sngoldstein
Forum Replies Created
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Double Umbilical Hernia
It sounds like you would be happier with a repair of your diastaisis which would also repair your hernias. It is my opinion, and that of most surgeons, that a mesh repair is the best way to accomplish this. I would recommend that you find a surgeon that does this repair robotically as this seems to be the best way to handle the problem. I must add that there is not a lot of good data to back up my opinion, but it does seem to work well.
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Why might a groin hernia cause testicle pain and/or spermatic cord pain?
What Dr. Towfigh said. Pain is caused by many things and can be very difficult to diagnose and treat. While a hernia repair will often cure exertional groin or testicle pain, nothing in medicine or biology is absolute.
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Importance of lipoma of the cord
The lipoma is different from the hernia sac. The hernia sac is an extension of the peritoneum (the bag that holds the intestines) that looks like a bag or sack that extends through a hernia opening and may contain bowel. A lipoma of the cord is fat on the outside of peritoneum that is protruding the hernia opening. I know this is all very complicated and most doctors do not understand much, if any of the groin anatomy. It takes several months of surgery residency watching hernia surgeries before understanding starts to set in.
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Importance of lipoma of the cord
A hernia is simply a hole in the abdominal wall. It is when something pokes through the hole there is a problem. If intestines poke through the hole, they can get pinched which is what causes a bowel obstruction. If there is only fat in the hole, we call that a lipoma of the cord. A sliding hernia is defined as when intestines are part of the hernia sac, so if you had a small hernia, it was not a slider. It sounds like you had a small hole with some fat in it which we often find when operating on someone with groin pain and no bulge. To fix this you remove the fat and close the hole. The fat does nothing except plug the hole and there are no side effects to removing it. In an open operation it is easier to excise the fat since it originates from inside the body. Once the fat is out of the way, you can see up the hole or put a mesh patch over it. The theoretical disadvantages of the anterior open approach are that sutures are required which can injure nerves or cause tension on nerves which causes pain. When patching the hole from the inside, in a laparoscopic repair, you pull the fat out of the hole from the inside. Since it is still attached to its blood supply, there is no need to remove it. In general, we are talking about something smaller than a grape. After the fat is removed, the hole is covered with a mesh patch. Since the natural pressure of the abdominal contents holds the mesh in place, like a patch between a tire and the tube, sutures are not necessary and there is less risk of injuring a nerve. If this still makes no sense, look at the hernia video on my website, http://www.littlescars.com.
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What ?s should surgeons be asking their patients?
As a surgeon, this is very interesting reading. Having been a patient and having dealt with the medical system with my elderly parents on several occasions, I know how frustrating it can be dealing with doctors and the medical system, especially when you don’t have 10-20 years of education in medicine. Unfortunately, our system is a business, and rapidly becoming a big business and many doctors are pressured to generate income. Patients with difficult problems take a lot of time for which the doctor is not reimbursed.
Hernia surgery is significantly more complex than most people imagine, and just like with any complex procedure, outcomes are dependent on skill and volume. I agree with all of you that there should be transparent data about surgeons and their volume and outcomes. The establishment has been talking about quality measurement for years but the best they have been able to come up with is how well we do at checking boxes on computerized forms.
At this point the best anyone can do is talk to their friends and find a surgeon who did good by them. Fortunately, and despite the stories in this feed, most hernia patients do quite well. Also, most doctors really are trying their best to make you better, it’s just that our system is not ideal and the information both the patient and doctor need to provide the best care is simply not available.
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Importance of lipoma of the cord
Both open and laparoscopic repair should adequately treat a cord lipoma. I am a lap surgeon and feel that approach works best but if your surgeon is more comfortable open, that will also give good results.
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Do I have a hernia?
My guess is a nerve being irritated or pinched as it comes through the connective tissue. Have a pain specialist inject some local anesthetic into the area and see if it gets better temporarily. If so, a nerve ablation may solve your problem. It could also be a small spigelian hernia, but with all those negative studies, that is less likely.
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Importance of lipoma of the cord
Cord “lipomas” are not really lipomas like tumors in your arm or leg. They are preperitoneal fat that has herniated through the internal ring. They are usually removed during open hernia surgery and not removed during laparoscopic repair because it is not necessary. They can produce the same symptoms as any hernia except for bowel obstruction because they push on nerves and can even strangulate which causes severe pain as the fat dies. There is no difference between a cord lipoma and a fat containing hernia.
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New to the forum need some advice.
No, that is not unusual. When I broke my ankle it ached on and off for about 2 years. That is how long it takes for the scar to fully remodel and the inflammation to subside. As long as there is no bulge and you are functional, you are fine. Some Ibuprofen will help when it bothers you.
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Is hernia mesh as scary as the internet makes it sound?
I have been doing mesh hernia repairs for 20 years and standard polypropylene mesh has been in use for at least twice that long. As Dr. Towfigh says, that is a huge denominator and most mesh patients do fine. I do not do any non-mesh repairs except in children because the recurrence rate is so high. If your native tissue failed, it was not strong enough to begin with, and if it is sewn back together it’s likely to be less strong. That is why you need mesh if your hernia is going to stay fixed. Although there are few studies about this, there is not likely any increase in pain or other problems with the use of mesh. In fact, the reason surgeons all use mesh to fix hernias is that the studies have overwhelmingly show better results with mesh.
There have been two major problems with mesh use that resulted in class action suits: one is using mesh transvaginally for incontinence which was, in retrospect, not a great idea. The other involves a mesh product that had a plastic ring which, on occasion, broke and caused bowel injuries. That has nothing to do with mesh, it was a poor product design.
I personally have implanted thousands of pieces of mesh and have seen very few problems. Like anything else, it has to be done correctly and you want an experienced surgeon fixing your hernia. Outside of that, I would not worry too much about mesh. If your surgeon is getting good results with their technique, you will probably get a good result.
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Mesh infection: Does it all need to come out?
It depends on a number of factors. What kind of mesh, patient factors like diabetes, obesity and smoking, and what kind of bacteria for starters. A recent study from The Carolinas Hernia group showed that about 30% of mesh could be salvaged but if you smoke or are diabetic, the rate was 0%.
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spegelian questions
Yes, that is a lot of questions. A true hernia is absence of the abdominal wall and unless it is very small will not be missed on a CT. Was your gallbladder done open? You may have a nerve injury from that surgery causing weakness of your abdominal muscles. You really need to see a surgeon who specializes in abdominal wall issues and have them examine you and review your CT images.
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Possible hernia in Los Angeles
You don’t need any more studies. You need a laparoscopy to look at the bowel and divide the adhesions that are causing the problem. If this is congenital it is indeed rare, but I have seen it before. Find a skilled laparoscopic general surgeon with an open mind.
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spegelian questions
Yes, a small fat containing hernia could be missed on a laparoscopy, If it was that small, it would pose no risk of bowel incarceration (getting stuck in the hernia), but it could cause pain. No, it would not be routine to take down the peritoneum as this is a big undertaking and would only be done if one was anticipating placing a preperitoneal mesh.
For a surgeon, a sliding inguinal hernia specifically refers to part of the hernia sac being the bowel, usually the colon. Sliding hernias are generally fairly large and easy to see on a CT scan or any other study. It is very difficult to differentiate small inguinal hernias from femoral hernias on physical exam and it is possible to confuse them on imaging. It really shouldn’t matter for a laparoscopic repair as it is quite easy to see the entire area at the time of surgery and most repair techniques cover both the inguinal and femoral spaces. All hernias, including spigelian hernias may contain only fat. Smaller hernias will contain preperitoneal fat, which is a layer of fat between the deep fascia (connective tissue) and the peritoneum (the membrane that lines the abdominal cavity). Hernias may also contain omentum, which is a curtain of fat that hangs over the bowel.
A flank bulge can be caused by numerous things including a hernia. A spigelian hernia will be a bulge on the edge of the abdominal muscle (rectus abdominus), usually below the level of the belly button.
A true flank hernia is quite rare unless you have had surgery through the flank, usually to remove a kidney or for vascular surgery. I would not expect a flank hernia to affect the thigh.
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Hernia and Pregnancy
While it generally safe to get pregnant after a hernia repair, pregnancy does stress the abdominal wall and could theoretically increase the risk of recurrence. Most surgeons would advise waiting until after you are finished having babies to repair a relatively small hernia if it is not bothering you. The uterus will block the hernia openings and generally prevent complications during pregnancy. Nothing is guaranteed, however, and if the hernia is bothering you or of significant size, you might want to consider getting it fixed.
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6th Right Inguinal Hernia
Dr. Earle is 100% correct. Unless there is a bulge, you are more likely to have strained something. There are very large muscles attached to relatively small bones in the groin and it is a common area for pain. Try ice and antiinflammatories. Keep moving without overexertion and realize that this may take several months to resolve.
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Chronic RUQ pain
I generally just place the needle by feel but I am a surgeon and pretty comfortable knowing exactly where I am, depth wise. A pain management doc may not be so comfortable. Unless you are really skinny it would be pretty hard to hit anything critical with a 1 inch long needle.
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Chronic RUQ pain
It’s going to be tough finding someone who even believes what you have is real. No laparoscopy is required. I inject people with some lidocaine at the point of maximal pain and see what happens. If they like the way they feel with the lidocaine, I inject them with phenol 6%, about 2-3cc. Works about 80% of the time. Some pain management guys will do this. They may even be able to see the nerve in question with a high resolution ultrasound, but no promises on that.
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Chronic RUQ pain
Katie;
I may have an answer to why this happens after having operated on a patient who actually had the spasm while in a CT scanner and was misdiagnosed as having a tumor. At surgery there was a thickened nerve coming through the connective tissue, supplying the area of muscle that was spasming. I cut the nerve and the patient has had no further problems. A chemical nerve ablation may solve your problem.Good luck,
Steve Goldstein -
Hernia Surgeon
I am a hernia surgeon just outside of Albany NY. I do TEP routinely and often combine that with a mesh umbilical repair. It should be no problem to excise a urachal remnant at the same time. If you want to travel a couple of hours, I’d be glad to take a look. My website is http://www.littlescars.com