LeviProcter
Forum Replies Created
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Where do you live? We can help figure out what type of surgeon you need.
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If you’re near Richmond, Va I’m happy to talk to you.
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Tacks can cause pain. Tacks, however, do have acceptable indications. Nothing is ever black and white accept alive or dead.
Before applying causality to the tacks you need to see a surgeon that deal with chronic groin pain relating to hernia repair. You need a thorough physical and history, dermatome map testing, review of operative report(s) and imaging. Without all of that you will go down numerous rabbit holes.
Where do you live? We can help find you someone that can assist you in this workup.
You can send me your images if you’d like and I can look at them. levi.procter@vcuhealth.org
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Intense in what way? Pain?
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What surgery(ies) led to your current hernia? How big is it?
Non-mesh repairs for a true incisional hernia have recurrence rates of approximately 50% at 2-5 years. If component separations are done at the same time of the tissue based repair the recurrence is lower but it’s a massive operation and burns bridges potentially for future repairs.
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Agree with the MRI.
Many potential causes.The MRI will be very helpful. Report back with that data. Likely scenarios are recurrent hernia, meshoma (wadded up mesh) and unrecognized occult hernia.
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Many approaches to this problem.
Recommendations for what type of surgeon is hard without imaging to review and your overall wellness and other data.
There are no credentialing processes for hernia surgeons. Hernia specialist doesn’t carry weight as it means different things to different people and is largely a marketing tool by hospitals.
We can help you find surgeons that could address your issue. Hernia surgeries need to be patient based and included expectations, future surgeries, etc.
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Vasectomy can cause this pain depending on where the vas was divided. If divide at the testicle (common) then its very unlikely this explains his pain.
A vasectomy performed near the testicles and mid groin would be nearly impossible to unroof or cause an inguinal hernia.
Hernia can cause the same pain.
Hernia and a post vasectomy patient could cause this pain.Vasectomy can injury genital branch of GFN. If vasectomy is performed near the inguinal external ring it could affect the ilioinguinal and genital branch of GFN which can cause similar symptoms..
Inguinal hernias can cause compression of this nerve.He should get a thorough physical exam.
He should get dermatome map testing of the groin.
He could get a cord block under ultrasound guidance. If this takes care of his pain one could consider resection of the genital nerve and vasa vasorum of the vas deferens during an open inguinal hernia repair.He should see someone familiar with groin pain, mesh removal, etc before proceeding with a hernia repair. There is much that should be considered, discussed to develop appropriate expectations for everyone involved.
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You should seek a second opinion before going down the imaging pathway.
Obtain your operative report and bring with you to the second opinion. -
Biologic implants that are not hybrid implants are not permanent. They go away.
The biologic implant serves as a lattice for your body’s tissue to grow into and ultimately replace in time.
However, we don’t have any that allow significant collagen (scar) deposition. They allow blood supply and other tissue ingrowth.
Therefore, when they’re absorbed your reply depends on the degree of tissue healing through mesh.
They generally are reserved for very high risk situations and have a poor long term success rate for maintaining inguinal hernia repair.
I would not recommend for most elective inguinal hernia repairs.
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I would see your surgeon if you haven’t.
I’m in Richmond Va and do mesh removal.
Igor Belyanski is a highly regarded surgeon fluent with this issue in Annapolis, Maryland.
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Leave them alone.
Pay attention in the future to pain and/or bulge in the region of the imaging locations of the hernia.
Lots of people have imaging only hernias without clinical symptoms.
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Removal is safe and with appropriate risks.
Real key is determining the cause of the pain first.
I would recommend seeing a surgeon familiar with groin pain and mesh removal.
In appropriately selected patients mesh removal plus or minus neurectomy is successful in pain relief.
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If there is concern for a hernia and there’s no obvious bulge then a CT scan of his abdomen is reasonable (while doing a valsalva maneuver).
this is pretty good at evaluation for a hernia.
If thats negative he should
follow back up with the urologist for a formal reveal. -
Yep. Open may be more beneficial as gravity will help pull abdominal wall down and intestines upright push against the anterior abdominal wall. Better than lying flat. Even if your MRI is negative you could still have a Spigelian hernia. It’s premature to comment on repair types (mesh, etc) until it is known what you have. Let us know what the MRI shows.
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Desarda is a tension free tissue repair. If I was having a tissue based inguinal repair I would personally (my opinion only) favor a Desarda over a Shouldice.
I would have to let Dr. Towfigh comment on robotic tissue repair as I currently don’t perform that type at present. They’re typically repairs involving suture/stitches to close the hernia without mesh.
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How did they fix your “sports hernias”? Did they place mesh at that time?
I’m suspicious you have a recurrence.
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Desarda repair is straightforward tissue repair also.
Yoire going to likely have to travel for the type of repairs you seek.
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Valsalva won’t hurt and can help find smaller hernias. If you can do it I would recommend it.
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I can email you an article on this if you’d like.
Here is the abstract:
Missed lipoma of the spermatic cord A pitfall of transabdominal preperitoneal laparoscopic hernia repair K. S. Gersin, B. T. Heniford, A. Garcia-Ruiz, J. L. Ponsky Minimally Invasive Surgery Center, Department of General Surgery, Cleveland Clinic Foundation, Department of General Surgery/A80, 9500 Euclid Avenue, Cleveland, OH 44195, USA Received: 22 July 1998/Accepted: 22 September 1998
Abstract
Background: Missed lipoma of the spermatic cord is a pitfall unique to the transabdominal preperitoneal (TAPP) laparoscopic hernia repair. This problem occurs when a palpable inguinal mass is noted preoperatively, but no identifiable hernia defect is found at time of laparoscopy and the procedure is terminated.
Methods: Our group encountered six patients without intraperitoneal defects that had large cord lipomas on preperitoneal exploration. Two of these patients had undergone previous intraabdominal laparoscopy for a proposed TAPP repair, which was aborted when no defect was seen.
Results: Both patients were referred for continued symptomatic groin masses, which were subsequently treated by lipoma resection in conjunction with inguinal floor repair.
Conclusions: When patients present with a groin mass, exploration of the preperitoneal space and cord structures is indicated during TAPP repair, even in the presence of a normal-appearing abdominal floor. Abandoning a transabdominal approach without exploration of the preperitoneal structures may lead to a failure to identify symptomatic and/or palpable cord lipomas.