[jzinckgra]

Recurrent pain?

So I went to my GI doc last week and his conclusion is that there is no GI issue, meaning he dones’t think my pain is diverticulitis/losis or IBS. He also had a hernia repair by the same surgeon that did mine and he said many of the symptoms and pain I’ve been having are similar to what he experienced in the past. I didn’t ask if his pains went away, but I’m 2.5 months into this and it’s bothersome. Went skiing yesterday and I could feel the discomfort most of day.

So at this point, I guess my only option is to go back to my surgeon, but what’s he going to be able to do? I feel like I’m stuck with no solution .

[jzinckgra]

Irritable Bowel Syndrom (IBS) and hernias

Man, I am sick and tired of this pain. Everyday lately has been the same. I lay in bed just before getting up and the gas buildup on left side begins just under the rib then down to inguinal spot of my repair. The gas is released, I feel momentarily better, then the cycles continues. Once I get out of bed, the pain pretty much goes away until I start my daily routine, then the inguinal region hurts off/on all day.

I have a GI appt tomorrow, but not sure what he is really going to say. Some days it seems like IBS, then others, I’m convinced it’s hernia related. I really don’t want to go through a bunch of tests. Since end of Sept, I’ve had pelvic CT scan, US to look at potential hernia on other side, blood test and temp check to rule out infection (diverticulitis). Last colonoscopy was 2 years ago, so don’t think there is anything nefarious causing the issue.

I could always go back to my surgeon that did lapro, but not sure what he’ll say. Maybe I should request MRI to see if patch has moved or in some way been compromised. When I saw Dr G end of Nov, he said it sounded like post-surgical pain.

One final thing. Having sex lately hurts a bit in the inguinal region and when I go to urinate I get some pain after that quickly subsides.
Very frustrated.

[jzinckgra]

Recurrent pain?

In an inguinal hernia, is it the small or large intestine that pokes through?

[jzinckgra]

Irritable Bowel Syndrom (IBS) and hernias

quote :

yes, fat containing hernias can cause GI symptoms, such as bloating, but usually not of cramping, unless it is a muscle cramp (not intestinal cramp).

in most situations, I make the correlation between hernia and activity-related symptoms. I do not necessarily have to see the actual intestine stuck in the hernia to make a convincing diagnosis. It is thus not critical to get an ultrasound, for example, immediately at the time of a hernia attack.

Dr. T,

Can fecal material moving through an area of recent (7 month) inguinal repair cause pain? I’ve mentioned in another thread I am trying to figure out if my pain is IBS or post-surgical related. Also, do you know if the area in the inguinal region also contains the sigmoid colon?

One other thing to mention is that when this pain started over 2months ago, I was also feeling some twitching inside at the site of repair. It would last for a min or two and I felt it off/on for several days, but not recently.

[jzinckgra]

Recurrent pain?

quote :

Thanks again for your reply. So, for a tension free repair like the one I got, other than the mesh which presumably prevents the intestine from poking through, does the actual hole ever heal over?

Please read this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477030/

Great article, thanks. Two statements caught my attention:

1. “While the inflammatory response generated by polypropylene contributes to its durability, it also increases adhesion formation when the mesh is used adjacent to the bowel. As a result, polypropylene is rarely used alone in the peritoneal cavity.”

What is meant by “adjacent to bowel?” I thought all patches were placed directly over the bowel, so contact with intestine is assumed is it not?

2. “The inflammatory response to polypropylene also causes the material to contract by 30 to 50%”

Other than blood tests, how would I know I had inflammatory response and potential patch shrinkage? In any case, that is a lot of shrinkage.

My surgical report makes no mention of whether the patch was sutured in place. It was a 10x15cm Bard PP patch. The report says:

“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.”

[jzinckgra]

Recurrent pain?

quote :

Let me answer your another question that you have asked the Pro by replying to you using other answers tree.
http://www.medtronic.com/us-en/patients/treatments-therapies/hernia-surgery.html
You have tension free repair done laparoscopic way with mesh. It means that your body tissues were not closed/pulled back together. The mesh covered the hole in the groin and attached to the healthy tissue around the defect. The whole idea of mesh is to prevent stress due to tension when two separated muscle edges are pulled and attached together. This old technique may cause another hernia due to another post-op tear. Here is the picture of this “old” technique.
http://hernia.tripod.com/techcomp.html
The drawback is that mesh is an implant that may create other problems such as nerve entrapment, shrinkage and deformation, adhesions, etc… Thus, please do not get wrong that repair under tension is no longer an option. It is applied only under circumstances when it is better than mesh option. Typically, once the muscle are attached together there is no need in mesh anymore.
Balled mesh may be seen on the MRI if done with a special regimen/protocol. Also, doctor does tests on the affected area to confirm the diagnose. Unfortunately, it appears to be not so rear…

I think you identified source of your problem, which is your current level and nature of physical activity. When I was younger I was also doing sport activities on a stressful level (other than ski). My genetics did not allow me to continue my career this way. You are, obviously, the boss of your body. However, let me express few points that may potentially help you. No offence. I just wish you the best. Possibly you are younger than me.

When your body experiences extra load in certain weak location, which is operated area in your case, it tries to absorb it by distributing load to other areas of proximity: oblique muscles, ligament and co-joint tendon, sometimes even adductors, etc… If any of these will be torn due to this activity… First, it will be hard to identify the root cause without surgery. In case of the repair the doctor will decide either to remove the mesh or not, which is complicated thing by itself. (Dr Towfigh has mentioned this several times). All or most defects (torn muscles) would need to be repaired using sutures (under tension) or reattachment techniques without mesh. In some cases tendon release is applied (it will be “cut” from it’s origin…). Recovery from such surgery is painful, indeed. There is much more pain than after lap hernia repair for a longer time. The surgery by itself is not a guarantee to recover 100%. Physical therapy is necessary in such cases and it is done through the pain. It is “unforgettable” and costly experience that, unfortunately, many people go through due to groin injuries, which are right there – near private area. You can search sports hernia forums and sites, and visit different discussion boards to read reviews and opinions.
Another thing that I have learned, this time from my orthopedic surgeon, is when my knee was injured. My doctor has started to ask me some strange questions about my opinion and character and so on… My meniscus was injured and in some cases doctors may fully recover knee by suturing tear under certain clinical circumstances. These circumstances are only discovered during the surgery. However, this reconstruction requires extra recovery time and a lot of discipline and commitment from the patient. Certain moves must be avoided, knee in cast, etc… The doctor explained that if he does not believe that the patient can control emotions and can break recovery protocol then he is not qualified for suture repair. Instead, trimming of meniscus will be done – faster recovery and loss of at least 25% cartilage. For example, for pro athletes 25-35% of saved cartilage may add extra $$$ during career. Someone may else prefer different route. Where I am coming from is that if you neglect signals from your body and the worst thing happens some doctors may even turn you off as a patient. I have never heard of any doctor who wants to see his/her patient back with recurrence. Doctors want to win the battle together with you. They typically have enough business.
One of my friends got abdominal pain and bowel movements after long break between gym exercises while he did not do any surgery at all! His groins and abdominal muscles were soar for almost 1.5 months! His treatment was rest because he was scared enough 🙂

With best wishes

Thanks again for your reply. So, for a tension free repair like the one I got, other than the mesh which presumably prevents the intestine from poking through, does the actual hole ever heal over?

[jzinckgra]

Recurrent pain?

quote :

This is a complex situation.

IBS is a diagnosis of last resort. If your pain is activity-related, your hernia/hernia repair may be the culprit. If it’s only GI symptoms, then the hernia is less likely a problem. That said, is the mesh confirmed to be flat? Is there any suggestion that the mesh is exposed and causing adhesions to bowel?,

Most of the pain is activity related. Most nights I go to bed and when I lay down I get some mild pain for a bit then doze off. When I awake, I have little to no pain until I start my day walking around, twisting torso, etc. Just today, I took 100mi snowmobile ride and with all the bumps, my abdo region gets jostled all day, getting worse by end of day. This happened last wknd too.

Can a surgeon tell of the mesh is flat by just feeling around? I’ve rubbed the area and felt around many times and I can’t feel anything, but I’m not trained to either, unless it would be really obvious. Since Dr. G appt, which resulted in no recurrent hernia and no hernia on other side, I have not seen my local surgeon. I do have a GI appt this month, but I don’t think it’s GI, but not 100%. Bowels have been pretty normal, but in saying this, if there were any irritation around repaired hernia, would it feel better after bowel movement, with pain coming back minutes later?

One other question. When an inguinal hernia is repaired, the surgeon doesn’t just place the patch directly over the hole then stitch the outside right? Don’t they first suture the inner tissue to close up the hole then place the patch? Many thanks.

[jzinckgra]

Recurrent pain?

quote :

Ogh, no doubt… Most of general surgeons are actually capable to perform groin hernia repair. This is why people typically look for the local general surgeon. However, open repair was developed prior to lap and every single general surgeon must be trained to do this type of surgery in open fashion. You probably never thought about pros and cons relying on the doc. This is what most people would do anyway. Now, going back to your groin pain in the operated area. Here are my 5 cents. If rest and aleve/naproxen (if you are not alergic) will not alleviate pain and you will not feel better in few months I would seek help from a doctor who will be able to separate such possible causes of the pain as damaged nerve, deformed mesh, torn muscles near operated area (sports hernia – often missed by general surgeons), occult hernia. It is very hard to find such specialist. Easy to write, however, only top notch surgeon can do this. You may consider Dr Towfigh services to help you. Good luck with your recovery.

Thanks for your reply. I wish I could take a few months off, but I am way to active to make such commitment. Stupid I know, but I love to ski, snowmobile and workout at the gym. I could try taking a week or so off and see what happens. Come Spring, I am back to cycling and hiking.

[jzinckgra]

Recurrent pain?

Trust me, I wished I had gone to Dr. G. for open repair. My lapro surgeon is considered good in this area, but I never researched how important it is to get a hernia surgeon as opposed to general surgeon.

[jzinckgra]

Recurrent pain?

Are any docs monitoring this site anymore? Dr. T? Thanks. 🙂

[jzinckgra]

Surgeon challenging Radiologist’s CT scan

Dr. T, could you provide any more comments on my last two images? thanks again.

[jzinckgra]

Surgeon challenging Radiologist’s CT scan

Dr. T,

I’ve attached one more CT image and recent US image of this fluid sac. Three different surgeons, including Dr. G said there is no hernia. The radiologist said there was small fat hernia. You had previously agreed with this. Do these added images support your original conclusion? Thank you.

[jzinckgra]

Pain/tender 2 years post open repair w/mesh

quote :

Looking for advice on best next step.

Had open repair with mesh for an incarcerated right inguinal hernia in September 2014. Done at Mayo Clinic where I was a fellow at the time (I’m a neuroradiologist). Recovery initially went fine but a month later developed new pain/burning in upper medial thigh. Called surgeon’s office, nurse told me it was common, should go away. It seemed to go away, then recurred a few months later and groin became tender to palpation. Went to a different surgeon at Mayo (first available since I was told my surgeon who operated on me couldn’t see me for another 3-4 months). She examined me, said there’s no recurrence, probably inflammation from mesh, take ibuprofen for 2 weeks. I did and the pain subsided. I went almost a year with occasional minor discomfort, thought I was out of the woods. In spring 2016 pain flared up again. Since then it waxes and wanes, sometimes seems better with exercise (I run and swim regularly). A pain specialist who practices in the same area of the hospital as me did a steroid injection on ilioinguinal and genital branch of genitofemoral nerves…not sure it helped. He prescribed compounded cream (lido/fentanyl/gabapentin/etc) which also has had dubious efficacy.

My preferred response to things like this is to ignore and hope it goes away, but it doesn’t seem to be going away. It gets distracting at times and I think I should at least explore options. I still get intermittent burning pain/sensitivity in my medial upper thigh and more pinching/squeezing-quality pain in my groin area, and my groin has been pretty tender to palpation for months now.

I’d be willing to travel to be evaluated by someone with expertise in this sort of thing, if you guys think it might be worthwhile. I now live in Missouri.

Interesting. I had inguinal repair using lapro 5 months ago. All was well until about 1.5 months ago and I’ve been getting daily pain exactly in the spot that was repaired. It’s more of a dull to moderate pain that goes away upon walking, but flares when sitting, driving car or other bending activtities. Very frustrating. I recently had it checked and was told no recurrent hernia. Probably post surgical pain, maybe scar tissue, not sure. I think it could also be IBS as I’ve had CT scans that have shown diverticula.

[jzinckgra]

Possible Hernia, But With Odd Symptoms?

quote :

Dr. Towfigh,

I was finally able to undergo a CT scan–with Vasalva, to my surprise. (Didn’t think the local imaging place would be that progressive.) Doctor phoned this morning to say it showed a small inguinal hernia with fat, not bowel. She’s referring me to a surgeon.

Because it consists of fat, I wonder if that might be affecting the dull ache I experience when I haven’t ejaculated. Can the fatty tissue be pressing on the spermatic cord? Is it possible this is a cord lipoma?

Of course, I’ll address these questions with the surgeon, but wanted to try and come armed with a little bit of knowledge. Thanks.

Go and read my post:Surgeon challenging Radiologist’s CT scan. CT scan showed herniation of fat, but surgeons (I went and got three different opinions) all concluded there was no hernia upon physical exam. Not saying that will be the case with you, but while the radiologist concluded hernia, all surgeons in my case said it was inconclusive.

[jzinckgra]

Surgeon challenging Radiologist’s CT scan

Saw Dr. Goodyear today, prepared for surgery, but he concluded while there is weakening of abdominal wall on right side, there is no hernia. Left side pain, in area of recent hernia repair likely post op pain. Nice doctor, but bitter sweet since I was hoping to resolve my issue. He recommended waiting and seeing what happens.

[jzinckgra]

Surgeon challenging Radiologist’s CT scan

So I got one more surgeon opinion before heading to Dr. Goodyear. Saw a local Dr. yesterday and like everyone else so far did not feel any hernia. He did feel an asymmetry in the spermatic cords, with the one on the right being larger in the area of the fluid buildup. He says it’s likely a lipoma and he suggested I wait it out unless it’s really bothering me (it is).

I’m just more frustrated as ever since everyone so far as a different opinion, which I somewhat understand given there appears to be no definitive result, either physical or imaging. He thought it was a good idea to get a 3rd opinion from Dr. Goodyear, but was hesitant about doing “same day surgery”. I think this was more about not knowing who Dr. Goodyear is and possibly thinking this is some fly by night surgery.

In any case, I’ll see Dr. G on the 29th. I have a feeling there will be no surgery since he likely won’t feel the hernia either. Which leads me to the next question, which is whether he would operate to at least remove the lipoma. Maybe while he’s doing that he will see the hernia that apparently can’t be felt.

[jzinckgra]

Surgeon challenging Radiologist’s CT scan

quote :

Agree with Ct reading.

How did your appointment with Dr Goodyear go?

My appt is in two weeks. I did speak with Dr. Goodyear on the phone and he said the CT was inconclusive. I guess I should expect Dr’s to have different interpretations on image results. I am somewhat confused about something he said about hydrocoels. He said those are only found in the scrotum and the buldge I am seeing is the hernia. I found it difficult to understand since the buldge, which comes and goes can be pretty noticeable and yet the ultrasound was neg, the CT scan depending on the doctor is pos or neg for a hernia and nobody has yet to physically feel the hernia. It was quite painful today. A couple questions:

1. do hernias cause hydrocoel formation or vice versa? Or are they totally two separate things?

2. are fat hernias vs intestinal more or less painful and is one more difficult to repair?

3. I have been having pain on the left sided repair which was fixed 4 months ago. Could I be feeling referred pain from the right side? Could it be scar tissue formation or possible recurrent? The patch size on that side is 10x15cm. Many thanks.

[jzinckgra]

Surgeon challenging Radiologist’s CT scan

Dr. T,

I have an appt to see Dr. Goodyear end of the month. I am still concerned that if he doens’t feel anything, like my surgeon didn’t, then he may not operate despite the CT report. I have attached one of a few CT images pointing out the area flagged by the radiologist indicating herniated fat. Not sure if the resolution is good enough, but what it your interpretation? Many thanks.

[jzinckgra]

Surgeon challenging Radiologist’s CT scan

Thank you very much. I just visited your website and it looks like a lot of good info. If the docs here in Maine can’t figure it out, I’ll be sure to contact your office. My inlaws are from LA. 🙂

[jzinckgra]

Surgeon challenging Radiologist’s CT scan

Hi Dr. But isn’t a hydrocele typically fluid around the testicle? This was ruled out. thank you. So I assume you would not be in favor of exploratory surgery as it seems like my current surgeon doesn’t want to admit he is wrong.