David M
Forum Replies Created
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Add Sensei and Edward to the lap pain group.
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Watchful, there are two different ways to look at the small numbers here.
First, yes, you would think there would be more people coming to seek help with their meshes-gone-wrong and that may suggest that the actual number of bad cases is relatively small.
On the other hand, without knowing what the actual combined totals’ percentage is, can we begin to get a picture of the way the pain is divided relative to type representation. I think maybe so.
I cant remember a single person on here who had open mesh and came to complain about the pain, but I can think of five off hand that had lap mesh removal due to pain. Chuck, GI, AJM, N**, and Herminius come to mind and I think there are more. If you fill a big hopper with 400000 black balls and 600000 white balls, representing the proportions of lap and open mesh surgeries according to the above chart, what are the chances that the first five balls drawn would all be black? The answer for .4 to the fifth is about 1%.
The proportion of lap surgery snafus here is therefore not that easily ignored. Is this not true?
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It could be just luck, but assuming the higher pain rates for lap that we see on here are representative, do you have any theory as to why lap might cause more pain?
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Tldr version:
1) bend over if you sneeze.
2) wear a truss.
3) proceed with life, but try not to sleep on the need to get it fixed -
Well, I wish I had some good advice worth sharing. Foremost, I wish I knew whether I should have done this before when maybe a tissue repair would be more trustworthy. I’ve been mostly issue free during the 15 years, though, so who knows what I should have done.
Back when I first noticed in 2008 that it didn’t look right….because there was more of a raised mound on that side…..I was still working and I really didn’t change my activities much. The only specific thing that I remember doing differently was that I would always bend over if I knew I were going to sneeze. Obviously, sneezing and coughing puts a lot of pressure on your innards done there and you can always feel the hernia moving. For some reason, though, bending over before a sneeze minimizes that reaction for me.
That was pretty much it for awhile. In 2018, I had a heart attack and, as a result, really wanted to make sure that I was getting enough exercise. By then, the hernia had gotten much more noticeable, both visually and reactively. So, I bought a truss and began to wear it all the time. I think it really helps, both when I’m exercising and when I’m not. I frequently have to readjust it, and it’s probable that it could fit more appropriately, but it still is much better wearing it than not. Overall, though, I think I could wear it for the rest of my life after my operation. And that presents a big question. If I did so, would it help in never having a recurrence? Even though it is minimally bothersome, there will be a temptation to quit wearing it without knowing the good involved.
Phase three on my life with a hernia started about a year ago. I caught a fairly hard version of the covid and had multiple hard coughing spells. I think it worsened the hernia somewhat. Then I caught something else in March with a lot of coughing to add more insult.
Generally, I’m not very symptomatic, even now, if I am wearing the truss and not coughing. It doesn’t keep the hernia totally in, though. My Hernia is probably a direct hernia and reducible, but it will still reemerge somewhat pretty quickly after moving around, even with the truss. So, the truss – at least the version I wear – doesn’t maintain the hernia as reduced, but it does prevent it from emerging far enough to cause any big discomfort. The truss itself can get slightly bothersome around the waist and make my abdomen feel slightly pressured at times, but that probably is a result of the intestinal pressure. That pressure is not a deal breaker of any sort. Sitting down and loosening the truss always seems to help with that waist pressure.
And I guess that’s about it for me. The big caution that I need to be aware of is that I can’t totally go to sleep on it at this point. There’s a question of how many windows will I have to get it fixed before/if it gets more dangerous. I can hear intestinal gurgling at times when the hernia is out, which makes me wonder if it somehow is weakening my intestines. Then there’s the worry about stretching the spermatic cord too tightly. I don’t know how rational these fears are.
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I agree with everyone else, Edward, that in spite of your trust in your surgeon, you should get another opinion from a hernia specialist.
I say that, though I’m just going for my initial appointment next month. I had set up an appointment back in February, but the ice storm occured and I couldn’t drive the moderate distance to the appointment with the roads on that day. I think they were in the process of canceling the appointments when I called. Shortly thereafter I was plagued with a cough, which is just now getting back to normal.
The surgeon is the closest to me that specializes in hernias and he says he does Shouldice, so I figure it is a place to start. I’ll let you know if I respect the guy. I don’t think he has ever been mentioned on the forum. He’s in the DFW area.
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Watchful, sorry to hear about your Dad’s health. It’s wonderful to have your parents live into their declining years, but it’s tough to see them deal with the problems. My Dad had dry macular degeneration that eventually turned into wet. When it went wet, he had the Eyelea shots for awhile. About the time he reached 100 the scarring made the shots ineffective. His last couple of years, he could see us and hear us…..fortunately his hearing in one ear was still good…..but his seeing wasn’t good enough for him to read or watch tv. Even then, for the most part he seemed to be glad to be alive.
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William, is your dad’s current hernia a recurrence? If so, can you give more details (if you know) about the size and the condition. Also, do you know if it is indirect or direct?
Watchful, do you know if your dad’s hernia is indirect or direct? Did he leave it as a result of his other health conditions. Your post makes it seem like it would have been preferable to get it fixed at some point, but perhaps that hasn’t been possible.
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“Camper’s fascia serves as a protector and an insulator to the deep, vital organs of the abdomen. The function of the fatty layer is to absorb impact and dissipate forces across a large surface area to reduce the amount of impact that is transmitted internally. The adipose tissue also acts as insulation to help maintain a constant temperature within the abdomen. Its thickness varies depending on one’s body habitus.
As a part of the fascial layers of the abdomen, Camper’s fascia serves a vital role by separating the skin from the muscles.[4] In the skin, there are nerve endings that contribute to touch, proprioception, and pain. Muscular nerve endings are responsible for muscle contraction and tone. If there is a break in the fascial plane, new nerve connections can form and cause undesirable outcomes.[5]”
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“The fascia of Camper is a thick superficial layer of the anterior abdominal wall.[1][2]
It is areolar in texture, and contains in its meshes a varying quantity of adipose tissue. It is found superficial to the fascia of Scarpa.”
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wikipedia description of Scarpa’s fascia function:
“Scarpa’s belief that the fascia stops hernias from forming is not thought to be true today. Some anatomists suggest the membranous superficial fascia is the scaffold which attaches the skin to the deeper structures so that the skin does not sag with gravity but still stretches as the body flexes or changes shape with exercise”
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Yeah, but I don’t know if those layers are purposed for holding back the hernia. When you watch the videos, Scarpa’s fascia and Camper’s fascia seem more amorphous to me and look more like flexible fat than a holding tissue barrier. Obviously the external oblique is something of a retaining barrier, but are the other tissues in between it and the transversalis fascia meant for retention or padding. To be honest, though, the transversalis fascia itself looks almost like saran wrap, but it must initially be tougher than that.
I would love it if Dr Towfigh could give us more of a primer on the functional nature of these tissues.
In one of her videos, her guest said something about patients not understanding that the hernia coming through was not that large. While my hernia portrays as the size of a tennis ball, the core hernia might be smaller ….maybe closer to a golf ball(?), with the layers of fascia and skin covering it making it seem bigger. Still, I wonder if these interposed tissues have any actual retaining function. Maybe they are there for padding protection of the cord, etc.
You initiated some good questions for thought.
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Herniacomps,
Was your only mesh not sutured on either side? One of the questions I have about Lichtenstein is with regard to the medial suturing. Laterally the mesh is sutured to the inguinal ligament, which seems adequate, but I can not get a clear imaginative picture of the suturing medially. The muscles and tendon types there do not seem substantial enough to not tear in the videos
The other thing that I wonder about is that the spermatic cord is just laid back on top of the mesh in a lictenstein.
How big was the onlay mesh in your plug and patch when it went in? Is it similar to the Lichtenstein mesh?
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Yes, I believe he routinely cuts them, or something. As you say, though, some feeling is lost in certain areas, but the implication was that this is less important than preventing the pain from nerves traumatized by the operation results.
Been a long time since I saw the video, but I believe he asked the audience how many did this. There was a significant percentage, so it’s an important question to ask.
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I could be wrong, but I think Brian Jacob was the one who said in one of those hernia surgeons meetings on youtube that he routinely took the nerves.
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I think this is a great idea and started to suggest the same a couple of days ago. It’s what every new person wants when they first get here, to have some sort of view of what to focus on given their particular case.
Since most hernias are inguinal, maybe just start with a decision tree for that.
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If no one else is seeing this, then that ups the possibility that I was wrong. I don’t really have a huge beef with someone doing this, because I dont believe the intention, if true, was negative.
It’s just that too much of the same thing can be a distraction.
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Ive been wearing a truss for about 4 years. I actually first realized I had a hernia in 2008, and I sort of wish I had started using the truss earlier. Perhaps it would have slowed the progression.
I’d rather not wear it, but i don’t find it all that uncomfortable most of the time and know it helps, at least, some. If I stand up without it for a long period of time…washing the dishes, for instance.., it will definitely begin to bother me. With it, most of the time I can take a long daily walk without even thinking about the hernia.
Now, it doesnt really keep the hernia from pushing out, but it does aid in restraining it.
One of the possibilities that I wonder about is doing tissue repair and then trying to supplement that repair by continuing to wear a truss.
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Let me reword that:
I continue to be amazed at the thoroughness with which Watchful approached his surgery and the open mindedness with which he shares his post surgery journey and thoughts. Very nice.
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I mistakenly referred above to scarpa’s and camper’s fascia as being between the external oblique and the transversalis fascia instead of between it and the skin.