specific populations at most risk for chronic mesh-related pain: they are young thin females. Mesh causes inflammation and I think perhaps if you don’t have enough far to buffer the inflammation, perhaps there is more perceived pain. Also, thinner patients may have more of a foreign body sensation, which can also be perceived as pain with the normal weight mesh, and so lighter weight mesh may be more appropriate for their habitus. Once again, it is less of an issue for laparoscopy, as the mesh is placed deeper, behind the muscle, but we still take these mesh weight factors into consideration.
With regard to tissue repair, it is no longer considered the “gold standard” for hernia repair, as mesh repair has a significantly lower recurrence rate. As a result, most modern surgeons do not have a large experience performing these. Those of us who employ the tissue repair into our practice may use it sparingly based on the needs of a patient. For example, I use the Bassini or Shouldice repair for inguinal hernias in some women, in those of any gender who do not wish a mesh repair, and in those with contraindications to mesh repair, such as infection or with specific reactions. The Shouldice clinic in Toronto is most famous for their tissue repair experience and have the lowest published rates of recurrence and complications. No one has been able to reproduce their data. In countries such as China, where 80-90% of hernias do not get mesh, there must be a lot of good experience with tissue repair. A rate of 30% recurrence is too high for a tissue repair. If you choose to have a tissue repair, I would seek out a surgeon who can perform this with results around 10-15% at the most, which is what the data used to show before mesh was introduced.
In conclusion, you need a consultation from a surgeon who can help you determine a) if you even need a hernia repair, b) which repair will best meet your needs with the best outcomes. As a 60-year old, and an athlete, I would not recommend a tissue repair unless you have true contraindications to mesh implantation. If you are thin, definitely a lightweight mesh is a good option. If you’re fit and healthy, laparoscopy is another good option. The type of hernia and size also factor in place (direct vs indirect).
Hope this helps!