LeviProcter
Forum Replies Created
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quote Momof4:I agree that Dr. Procter should be added to the list! I haven’t had surgery with him, but had an office consult for a mesh problem. My problem ended up being better handled with Dr. Towfigh, but Dr. Procter offered very insightful advice and answered all of my questions. He even consulted with other physicians to help me find the best solution for my situation. Thanks, Dr. Procter, for offering your expert advice here. It is truly appreciated.You’re very welcome.
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Dr. Pauli can get you sorted out. He is competent and you shouldn’t necessarily need to develop a game plan for him. He will do that for you. What can help him, or any other surgeon you see, is to get all imaging on a CD, all reports from imaging, all office notes from all the consultants that have evaluated you.
You likely could have a hernia that isn’t appreciated on exam and/or imaging.
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Yes.
Plenty of patients have clinically symptomatic hernias without developing a bulge.
They should be considered for an operation if the clinical history and exam supports it.
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It will not disappear.
It will always be there.
It will increase in size over time (unpredictable rate however).
If asymptomatic leave it alone.
I would not offer an operation if it was asymptomatic and without evidence of intestine in it.
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Drainage can be from many things.
Foreign body (mesh, suture, etc) can cause these issues.
This requires an evaluation by surgeons that remove mesh.
Brian Jacob is an excellent surgeon in NY that could help steer you in the correct direction.
https://www.laparoscopicsurgeons.com/our-surgeons/brian-jacob.html -
There is no best mesh.
Standard, agreed upon, mesh for an MIS inguinal is a standard weight polypropylene as delineated by the European Hernia Society Guidelines.
That mesh brand you have identified is one that fits this recommendation and is safe.
All mesh manufacturers have lawsuits.
Polypropylene has been used since the 60s for inguinal hernia.
It is safe.
It, and any other permanent prosthesis, can have consequences.
The majority of mesh complications (independent of manufacturer) are a result of surgical technique as compared to the mesh itself.
If I had an inguinal hernia I would go with a regular weight polypropylene product.
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Still pretty early in the postoperative course. Need to give it at least 6-8 weeks.
Gluteal nerve sensation is supplied by any nerves in the region of an MIS inguinal hernia repair.
See above link for skin sensation region based on the nerves at risk in an MIS inguinal:
– iliohypogastric
– ilioinguinal
– Genital branch of GFN
– Femoral branch of GFN
– Lateral femoral cutaneous nerveThe femoral nerve itself would be very difficult to in-advertantly injure. It’s difficult to even find and is often deep to psoas
Your symptoms don’t sound tack related.
Your symptoms seem to be pressure on some of the groin nerves (lateral fem cutaneous) related. If it occurs in a seated position it can be mesh pressing on the nerves but is relieve with moving. Your mesh is generating lots of inflammation as its intended at this time frame.The gluteal down to the foot can imply lumbar nerve root impingement vs muscle spasm related issue.
Nerves are not sought typically to prevent injury. Tacks are avoided in the triangle of pain (where the nerves primarily are).
Fixation often not needed unless large direct hernia >= 3cm.
If fixation is used it’s based on anatomy and landmarks.
Stretching is fine.Way too early to jump to conclusions.
Be active.
Give it 6-8 weeks before digging further. -
Mesh removal is a big deal. It can carries serious complications.
I appreciate your symptoms. You will require a very thorough workup to determine if the risk vs benefit of mesh removal is appropriate.
I agree that you should be seen by hernia surgeons that explant/remove mesh as they have a dedicated expertise to determine if this is needed.
Typically start with:
1. History and physical exam
2. Dermatome map testing in the office
3. Review operative report from initial surgery
4. MRI to look for recurrent and/or unrecognized hernia(S)
5. Then go from there…. -
quote Chaunce1234:How did the appointment go?
It sounds like the hernia doesn’t bother you much which is great. Also a chief of surgery would presumably have a good number of hernia procedures under their belt with a lot of experience, but you can always ask the surgeon how many hernias they have fixed too if you might find that helpful.
If you want a second opinion for whatever reason, the following is a list of eastern USA surgeons that either have a particular interest/specialty in hernias and/or possibly offer non-mesh repair if appropriate to the patient. Obviously there are going to be many great docs that are not on this list too.
– Dr Brian Jacobs in New York, NY
– Dr Samer Sbayi in Long Island, NY (trained at Shouldice clinic in Toronto)
– Dr William Meyers in Philadelphia, PA (special focus on athletes, sports hernia, and core injuries)
– Dr Alexander Poor in Philadelphia, PA
– Dr Jarrod P Kaufman MD in Brick, NJ
– Dr. Andrew Boyarsky in New Brunswick, NJ
– Dr Igor Belyansky in Annapolis, MD
– Dr David Grischkan in Cleveland, Ohio
– Dr Paul Szotek in Indianapolis, IN
– Dr Bruce Ramshaw in Knoxville, TN
– Dr Jonathan Yunis in Sarasota, FL
– Dr Robert Tomas in Fort Meyers, FL
Good luck and keep us updated on your decisions and progress.
You can add me to that list that can offer above, I’m in Richmond, VA.
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Mesh unlikely to move at this point. Typically after 8 weeks it’s relatively scarred in. Contraction of the mesh can happen over time to re-expose hernia(s).
Safe a time as any to get back in shape from a hernia standpoint. If it’s going to recur waiting longer won’t change anything.
If you were to have a bad outcome from a mesh based groin hernia repair, it should have happen by now.
By all accounts this is a successful repair.
The umbilical hernia may enlarge over time but if its asymptomatic you can see what happens with exercise. If it starts becoming painful, etc then you should see a surgeon about repair.
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First ? – Yes, it can be related to a hernia(s). However, a full history and physical by a clinician experienced in hernias and abdominal pain would be recommended.
Second ? – Avoid activities that worsen your symptoms. Aside from that without imaging, etc it’s hard to make other recommendations.
Third ? – Not always, but abdominal contents trapped or stuck in a hernia can cause symptoms. Strangulation has nausea associated with it but often many other symptoms.
Fourth ? – yes.
Fifth ? – Hernia exams often include various positions, etc to identify and delineate the extent of a hernia. -
Femoral hernias can be difficult to diagnose on exam and on certain imaging formats. The best imaging modality of un-appreciated hernias on other imaging (i.e. US, CT scan, etc) is an MRI. That imaging modality is the gold standard imaging for occult, or difficult to identify, hernias of the groin (inguinal/femoral/etc).
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Polypropylene (PP) has been used since the 1960s by Usher for hernia repair (Read, R.C.: Milestones in the history of hernia surgery: prosthetic repair. Hernia 8(1), 8–14 (2004)). PP itself is relatively inert and does degrade mildly overtime.