Watchful
Forum Replies Created
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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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I’m not a surgeon, but here’s my opinion.
I don’t know why some of your doctors recommend a neurectomy. Nerve involvement would be symptomatic well before 5 years.
It sounds like you simply have a recurrence. If your symptoms are minimal, you could just wait with that as one of your doctors recommended. If it bothers you too much, then you have to decide how to fix it. If it was me, I would go with laparoscopic mesh in this case. This is also what I was told at the Shouldice Hospital when I asked what to do if I get a recurrence after my Shouldice procedure.
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Right, what’s the role of the Shouldice part in this case? I guess there could be some types of tissue damage where just mesh isn’t sufficient.
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There’s also the other combo option of open preperitoneal mesh combined with a version of Shouldice. This is what is done at the Shouldice Hospital in rare cases of bad tissue quality (based on what I was told there).
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An inguinal hernia is one potential cause, but there could be others, such as a varicocele or a hydrocele.
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David M,
I’m not an expert on this. It seems that this depends on the tissue. Skin evolved to heal relatively well, but various internal tissue layers (such as fascia and muscles) may be different.
Internal scar tissue commonly appears in these open surgeries, and it’s one of the reasons for the difficulty with reoperations. I believe the injury to the internal tissues causes inflammation which results in scar tissue. This scarring can even spread further from the immediate vicinity of the injury as the inflammation sometimes spreads. The more extensive (or repeated) the injury, the more inflammation and scar tissue.
The scar tissue can encapsulate or impinge on various nerves and vessels, and it can cause nociceptive pain as well. In addition, you can get inflammation and scar tissue in the areas of stitching as you mentioned.
Reducing this type of injury is one of the advantages of laparoscopic or robotic surgery.