[pmv]

Thank you @drtowfigh.

My valsalva protocol 3T MRI (1 year after robotic inguinal hernia repair on my left side & ProGrip mesh implant) states that there is fat in my left inguinal canal which is “stable” “without evidence of inducibility.”

Is this different from a “spermatic cord lipoma”? (It seems as though a lot of terminology is used interchangeably.)

What is the significance of stable fat in the inguinal canal without inducibility, if there is no visible bulge and no pain in that immediate area?

Why is it difficult to remove a spermatic cord lipoma laparoscopically?

Would you ever recommend surgery for stable inguinal canal fat without evidence of inducibility that isn’t causing a visible bulge or any pain in the immediate area?

Thank you.

[pmv]

Hopefully, @drtowfigh can let us know (1) how fat gets into the inguinal canal, (2) the clinical significance of a lipoma in the inguinal canal with the abdominal Wall intact, (3) should lipoma (fat) in the inguinal canal be treated and, if so, how?

[pmv]

@good-intentions thank you.

You are very knowledgeable.

Are you a medical doctor?

Do you know if inguinal canal fat lipomas are benign? I know @drtowfigh has stated that fat in the inguinal canal can result in pain. Is this true even if the abdominal wall is intact?

According to the MRI report, the “stable fat in the inguinal canal without evidence of inducibility” is on the same side as the ProGrip mesh.

[pmv]

[USER=”2051″]ajm222[/USER] I also have suffered with a herniated disc in my lumbar spine at the L3-L4 level that caused excruciating pain down the front (not back) of my left leg. After approximately 12 weeks that pain subsided. And during that 12 week period. I didn’t notice any tightness/pulling in my inguinal area from the hernia surgery that was performed prior to the herniated disc.

That supports your “distraction” theory. When your mind is occupied with other issues (be them orher pain like my herniated disc or more pleasant experiences like going on vacation and forgetting about the demands of work) the bothersome symptoms seem to disappear, albeit temporarily. The mind-body connection is amazing and still not fully understood.

Along those lines, have you consulted with a pain medicine doctor to see if there is anything that can be done to alleviate your symptoms short of mesh-removal surgery? Also, have you considered alternative modalities like acupuncture? It may be worthwhile exploring these treatments before surgery? But only you know your body, your threshold for pain and not feeling normal, and your emotional/psychological makeup.

You sound like a very logical person. I am sure you will make the right choice. But, like me, try not to overthink your situation. It isn’t life-threatening. And is an elective procedure.

Again, I wish you (and others in the same position as you and I) the best.

[pmv]

[USER=”2051″]ajm222[/USER] your post-hernia surgery symptoms sound almost identical to mine.

It’s been about one year since my bilateral robotic inguinal hernia surgery and implantation of ProGrip mesh.

I am scheduled to have a 3T pelvic MRI next week in the hope of helping to determine the source of my symptoms. Symptoms which, I repeat, are almost identical to yours.

In the meantime, over the last year, I have been very physically active. Working out 6 days a week (mostly 60-90 minute sessions of cardio on stationary bike and elliptical & some light weightlifting). Also have been fastidiously been performing core strengthening exercises. The disturbing symptoms persist. But don’t appear to be worsened by my exercise regime. And, in fact, the core strengthening/stretching seem to “loosen up” the tightness and pulling in my groin, lower abdominal and hip region, at least temporarily.

Like you, I am also a person who is hypersensitive to physical sensations in my body. Always have been. Perhaps that hypersensitivity is genetic or related to my tendency to catastrophize.

Anyway, at this point, I am not willing to undergo additional abdominal surgery. I don’t have “pain” per se. And I can emotionally and physically endure the discomfort that you so eloquently describe. At least for the time being.

I will add that I have compiled a list of the best hernia surgeons in the country, including [USER=”935″]drtowfigh[/USER], if, at some point, I decide to take the risk — and there is risk — of more abdominal surgery, including the possibility of mesh removal. But, for now, not worth the risk to me. And possibility of little relief (and more complications) too great.

I wish you the best of luck in this difficult decision.

[pmv]

Thank you [USER=”935″]drtowfigh[/USER]. I am particularly interested in having a hernia expert review my MRI because it is possible (if not likely) that a radiologist might not see important subtleties indicative of an occult hernia that an experienced hernia surgeon can observe.

Also, is there any benefit whatsoever to have the pelvic MRI (including with the Valsalva protocol on a 3T scanner) performed with contrast? What benefits, beyond detection of an occult hernia, can be achieved by performing an MRI with contrast immediately following the non-contrast MRI? Does the contrast increase the chances of detecting any complications related to the mesh implant — for example, movement or balling up of the mesh. Does the contrast increase the possibility of detecting any impact on any of the nerves, tissues, tendons or muscles caused by the original robotic inguinal hernia surgery or caused by the mesh implant?

[pmv]

[USER=”935″]drtowfigh[/USER] where can I find the Pinned post?

[pmv]

[USER=”935″]drtowfigh[/USER] according to the operative report:

“The meshes were secured together in the midline using interrupted 2-0 Vicryl suture x2 at the midline. The peritoneal flap was then closed with 2-0 V-loc suture in a running fashion. Any holes or tears in the peritoneal flap were repaired with 2-0 Vicryl.”

Would I feel a seroma/hematoma, bilaterally, 1 year after the da Vinci robotic repair of my bilateral inguinal hernias (direct & indirect on right-side & direct on left-side)?

What I am experiencing, one year after the surgery, is a feeling of tightness, pulling, and cramping (but not pain, per se) bilaterally in my hypogastric/suprapubic area. These symptoms are persistent but ebb and flow. And don’t appear to be worsened by vigorous cardio exercise (stationary bike or elliptical for 60-90 minutes).

Is an MRI (with or without contrast) of my abdomen and pelvis worthwhile with or without valsalva movement on 3T scanner?

What else can I do to determine if there is a hernia reoccurrence and/or a problem with the ProGrip mesh (i.e., movement, shrinkage, etc.)?

Thank you, [USER=”935″]drtowfigh[/USER]

[pmv]

If you don’t mind sharing. For initial surgery or recurrent surgery or mesh removal surgery: What hernia surgeons would you recommend? And who would you avoid?

[pmv]

Are you the weightlifter ShoulderBrah?

[pmv]

I am sorry to hear about your awful experience.

I hope you are doing better physically and emotionally.

You are providing an important to service to many people by sharing your experience and knowledge. And, for that, you should be very proud.

Keep hope alive.

[pmv]

Good intentions,

That ProGrip “satisfaction” study is very interesting. And very limited.

I wasn’t a sedentary person when I had my surgery. I was a very active 61 year-old. Cardio & weightlifting workouts for 2-3 hrs/day, 6 days/week.

After reading the information you have shared, I suspect that the ProGrip mesh has, in some manner, interacted with my internal structures — nerves, muscle, tendons. And this interaction has caused “tension” (as you define the term more broadly).

At this point, I am going to get an MRI (with & without contrast; also using the valsalva protocol on a 3T scanner). Have to convince my insurer to authorize that imaging of my pelvis/abdomen.

In the meantime, I’ll just deal with the daily lower abdominal
discomfort best I can. But, Never Surrender.

Thanks, again!

pmv

[pmv]

Thank you, Good intentions.

You are very knowledgeable. And it is very thoughtful of you to share your knowledge and experience with me and others on herniatalk.

If you don’t mind. What was your hernia repair experience? Good? Bad? Surgeon? Mesh or no mesh? And how are you doing now?

pmv

[pmv]

Good intentions,

Regarding “tension.” Dr. Towfigh states that all mesh repairs for inguinals are “tension-free”?

Could you explain?

Thanks.

[pmv]

Thank you so much, Good intentions!

The surgery notes describes the mesh as follows:

Mesh ProGrip Flat Sheet 12cm × 12cm (LPG1612 BX/1-LOG235319).

Yes, you were right. Approximately, 48 square inches (hopefully lying flat) in my abdomen.

A few questions, if you don’t mind:

1. How does the mesh cause “tension”? What internal nerves, ligaments, muscles, etc. is it impacting?

2. Is there anything that can be done to reduce the “tension” (i.e., the lower abdominal discomfort)? Or is this something that I just have to learn to live with?

3. Are there any activities that I should avoid because they might increase the “tension”?

4. Is it normal for the “tension” to be more noticeable about one-year after the surgery, than it was earlier on, as in my situation?

5. Is it worthwhile having imaging performed to help determine if the lower abdominal discomfort I am experiencing is, in fact, a result of “tension” from the mesh or, perhaps, caused by a recurrence of a direct or indirect inguinal hernia, or an occult hernia?

6. Clinically and visually, is there any additional signs that would indicate that I have a hernia recurrence or a new hernia if, as in my situation, visually I notice raised skin (and a tiny bump) bilaterally over the path of the inguinal canal — kind of like a ridge line?

7. Any other thoughts on my situation?

Once again, thank you.

Have a great holiday season!

pmv

[pmv]

Have you been able to get your pain under control? If yes, what works?

Did you have any imaging or other testing done to determine the location of the nerve injury?

I have not had any diagnostic nerve blocks. But I will discuss them with my pain medicine doctor.

Thank you for your response and suggestion.

I hope you are able to get control of your pain.