[jzinckgra]

Juts to clarify, I had mesh repair not shouldice. Anyways, I called surgeon and they obviously need to see me in person to check for recurrence. Kinda stinks as they are 2.5hr away from me, but I realize this is the only way to know. I am starting to question my PCPs diagnosis thinking that maybe what she felt when I coughed was the hernia pressing against the mesh and not on the outside perimeter of mesh. As I said, I do not have visible buldge. The mesh size used was ~4×6″ and given I am a lean guy (6’1″, 155lbs), it seems hard to imagine the hernia would be poking out below the lower perimeter of the mesh. If this were the case, it would practically be at the base of penis, which seems very unlikely and isn’t where it hurts anyways. Today I feel totally fine. It just waxes and wanes from one day to the next.

[jzinckgra]

Sorry, it was mesh repair

[jzinckgra]

Lucky me, I had my annual physical with my PCP today and she said she could feel a hernia just below the repair I had last year. Can’t say I’m surprised based on recent nagging pain again, but very disappointed. The repair was 16 months ago. PCP thinks the hernia is pressing just below where patch likely is. Not sure if patch moved over last several months or possibly it wasn’t placed optimally, but will call surgeon next week. Given this was an open shouldice repair, can this be fixed with another open or must it be lapro?

[jzinckgra]

GI, thanks for your reply.

[jzinckgra]

Dr. Reinhorn who conducted surgery said to give it another week then do an in-person assessment. He thinks it’s likely a core muscle injury.

[jzinckgra]

quote sambuka:

I wanted to add too that Dr Reinhorn does surgery at the newton wellesley hospital but he also does it as a surgery center in waltham which has a good reputation. The surgery center in waltham only charges $5000 for the whole surgery so if you have insurance the cost is truly minimal compared to the hospital.

I just had my open mesh repair done by Reinhorn. My surgery was done at the Nashua facility. Total cost ~$5500. Dr. Reinhorn I felt was a very experienced and knowledgeable surgeon, but can’t comment on his shouldice experience, other then he told me how he learned how to do it, just like he told you.

[jzinckgra]

I can’t comment on what he said, but he just did my hernia open mesh repair. His reviews are very solid and his knowledge is quite vast from what I gathered, but best to get another opinion.

[jzinckgra]

quote Jnomesh:

For non mesh inguinal hernia repairs the surgeons most notes are:
robert Tomas-sedates repair
shouldice hospital toronto
dr. William Brown (CA)-knows how to do all types of methods including Bassini and tailors approach to patients particular circumstances once inside
Dr. kang (S. Korea) kang repair.
Dr. Grishken (Ohio)- own method (heard mixed reviews)
There are a few others but these seem to be the top 3

Don’t forget Dr. Reinhorn in Boston. He just did my open mesh, but also does Shouldice. No lapro though.

[jzinckgra]

Had my 3 week post-op visit yesterday. All went well. Still a bit of pain, but starting to cycle again this week. One question: Surgeon told me that even with mesh, hernia’s continue to grow in size. I may have misunderstood what he said, but is this true? Why wouldn’t everyone do Shouldice and use tissue to close the hole if the mesh wasn’t supposed to stop the hole from growing?

[jzinckgra]

quote Good intentions:

Yes, there is something off with the overall description. Either the original mesh was placed incorrectly or moved immediately, or it moved quite a distance before it was “incorporated”, or it migrated over a longer time, or jzinckgra actually had a bilateral mesh placement. The notes from the first surgery would tell something. Without those it’s a mystery.

Here is a snippet from my left side lapro surgery:

“The mesh was then inserted via the umbilical trocar and positioned in the left inguinofemoral region to completely cover the direct,indirect and fenrcral spaces widely. The mesh extended lateral to the internal ring,deep to the Coope/s ligament and to the midline. CO2 was then evacuated under direct visualization as the trocars were removed. The mesh maintained good position and trocar sites were hemostaiic.”

Based on the position over to the midline, I am not surprised it got in the way of the right side mesh.

[jzinckgra]

I’ll spare you my long story, but yes, I had lapro mesh repair in June 2016 for left side IH. Two weeks later, started feeling and seeing right side issue. Drs all said no hernia, CT scan showed otherwise. Didn’t do anything about it then cause it sorta went away for over 2 yrs until this yr. Started getting dragging feeling, bulge, some pain in right side. Ended up getting open mesh procedure two weeks ago to fix it. Oddly and somewhat frustrating to say, I’ve had pain again on left side and hoping I don’t have recurrent one. These hernias are a PITA. In case you’re wondering why I went open vs lapro 2nd go-around was because I heard recovery time and pain levels were slightly less with open procedure. I can tell you for me, that was not the case. While the open wasn’t/isn’t terrible, I have more pain during recovery mostly due to the 1.5″ incision at 2 wks post-op then I did with lapro.

[jzinckgra]

quote kaspa:

I’m trying to understand this and hope I won’t say something too ignorant.

As I understand, JZ had a laparoscopic repair of left inguinal hernia and now had an open one for right hernia. When suturing at 2 points in Cooper ligament, one point included previous left mesh.

So the question here is, wouldn’t previous doctor wish to have a bilateral repair, something not too difficult by laparoscopy, perhaps as prophylaxis for right side?

A month or so after lapro on left side was done I started getting right side pain with bulge. I assumed another hernia. Doc said no. I went to two other docs, including Dr. Goodyear who also said no hernia felt. CT scan did show fat hernia but since docs couldn’t feel it they wouldn’t do surgery. Fast forward three years and I had hernia on right side which was just patched.
i dont think patch from lapro moved. I read surgery report and can post here, but ultimately that patch which was 5.5″ in length was placed lengthwise across abdomen and extending to the midline. Whether this was oriented incorrectly I don’t know, but it’s not hard to understand why recent right side open surgery ran into the other patch. I have follow up appt with Dr for recent surgery and I will ask more about what he encountered during surgery

[jzinckgra]

In my report, Dr says he used two sutures to hold mesh in place. It states “…and 14 x 11mesh placed in place and sutured to the Cooper ligament in two places, one of which incorporated the previous mesh.” Am I to infer one of the sutures was actually placed between the new and old mesh? Or that both sutures are in the Copper’s ligament?

[jzinckgra]

quote scaredtodeath:

How is your pain level from the procedure

Getting better. Day 6. Pain is mostly from the incision now and less of the deep pain.

[jzinckgra]

quote Good intentions:

[USER=”1438″]jzinckgra[/USER] I saw your post of today that contained the records. Apparently it’s been removed or unapproved for some reason, since I saw it this morning.

But I noticed that the records implied that the new hernia was on the same side, the right, as the old one. It might just have been a typo in your medical procedure notes, my medical notes had significant errors also, with metal tacks mentioned, which were not seen by MRI or found during later mesh removal, and also referring to me as “she” in one instance.

Anyway, if you can get the records from your first surgery that would help you understand why the mesh was there, possibly. I still think it’s possible that you had bilateral repair, but just did not realize it.

Hi,

Here is the report again. I edited the last post too many times and it got flagged for spam. To answer your question about same side repair, I realize the surgery report below doesn’t specify, but when he refers to the fact there was mesh on the right side, one would assume this is the side of the previous patch. This is NOT the case. 1st hernia was left side, 2nd and most recent is right. Following the report, I have a few questions.

PREOPERATIVE DIAGNOSIS: Right inguinal hernia.
POSTOPERATIVE DIAGNOSIS: Right inguinal hemia.
PROCEDURE PERFORMED: Right inguinal hernia repair.
ANESTHESIA:Total intravenous anesthesia.

Us r: LP593 6/25/2019

INDICATIONS: . This is a 46-year-old male with symptomatic right inguinal hernia after previous laparoscopic repair. He understands the risks of surgery including bleeding, infection, recurrent hernia, chronic pain and informed consent was obtained.

OPERATIVE FINDINGS: There is an indirect right inguinal hernia repaired with a 14x 11mesh. There was mesh from the previous surgery extending to Hesselbach triangle and cue to the anterior abdominal wall. I had to excise some dense peritoneal adhesions
to the anterior abdominal wall and repair the peritoneum in order to facilitate the insertion of 14
x 11 mesh.

PROCEDURE IN DETAIL: After anesthesia was administered, local anesthetic was given after prep and drape. The preperitoneal dissection space was entered in the usual fashion and preperitoneal dissection was carried by first taking down the indirect sac, passed the bifurcation, spermatic vessels and vas deferens. The direct space was socked in from adhesions and I ended up opening the peritoneum and dividing the peritoneum leaving some of the anterior abdominal wall until I could create a pocket for the mesh. I then closed the peritoneum with running 3-0 Vicryl. Hemostasis was obtained with electrocautery and 14 x 11mesh placed in place and sutured to the Cooper ligament in two places, one of which incorporated the previous mesh. I then closed the external oblique and Scarpa with 3-0 Vicryl and 4-0 Vicryl for skin.
Steri-Strips and dressings were applied. Sponge, needle, and instruments counts were correct. At the end of the case, the patient tolerated the procedure well and taken to Recovery.

Questions:
1. I’m am thin (6’1″, 155lbs) guy so thinking the left side lapro which used a 6″ long patch was placed across abdo, so that explains why it extended over to right side triangle. Agree?

2. Is removal of adhesions, presumably from last surgery common?

3. Report said he had to repair the peritoneum. Is this above and beyond what’s usually done for IH? I believe he had to do it due to adhesions.

4. I’m an avid cyclist and go to the gym and was told to not do both for 3 wks as opposed to std 2 wks he usually advises. Could I do stationary bike and/or stair stepper lightly starting next wk? I forgot to ask Dr. I don’t want to screw up the surgery and think I overdid 3yrs ago too soon after first hernia, so just asking….

[jzinckgra]

To clarify, I did not have repair of recurrent hernia. The left side was patched three years ago using lapro. I got a new hernia on right side and this one was patched last week using open mesh.

[jzinckgra]

Well I thought my problems we’re long gone. After my last post in January, I saw my GI doc who ruled out anything GI related. By April or so, left side pain was gone until about 2 weeks ago. Now I’m having the exact same issues as before. Interestingly, the pain where the hernia was repaired began around the same time as last year, Oct. 2016. The only thing I can think of is working out more at the gym and weight lifting recently. Typically, I resort to cycling during the summer into Fall with little lifting, which probably explains the lack of pain during this time. But, anyways, it’s the same old issue as before. Feels good when I get up, but pain starts after any activity, worse when sitting, better when walking around. Seems like a correlation to less pain right after a bowel movement, then pain returns. As much as I want to believe the GI doc, I still can’t dismiss the possibility of it being GI related, although the gym correlation is strong too. Aggrevating. …

[jzinckgra]

quote jzinckgra:

Recurrent pain?

Dr T,

Does the actual hernia hole heal itself closed? I am trying to understand my recurrent pain. As mentioned in another thread, my surgeon placed the mesh without sutures or tacks. I’ve heard one can get scar tissue, but how could that happen in my case? I undrtdtand that my own tissue is supposed to grow into the mesh and essentially become “one”, so why would I have recurrent pain?

If the hernia hole never really heals itself closed, then I can totally understand the pain as it would seem to suggest the intestinal content is still trying to get through, but is prevented by the mesh. Is this accurate?

HI,

Was following up to my recent questions. thanks.

[jzinckgra]

Recurrent pain?

Dr T,

Does the actual hernia hole heal itself closed? I am trying to understand my recurrent pain. As mentioned in another thread, my surgeon placed the mesh without sutures or tacks. I’ve heard one can get scar tissue, but how could that happen in my case? I undrtdtand that my own tissue is supposed to grow into the mesh and essentially become “one”, so why would I have recurrent pain?

If the hernia hole never really heals itself closed, then I can totally understand the pain as it would seem to suggest the intestinal content is still trying to get through, but is prevented by the mesh. Is this accurate?

[jzinckgra]

Inguinal Hernia Surgey Complication In Progress?

My surgeon just called about my constant repair pain. I asked if he used staples or tacks to hold mesh in place. He said neither. The mesh is free flosting. Is this common?