MikeL
Forum Replies Created
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I personally would recommend to rule out concurrent groin disruption aka sports hernia first before concluding that incisional hernia is the only culprit. Unfortunately, oftentimes this can only be discovered at time of surgery done in open fashion. MRI and ultrasound may not be sensitive enough. May be 2 issues should be taken care of at the same time? Only surgeon makes call how to fix it: mesh or no mesh, should surgery be converted from open to lap etc… Personally, I would be pursuing fix and get 2-3 opinions from best top notch surgeons like Dr Towfigh and/or others mentioned in this forum. Good luck.
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Your question seems very specific and I don’t have precise answer. However, dissolvable sutures are oftentimes used to stitch upper layer of muscles while lower level (stronger) muscles are “closed” with permanent sutures at pure tissue repair. UK doctors who use pure tissue repair based on internet info are Aalie Sheen from Manchester and Simon Marsh from London. I am 100% sure that there are more surgeons in UK who use pure tissue repair. I would also mention that you should be very careful with Desarda technique, which was criticised enough.
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I am not a doctor, but my advise is to get rest from aggrevating activities, indeed (possibly for months). Let the pain subside. Take anti-inflammatory. I personally prefer naproxen-Aleve for muscle injuries, which you can buy over the counter. If it doesn’t help then you should definitely visit a hernia surgeon preferably who is knowledgeable in the area of sports hernia. If no hernia observed then your option narrows down to a specialist in groin disruption repairs/sportsman hernia. Any hernia surgeon may give you cortisone (or similar) injection to reduce inflammation. Good luck.
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I think that only MD can answer these questions after examination. At some point doctors may want to order MRI. If you think that rest helps then try to rest and take some anti inflammatory.
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What you describe is something similar to athlete injuries in groin and hip with no evidence of true hernia. They go together very often. Google Dr William Meyers. Many patients-athletes come to see him with hip/labrar tears/abdominal tears (aka sports hernia). It’s important to mention that order of surgical treatment of these areas is important. Typically, groin area is treated last. However, first you must make sure there is no true hernia. Also, possibly need to visit hip surgeon as well.
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Lifeboat, I assume that mesh was left when other groin reconstruction was done years later. Your lap repair was done in tension free fashoin while following core muscle surgeries have been performed using pure tissue repair techniques. No mesh repair does induce tension in the groin (besides scar tissue problem). Even if the scar tissue breaks mesh and surrounding tissues under tension may still contribute to your symptoms. Possibly, if symptoms persist for a ling time, you should seek second opinion and specifically ask hernia surgeon about neurectomy, which is done as open repair.
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No tacks or sutures for mesh?
May be this will help
https://www.ncbi.nlm.nih.gov/pubmed/23975444 -
Recurrent pain?
I think what it simply means that the mesh may potentially adhere to your internals. However, it is attached to your muscles from inside. You should ask your surgeon what technique he/she used to attach the mesh. Only imaging tests may help to identify mesh current form and position as Dr Towfigh has mentioned. It’s probably still challenge to catch all this mesh information. I am sure that Dr will define special imaging protocol and prefer machine of a higher end. This article briefly describes mesh attachment methods. There are videos on the YouTube that can educate you if you tolerate all this stuff …
https://m.youtube.com/watch?v=TGFtFQ_hY0Qhttps://www.facs.org/~/media/files/education/patient%20ed/ventral_hernia.ashx
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Not sure what to do – surgery or not
Dear Norton,
I think that the best way to study statistics is to read studies outside of this forum. You may find out that “the grass is not so green” even in case of pure tissue repair. Where mesh is definitely blamed is occurencies of deformed mesh/ball mesh, nerve entrapment, adhesions to other parts of abdomen. These cases are not considered as so frequent statistically. Nerve entrapment by either scar tissue or mesh in many cases is successfully managed by few steroid injections, etc… As of pure tissue repair, overtightening of the torn muscle that is pulled together is menioned as another case of chronic pain. The advantage of the no mesh repair, in my opinion, is not mainly because of eliminating any nerve entrapment or balled mesh causes. It is rather the possible corrective action is more straight forward. Literature mentions ischemic pain in the region tighten by sutures with no mesh. If the pain source will be from there and will not respont to non-surgical pain management then redo surgery will use mesh. In other words no mesh removal is involved as corrective action. Now, tightness in the operated area is affected by skills of the surgeon and how healthy your tissues are. I think the younger the person the stronger and more flexible muscles are. However, if you are in a good shape it is very possible that you belong to this category as well.
Please read these articles. You may find the stats you are looking for.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421159/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075594/
In my opinion the healhier the torn tissue, I mean smaller tear and less painful preoperative conditions, the better expected outcome is. Why should you wait for pain and other symptoms? Earlier you address the problem easier the repair on you is supposed to be. You mentioned that hernia is of a certain size. It does not automatically mean that length of applied sutures will be the same. It will depend on how bad and weak surrounding tissues will look alike.
I think that medical hernia society should weight and re-estimate surgical approaches based on patient segmentation analysis. More robots entering operative room potentially downgrading surgeon skills and narrowing number of offered solutions. US surgeons lost capabilities of hernia pure tissue repair to large extent (I mean it is hard to find them), many offer lap repair and try to avoid open repair with mesh. Are universities teaching surgeons to perform this type of surgeries? What to be expected in 10 years from now when the old school doctors retire?
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Not sure what to do – surgery or not
If I would want to continue running at this age I would definitely take care of the hernia. If the doctor thinks you are a good candidate for pure tissue repair then you probably are… Not everyone can qualify for this type of surgery. Overweight people may not handle this very well and get recurrent one fairly quickly. As of mesh… You see here a lot of people here in this forum while the reality is that probably 95-98% of population (after hernia repair with mesh) never heard anything about hernia complications… I would recommend to keep in mind the following. Any pure tissue repair is more invasive than mesh repair. You will probably end up with some ischemic region where the sutures will be placed, which is normal. Some mild tight and numb feeling will be there “forever” (not a big deal in my opinion either). Recovery on average is longer and more painful, which is also very normal. Be honest with you, runners primarily experience “horse” type monotonic loads on the groins and get wear because of that rather than twisting or pushing. I would find another good doctor for 2nd opinion who is very proficient with mesh and ask about so called “soft” type mesh that could fit your runner’s goal, although modern lightweight mesh can be great fit. I am not a specialist… In my opinion, mesh would be better option for runner at this age rather than any type of pure tissue repair simply because you do not do moves similar to what gymnasts, figure skaters, soccer and football players do. Those folks may demand pure tissue repair simply because they would want “working” aligned muscles attached together. Open mesh repair – Lichtenstein repair is the golden standard (no lap). However, my advice is to go with your own personal “animal” feeling. You feel safe with no mesh – go for it if the doctor qualified you as a good candidate. Doctor does not want to fail either.
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Recurrent pain?
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/
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Recurrent pain?
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
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Recurrent pain?
Dr Towfigh, how difficult would it be to catch this possible adhesion to bowel? According to this article MRI may be reliable way to approach such gastro- related issue. https://www.hindawi.com/journals/grp/2016/2631598/
At the same time the researchers claim that adhesions are not cause of a long term pain, which sounds surprising to a non-professional ear. May be these results are primarily correct for ventral hernia mesh repair and should not be extended to other type of hernia? If adhesion is confirmed how complex corrective repair is? -
Recurrent pain?
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.
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Recurrent pain?
Hi, I am not a doctor, however, during my life have had enough muscular injuries including groin… Your dull groin pain (you would need to rule out gastro with a specialist) sounds like muscular. If you have done some more agressive physical activity prior to time when the groin pain started to bother you then it can be tissue in the operated area. Please keep in mind that post surgical physical activities may not look excessive, but… they may be strong enough to cause at least some micro trauma. If it is the case then you may allow this to heal by rest for another 3 months or so unless pain starts to intensify… Btw, why did you go with lap repair when the golden standard is open surgery with lightweight mesh? This was mentioned by Dr Towfigh in this forum. Open repair typically allows better exploratory look and easier to correct if any issue pops up down the road.
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Post op ilionguinal neurectomy
I am really sorry to hear that.
I just want to point out on something that might not be in focus due to post-op complications. In general, when there is groin pain after any excessive physical activity it is highly recommended to get at least couple opinions from experienced surgeons. Obviously, one should be hernia specialist while another opinion should come from the surgeon who is experienced with so called “sport hernia” injuries. These types of traumas typically involve groin muscle tears without protrusion of intestines and bulge. Unfortunately, there is relatively small number of general surgeons who have wide experience with such traumas. Did your surgeon look at all the groin tendons and muscles that are typically not involved witn true hernia symptoms? Have you discussed this “sports hernia” topic with him/her? Hopefully, swelling issues will be addressed and go away within short time frame. If the groin pain will stay for longer than 3 months (doctors may correct me if I am wrong with this “rule”) after the surgery then you may want to consult with a surgeon who is experienced in this field (not necessarily from your local region/state).
I am not a doctor and just want to help by providing an advise. Wish you proper and fast recovery. -
Neurectomy with 2nd surgery
First of all, I am deeply sorry to hear that such shocking result took place with neurectomy. I should probably be more specific with my question. Namely, I was referring to ilioinguinal and iliohypogastric nerves going through the groin area affected by torn tissues and mesh. Literature reports about success of such type of procedure when applicable. For example:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570605/
http://www.giornalechirurgia.it/index.php?PAGE=articolo_dett&id_article=5296&ID_ISSUE=613
I also believe that there is a debate that has started among specialists about mesh vs pure tissue repair. Mesh was primarily targeting high hernia recurrence rate occurred with non-mesh technique. However, nerves are seems to be down side of the open repair using mesh. I do realize the lap repair was developed to minimize problems with nerves. However, I am sure that lap approach has its own potential drawbacks. I also believe that any general surgeon must have all techniques in his possession to address any groin issue (including pure tissue repair). I think that general perception of hernia procedure as some sort of commodotized medical procedure among many people is a big problem and possibly it is worth of establishing general groin surgeon specialty that would include pelvic region and adductors. I am not a medical doctor or professional and my opinion is based on my personal very limited observation of the groin medical problems.