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  • sngoldstein

    Member
    November 28, 2016 at 9:20 pm in reply to: 6th Right Inguinal Hernia

    6th Right Inguinal Hernia

    The East coast is big. I am in Albany NY and would be glad to see you. Brian in NYC and Eric in PA can are also excellent but there is most likely a good lap/robotic hernia surgeon in every city. I’m sure we can steer you in the right direction.

  • sngoldstein

    Member
    June 23, 2016 at 8:45 pm in reply to: 4 weeks post op inguinal hernia surgery

    4 weeks post op inguinal hernia surgery

    I think Dr. Earle was sabatoged by spell check and meant “reoperating”. Dr. Belyansky is excellent and a great person to see.

  • sngoldstein

    Member
    June 23, 2016 at 2:48 pm in reply to: 4 weeks post op inguinal hernia surgery

    Surgery VS Watchful Waiting

    Dr. Earle is correct that this is not the usual post-op course after a routine hernia repair. Your symptoms, however, are difficult to correlate with unilateral surgery which is why I think that this may be some sort of generalized problem. Gabapentin is supposed to work by inhibiting nerve conduction at the level of the spine, but I doubt we really understand completely what it does. Side effects are mostly tiredness and resolve with time in most people. Light jogging is probably OK, but I would get on a bike first. It’s much lower impact. Time does, indeed, frequently fix these issues.

  • sngoldstein

    Member
    June 21, 2016 at 9:24 pm in reply to: Need guidance

    Need guidance

    Sounds like a small asymptomatic hernia. Watchful waiting has been shown to be generally safe with a 1-2% yearly risk of needing emergency surgery. Yoga is probably beneficial as it doesn’t really increase intraabdominal pressure significantly. Coughing, sneezing and jumping increase pressure the most. You are definitely better off waiting at least a year after those stents when it is safer to hold the blood thinners for a few days. If you start having pain, then it may be time to reassess your situation. You may also want to at least touch base with a surgeon so if there is a problem, they will already know you.

  • sngoldstein

    Member
    June 21, 2016 at 3:59 pm in reply to: 4 weeks post op inguinal hernia surgery

    4 weeks post op inguinal hernia surgery

    I am sorry that you are having problems. Understand that pain is a symptom and can have may causes and it is not always possible to determine exactly what is causing it. It is not unusual to have pain develop several weeks after surgery as you stop taking medications and begin to return to normal activities. It takes many months if not years for full healing. It sounds like some inflammatory process around the mesh, which again, is not unusual. The pain in your legs, especially on the side opposite from your surgery is very difficult to explain and may represent some other issue, which is why the gabapentin may help. Activity has been shown to be better than medication for chronic pain reduction, so I would recommend you move as much as you can, try the gabapentin, and give it some time.

  • sngoldstein

    Member
    June 17, 2016 at 4:22 am in reply to: Hard to Detect Femoral Hernia Advice. Please Help!

    Hard to Detect Femoral Hernia Advice. Please Help!

    There are many causes of groin pain; most of which are not life threatening. Unless the patient is fairly obese, a hernia capable of strangulating should cause an obvious bulge. The other sign of a hernia being the cause of the pain is if it is gone in the morning and gets worse during the day. The few strangulated femoral hernias I have seen that were not obvious were in elderly women that were a bit stout.

    As far as exercise goes, studies have shown that coughing, sneezing and jumping increase intraabdominal pressure more than lifting and yoga should really not be a problem so, in general, my advice is that if it doesn’t hurt, it’s probably OK.

    The signs of a strangulated hernia are severe pain in the groin and abdomen, nausea and vomiting, inability to pass gas and a painful lump. I have, however, seen patients without the severe pain despite having compromised bowel.

    There are no special protocols for pain management of a hernia except to get it fixed. Your first step, however, is to get a diagnosis. I would agree that Brian Jacob is a good choice in NYC.

  • Diagnostic laparoscopy as the definitive means of hernia detection?

    It’s not that simple. First, even though laparoscopy is a fairly low risk procedure, it is not risk free and that risk goes up significantly in patients with prior surgery. Second, small fat containing hernias are not always seen in a standard laparoscopy. The peritoneum needs to be opened which adds significantly to the procedure. Third, a hernia may or may not be the cause of pain and sometimes the only way to know is to do a repair, which can actually make things worse. The bottom line is that there are no easy answers and the decision has to come after a detailed discussion between the patient and surgeon.

  • Continued proliferation of Millikan tension-free plug and patch repair?

    I would echo Dr.Szotek’s comments. I remove at least one plug a month for pain. I highly recommend finding an experienced laparoscopic surgeon to fix your hernia.

  • sngoldstein

    Member
    June 15, 2016 at 11:11 am in reply to: 4 years of hip/groin pain. Help!

    4 years of hip/groin pain. Help!

    I advise patients with exertional groin pain and no definite findings that a laparoscopic hernia repair offers about an 80% chance of improvement, a 5% chance of making things worse and a15% chance that there will be no change. I don’t know the data on hip surgery but I would recommend doing things one at a time to minimize risk and to know where the problem is if very something gets worse after surgery.

  • sngoldstein

    Member
    April 26, 2016 at 8:27 pm in reply to: Encouraging percentages from Docs please!

    Encouraging percentages from Docs please!

    As a surgeon I smile when I hear stories like yours. A healthy patient whose life was really saved by modern care. The data is overwhelmingly in favor of using mesh to repair your hernia. Recurrence rates are over 20% without mesh in the best studies and probably approach 100% if you follow patients long enough. The Rives-Stoppa repair which puts the mesh behind the muscles and outside of the abdomen is an excellent option as it avoids doing an extensive dissection around your bowels and is easy to reoperate through if you ever need that. Also, if it gets infected, it can often be treated without removing the mesh. Mesh complications, which are abundant on the internet, are actually fairly rare in practice. If everyone had problems with mesh, we wouldn’t use it. I do mesh repairs on 10-20 patients weekly, and very rarely see a complication. Pick a surgeon who fixes a lot of hernias and you like, and you will do fine. As far as what you can do, being thin, well nourished and not smoking are the biggies.

  • sngoldstein

    Member
    April 17, 2016 at 12:20 am in reply to: Lymphocyte

    Lymphocyte

    I have had patients complain about unusual sensations for several months to years after surgery. The question is, does it affect your life significantly or is it a minor annoyance? Every thing we do has risk and trying to make “good” better, is not always the right thing to do.

  • sngoldstein

    Member
    April 16, 2016 at 7:50 pm in reply to: New to the forum need some advice.

    New to the forum need some advice.

    Thanks for posting. This is the result 95% of patients get with modern hernia surgery. And, unfortunately, the 5% who are unhappy scare a lot of people who would benefit from an operation.

  • sngoldstein

    Member
    April 11, 2016 at 1:10 am in reply to: Lymphocyte

    Lymphocyte

    It’s usually about 6-8 weeks after surgery but it depends on the size. Larger ones take longer. Dr. Towfigh is correct that they can be drained under ultrasound or CT guidance but if it’s behind the mesh I would not recommend that. There is a risk of infection and putting a needle through the mesh is difficult and could risk injuring other structures.

  • sngoldstein

    Member
    April 10, 2016 at 3:17 am in reply to: Lingering problems after possible scar tissue break

    Lingering problems after possible scar tissue break

    I am assuming you had a laparoscopic repair. I see this occasionally. I think what is happening is that the mesh is less complaint than the abdominal wall tissue and you can get some tearing or stretching at the interface between the mesh and the fascia. Usually the pain is self-limited, but if a nerve is involved it may persist. An injection of local anesthetic will tell you if it will respond to a nerve ablation.

  • sngoldstein

    Member
    April 9, 2016 at 10:17 pm in reply to: Lymphocyte

    Lymphocyte

    Yes. Exercise has been shown to be better than medication for relieving pain.

  • sngoldstein

    Member
    April 9, 2016 at 12:01 am in reply to: Lymphocyte

    Lymphocyte

    I am not sure if there is a correlation between seroma size and pain. They typically resolve in 6 to 8 weeks. I generally recommend waiting at least 4 months after a hernia operation to intervene for pain unless it is getting worse. It takes over a year for things to fully heal and the inflammation to subside.

  • sngoldstein

    Member
    April 7, 2016 at 1:12 pm in reply to: Is it possible for Hernia Without surgery?

    Is it possible for Hernia Without surgery?

    In the words of PT Barnum: “There’s a sucker born every minute.” Faith and belief may make you feel better but don’t cure anything, except maybe depression. If you have a real hernia the only way to fix it is surgery. Whether or not it needs to be fixed is a different story, and for that you will need to see a surgeon.

  • sngoldstein

    Member
    April 6, 2016 at 11:38 pm in reply to: Lymphocyte

    Lymphocyte

    I think you mean “lymphocele.” That is simply a fluid collection near the mesh. Surgeons usually refer to them as seromas. They are not unusual and will almost always resolve on their own. I have seen them cause significant pain for several weeks, however. Antiinflammatories like ibuprofen are your best bet.

  • sngoldstein

    Member
    April 5, 2016 at 1:00 pm in reply to: Epigastric hernia becoming painful

    Epigastric hernia becoming painful

    I agree with Dr. Towfigh. It would be very unlikely for intestine to get into a hernia that small. If it is bothering you, though, you should consider repair. It will only get worse with time and it should be a relatively simple fix now.

  • sngoldstein

    Member
    March 31, 2016 at 2:27 am in reply to: Double Umbilical Hernia

    Double Umbilical Hernia

    I do them all robotically with mesh. Without mesh, the repair is likely to fail. It is 3 small incisions in your c-section scar. Excellent cosmetic result.

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