Watchful
Forum Replies Created
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Hi ajm222,
Have you had a dynamic ultrasound or MRI to check if there’s a hernia?
What kind of mesh surgery did you have originally? Was it open or laparoscopic?
It’s common for surgeons to tell you that symptoms that persist for over 6 months or a year will not improve or go away. However, in my personal experience the situation may still improve. I’ve had symptoms similar to yours after a Shouldice procedure, and they improved around two years after the surgery. They didn’t resolve, but they’re better.
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Sorry to hear that. Assuming it’s not obvious if you have a recurrence, you need to go to a top place to diagnose. A really good surgeon (like Dr. Chen) may be able to feel it with a physical exam. Expect this to be painful if they truly make an effort. Most surgeons won’t. You can also get a dynamic ultrasound or MRI done. These show recurrences. Again, there are very few places that know how to do this.
If you have a recurrence, the best way to fix it is most likely laparoscopic or robotic mesh.
If the symptoms don’t bother you too much, I wouldn’t do further surgery unless it starts bothering you too much. No harm in trying to have it diagnosed, though.
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My advice – continue waiting. I don’t see why you would take the risks of surgery when your hernia symptoms are mild.
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Grischkan and Petersen are exceptions if that’s what they said. If you ask surgeons who do both, such as the Germans, Towfigh, Yunis, you’ll hear the opposite about recurrence (higher rates with tissue repair).
Chronic pain is a harder question. Not much clarity on that.
As I said many times before, if I had to do if all over again, I would do Lichtenstein in my particular case. I think that in some simple/easy cases tissue repair is a better choice since the risks of mesh are avoided while still providing a good repair. With a large hernia, weak tissues, bad anatomy, just go with mesh.
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@markk
Yes, recurrence rates are believed/known to be higher for tissue repair of inguinal hernia. I don’t think doctors are hiding this (quite the contrary) – they will tell you exactly that if you ask. Tissue repair of inguinal hernias has largely disappeared from modern medicine for good reasons. The results weren’t particularly good back in the days when it was widely practiced. That doesn’t mean that mesh doesn’t have its own issues, of course.
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Come on, you should really stop this, Chuck. See my suggestion of rebranding yourself as JimH, and sticking to that. You really don’t need to pretend to be someone else to ask your questions.
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The Chuckster is becoming a master puppeteer running multiple sock puppets at the same time these days, and these sock puppets even talk to each other sometimes (like “MarkK” and “Kody”).
Chuck – How about calling yourself JimH (after Jim Henson, the famous puppeteer), and sticking to that persona from now on? You can ask the same questions – just stick to one identity.
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The hard bacon with nerves pictures that I saw were from Lichtenstein.
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They all have potential issues. The pictures of Lichtenstein mesh turning into hard bacon with nerves and other structures attached are not something that’s easily forgotten. Those are the pictures shown by Brown, Muschaweck, and other mesh removal surgeons.
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I still like tissue repair more, but only in cases where it’s a good fit for the patient. Unfortunately, it’s not really possible to tell for sure before surgery. You don’t want to go to a tissue repair surgeon who will force a tissue repair on you even when it’s not a good fit for your particular situation.
Like I said many times before, my recommendation is to go to a surgeon who can do both tissue repair and mesh very well, such as Conze and Lorenz, and let them decide based on what they see during surgery.
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Chuck – There is no answer. Both types of approaches are problematic, and the variations between different patients and different surgeons are likely more significant to the outcomes.
I don’t know yet what I’ll do about my chronic pain and discomfort. Obviously, there is no “mesh removal” option in tissue repair… I haven’t consulted with anyone yet. I’m guessing that a neurectomy would be the only option, and it’s not clear to what degree it will help, and what issues such a surgery could introduce. I’m still waiting with the hope that things get better with more time.
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The same can and does happen with tissue repair as well. This kind of bad outcome isn’t limited to mesh. It’s rare in both types of repair, but it happens.
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I’ve had some pain symptoms on both sides after my surgery even though the surgery was only on one side. It is possible that some direct or indirect damage was caused on the left side even though the surgery was on the right side. Inflammation can spread, for example.
Also, the nervous system isn’t really all that well understood. For example, there are some documented cases of testicular pain where the patient had an orchiectomy for the painful testicle, and the pain then moved to the other testicle.
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I think there was only one person on this forum who had Desarda (Casimir), so there isn’t much direct experience with that procedure here. His surgery (with Tomas) was bad, and he had another surgery (with Grischkan) if I remember correctly.
All these surgeries are a crapshoot. Based on what you’re describing, I would keep waiting as long as things are stable.
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David M,
I think you’re referring to the Halsted method from the 19th century.
When I consulted with Dr. Brown, I was grilling him a bit on what he was actually going to do in my case. It sounded like a Marcy reinforced with a Desarda. He refused to use the actual names of these procedures for some reason. When I asked him if the reinforcement was a Desarda, he said that Desarda didn’t invent anything new, and this approach had already been known as Halsted. These aren’t actually the same technique, of course. He gave me the willies.
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Is there anything in particular about your symptoms that makes this surgeon suspect that there’s more going on than just a recurrence?
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ajm22,
In my case, the scar tissue kept remodeling and softening for a very long time. It got noticeably softer at two years, which was also when I had the improvement in symptoms.
With an additional surgery, you are likely to get more scar tissue, not less. Unless the surgeon has a clear good plan of what they’ll be doing in there once they open you up again, I would be very reluctant.
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I actually asked him this question, and he said fix the recurrence with mesh.
It’s true that in the old days tissue repair was used to repair tissue repair recurrences. However, even primary tissue repair results were fairly poor on average, and recurrence repairs did even worse. There were good reasons for the fast adoption of mesh – it wasn’t primarily driven by some corporate conspiracy, at least not for inguinal hernia applications.
The Shouldice Hospital was one of very few places that reported very low recurrence rates with tissue repair. They reported higher recurrence rates after recurrent hernia repair, but still reasonable. They never studied properly their chronic pain rates. Not sure how well recurrences were studied either – they don’t really follow up with their patients. Also, they don’t consider hernias without a bulge to be real, so if it’s just seen in imaging, they ignore it. Oceanic’s case wouldn’t be considered a recurrence in their official stance, which is ridiculous. These days, when asking about what to do for recurrence, even they say lap mesh, or at least that’s what they said in my case.
I’m not a fan of any of these surgeries – they’re problematic in way too many cases based on the research papers and the individual cases that I’m familiar with, which is the reason I believe in watchful waiting when possible. It’s even trickier with recurrences. You can’t keep going back in again and again without repercussions, so you need something that would minimize the risk of recurring.
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Not sure if it will inevitably get bigger since the area around it may be stronger than normal thanks to the repair. It’s certainly a concern, but inevitable may be too strong. Maybe wait and see if this actually happens or not. It’s typically a gradual, not sudden process. Also, if you go with lap mesh eventually, it won’t really matter if you let the hernia grow or not by waiting.
You can’t go back in again and again safely. The risks of chronic pain and blood supply damage (even risking your testicle) increase. It’s very important to get it right the first time. Since that didn’t happen for you the first time, you really need to get it right (that is a good repair) the second time if you decide to treat it. Lap will give you a good repair that will last without going back into an already operated area. All these hernia surgeries are risky, but this is probably less risky than going open again to do a questionable repair which may lead to further surgeries.
Like I said, my approach would be watchful waiting as long as the symptoms don’t bother you too much and the hernia size is stable. Even if you ultimately need to have surgery again, at least you won yourself some more time without living with the potentially bad repercussions of another surgery. If your quality of life is pretty good right now, don’t risk it would be my advice.
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This reply was modified 3 months ago by Watchful.
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This reply was modified 3 months ago by
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As far as I know, Dr. Krpata doesn’t do laparoscopic or robotic surgery.
I asked multiple surgeons who do both open and lap about what to do after Shouldice recurrence. They all said lap. Even my Shouldice Hospital surgeon (who doesn’t do lap) said lap. Not that I trust him much after what happened with my surgery.
One big problem with the situation is that you can’t be sure that the symptoms are caused by the recurrence. They could be caused by the Shouldice repair. In that case, you can end up repairing the hernia laparoscopically, but still suffering from the symptoms plus adding whatever issues you get from the lap surgery (hopefully none, but as we know from all the papers we read, the incidence of problems with that procedure is far from negligible).
There are no easy answers, unfortunately. It’s a crapshoot. My inclination would be to do nothing as long as the symptoms aren’t too bad, and the hernia size is stable.