[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

I’m having blood tests run this week. But in general nerve pain has gotten worse the further out from the surgery I get. The site is hardening up a lot. I don’t know if it’s scar tissue or the mesh wadding up but something isnt right. I’ve had chills for over a month and have had issues getting the digestive system to move the way it used to. I wake up every day and know I didn’t used to feel like this.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Thanks for the additional resources.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

I went back with the pain I was experiencing 6-7 months out and I got the “everything looks great” response. I have not been back since my other issues began. I’m going to start by having my regular doc run blood work and go over my symptoms with them. It is so frustrating to know that this is such a serious issue that not many doctors are proficient in. I really want someone to evaluate if I am crazy or is this evil inside me really needs to come out. I wish I knew more before let this happen to myself.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Good Intentions,

Thank you for your comments. I’m located in Oklahoma.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Dear Dr. Kang,

I am a 58 year old female. I’ve had intermittent groin pain and classic hernia symptoms for 4 years but no visible or palpable bulge. There was no injury and both my parents have had inguinal hernias. Two years ago, an ultrasound revealed a small, 6mm indirect inguinal hernia. My questions for you:

– In your opinion, is this not what is often referred to as an occult or ‘hidden hernia’? If not, what would you call it or how might you diagnose it?

– Do you believe that a 6mm defect is too small to cause pain and that my symptoms are likely caused by something else?

– do you believe that this hernia will inevitably grow bigger and that a bulge will eventually appear? If so, would it not be better to get it repaired while it is small – particularly as it is symptomatic?

– would you perform surgery on such a hernia?

Thank you!

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Dr. Procter – would you offer surgery to a 57 year old woman with no bulge but classic groin pain, family history and an ultrasound report showing a very small, indirect inguinal hernia? If so, what sort of surgery would you recommend? If not, would you propose waiting until a bulge appears? Or would you say that it is likely something else like nerve entrapment and recommend steroid injections? Thank you.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Thanks, Chaunce, for your insights. I agree with all you say. The thing I don’t understand is, why are hidden hernias so controversial? Why do so many doctors and surgeons doubt that a small bit of fat lodged in the canal can be painful?

I live in Canada. I’ve consulted with two surgeons in my home town (Calgary) and neither are convinced my pain is caused by a hernia – despite my classic symptoms, family history and an ultrasound report. They are of the opinion that a 6mm ‘hernia’ is little more than a natural gap in the muscle wall. They believe nerve entrapment is a more likely scenario and suggest I try steroid injections.

Without insurance, I can’t afford to pay for surgery in the US. I would be interested in going to the Shouldice Clinic (near Toronto) but they won’t accept you unless a bulge is felt. The reason (according to Dr. Towfigh) is that they believe patients are less likely to have a good outcome (I suspect this means they believe there is a greater likelihood of pain post-surgery). One surgeon I spoke with believes this is because the pre-surgery pain was likely caused by something other than hernia and that the surgery was needless or, worse, caused injury. And this is what scares me. And so I do nothing and live with intermittent moderate pain/discomfort, wondering if I a bulge will appear if I stopped doing pilates…..

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

quote drkang:

Real watchful waiting should have strict conditions.
That is, it should be carried out under the condition that operation would be performed if the size increases over certain level, some pain appears, the frequency of pain increases, or other discomfort occurs and so on.
But many people are just waiting until the condition becomes very serious.
It is not ‘watchful waiting’ but just ‘neglecting’

As you know, herniated bowel or contents could be incarcerated/strangulated though it happens rarely.
But that is not the only problem.
The bigger the hernia is, the more difficult the repair is.
And the recurrence and complication after repair might also be increased.

So I think the sooner the better.
I personally recommend you to get hernia repaired if it is bigger than a cherry even though it doesn’t hurt at all.

I understand the possible mesh complication makes many people to hesitate.
And I know it’s difficult to find a surgeon who does tissue repair properly with low recurrence and less complication.
That is a pitiful dillema.

But I don’t think the so-called ‘hidden hernia’ should be repaired.
‘Hidden hernia’ is not a real hernia as dragon is not a real animal.
I think hidden hernia issue appeared after the inguinal hernia began to be repaired laparoscopically, because laparoscopically the operative procedures for real hernia and so called ‘hidden hernia’ are the same.
Actually that for hidden hernia(in other word, absence of real hernia)) is much more simple.
They just put the large mesh around inguinal area.

I hope that everyone would be able to have a hernia operation without worrying about it soon.

Dear Dr. Kang,

I have a few questions regarding your comments on “so-called hidden hernias”:

Do you believe that hidden hernias are the first stages of a ‘real’ hernia? Or are they something else entirely?

I’ve had groin pain for 4 years but no visible or palpable bulge. Two years ago, an ultrasound revealed a small, 6mm indirect inguinal hernia. Is it your opinion that it should not be repaired? If so, is this because open, non-mesh surgery is not possible for hidden hernias – and that you don’t recommend laparoscopic repair with mesh? Or do you believe my pain is likely caused by something else?

Also, do you believe that this hernia will inevitably grow bigger and that a bulge will eventually appear? If so, would it not be better to get it repaired while it is small – particularly as it is symptomatic?

Thank you.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Hello Dr. Towfigh – a couple of questions to add to this thread:

– I understand that the risk of recurrence is greater with a non-mesh repair but are you also saying that the risk of nerve injury is greater with a tissue repair than it is with mesh? If so, is this because of the physical stitching required vs placing of mesh?

– In terms of chronic pain, what are the most likely causes with a laparoscopic mesh repair? Is it the mesh itself or are there other ways in which this procedure can injure nerves?

Thank you!

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

4 Days Post-Op (Laparoscopic Hernia Repair)

Thank you for your thorough reply! It’s very helpful to hear about your experience. I certainly understand that surgery is a big decision and that there are risks – however, the ignorance about ‘occult’ hernias (particularly in women) among doctors/surgeons is very frustrating! I have tried to bring in info (from this forum and reputable sources online) and it has been dismissed.

My pain isn’t constant and I’m doing pilates which I think is helping. Your story, however, gives me courage to pursue surgery – particularly as chances are good it will get worse.

Looking forward to hearing updates!

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Irritable Bowel Syndrom (IBS) and hernias

Dr. Towfigh, thank you for your post. Is it possible to have abdominal cramping/digestive symptoms if the hernia contains only fat?

Also, if entrapment of the small intestine can be intermittent, is it important to get an ultrasound (or other scan) while experiencing symptoms? In other words, would it only be detected while it is painful and therefore likely entrapped?

Thank you.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

4 Days Post-Op (Laparoscopic Hernia Repair)

Thank you for the post and please do keep us updated with news of your post-op recovery! I’m in a similar situation with ongoing groin pain which doctors don’t take seriously. Even with a positive ultrasound showing a small (6mm) inguinal hernia, I’ve been told that, at that size, it barely qualifies as a hernia and is too small to cause pain.

I don’t believe this to be true and am convinced my symptoms are caused by the hernia. However, because my pain is intermittent – and because my GP and 2 surgeons strongly advise against surgery – I’ve been avoiding it.

Can I ask how much pain you’ve been in? Was it constant and did you have other symptoms (i.e. bloating)? Did it seriously affect your quality of life? Was your hernia also very small? (I’m assuming it was as it didn’t show up on tests). BTW, I am a 56 year old female.

Thank you and all the best with your recovery.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Choosing Method of Repair

Thanks Dr. Towfigh,

Can you explain why fewer surgeons are performing the Kugel technique? By the description (on various sites), it sounds like it would offer the best of both open and laparoscopic techniques(?)

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Surgery VS Watchful Waiting

Thanks for the helpful info! There are still two points I’m curious/confused about:

– Would you say that intermittent pain (few weeks on, few weeks off) is typical of (hidden) inguinal hernia? If so, would you guess that pain is triggered when tissue is in the canal, and relieved when it is not? (I understand there is no way to heal the hernia but wondering if targeted exercise might actually keep the pesky tissue at bay!)

– regarding pre-op pain predicting stronger likelihood of post-op chronic pain (according to Manual of Groin Pain): I understand that in some cases this is because pain is caused by something other than the hernia. If, however, my pain IS due to hernia (difficult to prove, I know), would my chances of post-op pain still be greater than those who went into surgery with no pain? If so, can this be explained?

As mentioned at the top of this thread, pain/discomfort is the main reason many of us would risk surgery. If, however, the odds of ending up with symptoms that are the same or worse (even in expert hands), this is something we need to consider carefully.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Surgery VS Watchful Waiting

Thank you, Dr. Szotek for the thorough response. A few follow up questions and comments:

1. When you refer to the “patient’s anatomy/neurogenic in nature” are you meaning that there are sort of ‘phantom pain pathways’ caused by the hernia – that can remain after the hernia is fixed?

2. I certainly understand and feel the effects of standing for hours but by ‘intermittent’, I was meaning a few weeks of discomfort followed by a few weeks of almost no pain. I’m trying to understand the mechanics of this! I do pilates and yoga and wonder if there is any correlation between exercise and degree of pain – or if it’s more random. This may be a dumb question but if pain is caused by tissue in the hole (?), is it possible that exercise can keep it out of the hole?

3. Does strangulation only involve bowel (or maybe bladder?) – or can a piece of fat dangerously strangulate? When diagnosed 8 months ago, my hernia was only 6mm – not sure what it is now. One surgeon I met with believes that a hernia that size (and with no bulge) barely qualifies as a hernia and that performing surgery on me would be almost unethical. Elsewhere I read that ALL hernias in women should be operated on. Do you agree with this and, if so, is it because it’s possible that femoral hernias (which are more dangerous) can be mistaken for inguinal hernias?

Thanks!

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Hernia or Psoas?

Hello!

I’m still debating whether or not to have surgery for small, hidden, inguinal hernia. The pain is intermittent (i.e. a few days of significant discomfort followed a week or two of almost no pain). The pain is a pinching, pulling aching from the pubic bone to the hip. Sports and activity do not generally provoke pain so my life is not really limited per se – I’m just chronically uncomfortable. On bad days, I feel lousy. I lose my mojo and feel convinced that surgery is the right thing. But then it passes and I think (particularly after reading statistics and stories…) that I would be foolish to risk my relatively OK quality of life.

With hopes you can help me (and others) weigh my symptoms versus the risks, I have a few more questions:

– According to the Manual of Groin Pain recommended by (and with contributions from) Dr. Towfigh, “preoperative groin pain predicts an increased likelihood of postoperative chronic groin pain”. Can anyone clarify why this is so? Is it because groin pain is more often caused by something other than the hernia (as was told to me by one surgeon). As groin pain is a common symptom of hernia – and one of the main reasons for risking surgery – it’s something of a conundrum!

– Is intermittent pain typical of hernia? If so, would you say this is because pain is felt when the piece of tissue is lodged in the canal causing pressure – and relieved when it is not?

– Is bladder pressure a typical symptom of a small hernia? If so, is it because the bladder is literally being pressed upon or would this likely be a referred nerve issue?

– Is it possible that a hernia will become less painful when the hole gets bigger thus relieving some pressure or is it more likely to get worse as it progresses? (I seem to have pain less often than I did two years ago).

– Would nerve blocks be a viable alternative to surgery in some cases?

– And finally, is fatty tissue in danger of strangulation – or just bowel or bladder?

Many thanks.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Is hernia mesh as scary as the internet makes it sound?

Dr. Towfigh,

I did not know you did the Shouldice repair for an inguinal hernia. I would consider this type of repair for my inguinal hernia.

quote :

Is hernia mesh as scary as the internet makes it sound? Are complications as common as they seem? The majority of discussion online around hernia mesh is quite negative, as I’m sure many patients and doctors are aware, but that is not particularly reassuring when you’re a potential patient. My doctor told me not to google it, but it’s hard not to! At the same time, there are seemingly no surgeons outside of Shouldice and a private clinic or two on the east coast who perform a ‘pure tissue’ repair anymore, why is that?

I realize happy people likely don’t get on the internet and rave about positive or uneventful experiences with surgery, so what’s the real story about hernia mesh?

Any comments from patients, surgeons, health care providers would be very welcome! Thanks!

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Medium inguinal Hernia – Traditional Tension Repair

Thank you so much. Dr. Brown called me this past Saturday morning and we discussed my hernia. He does do tissue only inguinal hernia repairs and he refers to his technique as a low-tension repair. He said his technique is a combination of the Shouldice and Desarda techniques. I am very pleased to know there is someone near by that can do this type of repair. I am not ready for surgery yet, but I will make an appointment to see him when I am ready.

quote :

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!

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Medium inguinal Hernia – Traditional Tension Repair

Dr. Towfigh,

Thanks so much. I have contacted two of the surgeons you recommended and one has gotten back to me. He said my options are a primary repair or laparoscopic repair with biological mesh. I am assuming the primary repair would be covered by my insurance and the biological repair would not. I will make an appointment to see you when I am ready to move forward.

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Medium inguinal Hernia – Traditional Tension Repair

Thank you. I need at least one more surgeon so I can have two opinions. Preferably someone in the south bay near San Jose. Maybe someone else who reads this board can add a recommendation.