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Importance of lipoma of the cord

quote :

That may be the best short answer to the difference in why in open surgery it is removed and lap surgery it is not. This response should be a sticky. One more question on this is a lipoma the same as a hernia sac?

Not sure if you or anyone else would want to hear my op report and any of the history before and after the surgery.

Thanks again for the excellent response.

Beenthere, I would be interested in hearing your details and history before and after surgery, and I am sure other forum readers would as well. Hernias are clearly complex, and the more information out there the better in my view.

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What ?s should surgeons be asking their patients?

[quote]HI Groundfaller,

I hope things are better for you. What you describe sounds very much like my experience. As soon as my condition worsened about 7 weeks post surgery I found out the truth about my quote expert hernia surgeon who supposedly performed a large number of hernia surgeries with less than 8% total side effects and complications prior to mine. Afterward when I got worse, I was told the surgeon had no idea what was wrong since he performed so few hernia sugeries. Six years post surgery I just found out he had done a whopping 2 hernia surgeries(just days before my operation) before mine in the previous 18 months. What is also shocking he is now posting online as a surgeon at a Hernia Clinic. And according to a report I received if accurate he did not perform one hernia surgery between 2011 and 2015.

When my problems started it was me that was the problem and was bounced from different specialist to different specialist but when questioned they had no real expertise in this matter unlike the moderators on this site. I finally got new insurance and paid out of pocket to go to one of the real hernia experts to be fixed. Less than a week after corrective surgery I was without the previous pain, walking normally and even spent 11/2 days spectating at an auto race, meaning I was walking the whole day.

I agree with your “First and most importantly, there needs to be more dialogue and more time spent working with the patient. For lack of a clinical term, don’t leave your patient with “lost cause syndrome.”” statement.

I firmly believe that every hernia patient should be given this website address, Dr Goodyears website address and be given a copy of the book Unaccountable before surgery unless an emergency. This would give the patient a much better understanding and true picture of what is to come.

Next there should be a complete checklist that both the Dr. and patient need to check all of the boxes on all aspects of the surgery before the informed consent.

Than the patient should be given a complete copy of all presurgical visit notes and the agreed upon surgical treatment plan to take home and review to make sure it is accurate and complete. I thought I covered all the bases with my surgeon and his staff prior to my surgery, but when reviewing my medical history post surgery I found they failed to note any of the agreed upon treatment plans and none of my history was accurate and no notes by the doctor on the location of my hernia. Here is one example]

It would be nice if statistical information about surgeons, their procedures, numbers, and their outcomes, as well as anonymous patient info were public data, so this type of situation could possibly be avoided.

It may be helpful for you to share the name(s) of the providers who ended up assisting you in correcting and recovering from your first unsuccessful surgery, if you are comfortable sharing that information.

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What ?s should surgeons be asking their patients?

quote :

Wow! I was surprised to have been brought back to this post but here I am. My surgery was nearly two years ago. The first year after the surgery was a absolute hell. I was not prepared for the difficulty. I was also not prepared for the lack of support.

Ultimately, almost 18 months after the surgery, I found a physical therapist who was willing to put in the time and energy to help me as well as install a sense of confidence that I can be helped. He was great.

I want to emphsize a couple of points. First and most importantly, there needs to be more dialogue and more time spent working with the patient. For lack of a clinical term, don’t leave your patient with “lost cause syndrome.” It can be deadly. I am not exaggerating when I say that I felt hopeless and the idea of suicide crossed my mind as I wasn’t recovering.

Secondly, someone, somewhere, somehow needs to develop a comprehensive physical therapy/rehabilitation program to recover from this kind of surgery. This is one of the most common major surgeries which has a high incidence of complications. Professionals, please, I beg you, consider a better after care process. I can’t stress this enough. Don’t let people sit and waste away.

Can you detail what physical therapy regimen has assisted you in your recovery?

I have found an online physical therapy protocol for sports hernia type injury, which may be relevant to some patients of other types of groin pain and perhaps even groin surgeries.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273884/

I know that Shouldice clinic in Canada encourages near immediate post-surgical minor activity, walking, and they have pool tables set up which obviously forces people to bend at the waist a bit. Similarly, when you hear about professional athletes being sidelined by surgery, they always have rehab and recovery for 6-12 weeks. There must be something to it.

Perhaps some sort of protocol should be standardized and recommended for all patients?

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Why might a groin hernia cause testicle pain and/or spermatic cord pain?

Thanks for the info.

Is there any way to conclusively figure out if something wedged in the inguinal canal is the cause of the pain? Is surgery removal of hernia contents from the canal the only way to know if this may be the cause of testicle pain?

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Importance of lipoma of the cord

Does this suggest that open surgery is better for patients with small fat containing hernias or lipomas that cause pain? Would the fat not be seen or accessible in an inguinal laparoscopic repair and that is why it’s not removed in laparopscopic approach?

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Dr. Towfigh – Neurectomy

Dr Towfigh,

Thank you for your insight, this is very interesting!

I have no prior surgery or known injuries to the groin, just pain and different unpleasant feelings along the same nerve pathways from near the hip bone down into the testicle. Could a very small occult hernia cause nerve impingement or nerve damage if it went untreated?

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Alternatives to mesh

Hi conniernordan,

Dr Meyers in Philadelphia is a great resource for athletic pubalgia, abdominal tear, and abductor injuries (these conditions are usually the “sports hernia” you hear about on ESPN, despite the naming it is not a typical groin hernia), and Vincera does also have a hernia clinic for those with traditional groin and abdominal hernias as well. My understanding is the repair varies on the patient, and they are able to use no mesh tissue repairs for most patients who are reasonably physically fit and with a reasonable body composition, but on some patients mesh may be necessary for a true hernia and recurrences. As far as I know, the ‘sports hernia’ repair never includes mesh at that clinic, but some other places do use mesh for sports hernias.

Things get murky with groin pain of all types and hernias when there isn’t an obvious bulge. The Meyers clinic will give you an MRI and look at all possible pathology (and look for the sports hernia injuries which many people overlook), whereas Shouldice looks only for the obvious hernia bulge, and if Shouldice can’t see and feel a bulge they do not think you have a hernia regardless of MRI etc. If you’re already on the east coast, the two are a days drive or quick flight apart, may as well visit both clinics if you have the means.

Something else to consider about Dr Meyers impressive success rate is that many of his patients are pro-athletes to begin with. This means they are in great physical shape, they have near immediate diagnosis, MRI, personal trainers, and go through intensive physical rehabilitation starting the day after surgery. Most standard patients and weekend warriors do not have that level of attention from a dedicated team doctor, the same physical stamina, let alone a committed rehab team. I guess my point is, patient rehab should probably be included in ALL patient recovers and not just pro athletes, as it surely must make a difference in loosening up scar tissue and maintaining fitness, which is obviously why the pro athletes have those protocols. Again, the average Jane and Joe may not have that available, but usually a doctor can prescribe rehab and have it covered by insurance for at least a little while.

There is an incredibly helpful and multi-year long internet thread about the “sports hernia” (and sometimes real groin hernias) on a runner enthusiast website, it is a good resource if you are considering going to see Dr Meyers and want to read other patient experiences over many years.

http://www.letsrun.com/forum/flat_read.php?thread=559820

Many patients in that thread have had the sports hernia repair with and without mesh, it is a worthwhile read, all 150 pages of it!!! if you are actively researching the procedure(s) and outcomes.

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Medium inguinal Hernia – Traditional Tension Repair

Hi HowardF,

This may or may not be helpful to you, but there is a Dr William Brown in Fremont California who specializes in “sports hernias” and does a tissue repair for it. Yes a sports hernia is different from a real groin hernia, but my understanding is the repair is similar to a ‘real hernia’ repair and sometimes real hernias are found during the procedure, so there must be an understanding of both conditions. It could be a resource for you to consult with, or maybe not, I have no experience beyond just stumbling across the doctors name and site a few times from researching my own condition.

If you do decide to have a tissue repair or a biologic laparoscopic repair, please do post back with your results, surgeon, and experience, there are many of us who would be interested in hearing about the experience!

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Dr. Towfigh – Neurectomy

@21tomlinson

Sorry you are going through this. I’m a fellow patient with groin pain who has done a fair amount of studying and reading, so take my advice with a grain of salt, but… don’t give up! And please keep us all updated on your progress! Does anything feel any different now that you are a few days out? Any better or worse? Are you taking tylenol or advil or anything for pain and does it work?

Perhaps you have pain signals in the ilioinguinal nerve still? Maybe try a nerve block in that remaining nerve? I could be wrong but based on my own research it looks like the ilioinguinal (and genitofemoral) nerve is alongside the spermatic cord, so I could think it possible to damage in a cord stripping procedure.

For what it’s worth, I have had chronic testicle / cord and groin pain and was also looking into the denervation procedure at a place in Florida after being initially written off by doctors as having some idiopathic groin pain, but it turns out I may actually have a very small hernia in the area, they just aren’t sure if it would cause the pain. It may not apply to you, but perhaps try requesting a Dynamic Ultrasound with straining, it could turn up something?

Good luck, stay positive, and keep us updated!