[wes878]

4 years of hip/groin pain. Help!

Hi guys,

I did end up doing the labrum surgery again about 2 months ago. Turns out the labrum had calcified somewhat after the last surgery, and I also had a bone spur forming on the edge of the acetabulum. The surgeon shave those down and then replaced that area of the labrum with a piece of my IT band. Fun stuff! I do have less pain now in the anterior portion of the hip now (though still have some), so it was probably more likely it was labrum and not a hernia. Unfortunately it hasn’t really done anything for my posterior pain, even with all the PT and massage I have been getting in the area. So I am somewhat better, but not back to normal. The surgeon isn’t quite sure why I still have pain in that area. Might try a cortisone shot right on the exact spot into the muscle/tendon on my next visit.

[wes878]

Diagnostic laparoscopy as the definitive means of hernia detection?

Thanks Dr. Szotek. I guess my question is, is the peritoneum vital to have intact? Once it is taken down, can it be placed back to where it was before, or does something else (mesh) have to be inserted in it’s place? This is assuming everything looks normal on close inspection, no hernia or lipoma. Also, is insurance covering this “experimental” robotic repair? Thank you

[wes878]

4 years of hip/groin pain. Help!

Thank you Dr. Earle and Dr. Towfigh for all your advice. I have decided to have another labrum surgery next week to see if I need it reconstructed this time, as I have seen 3 different general surgeons, all of whom can’t definitely say I even have a hernia to begin with (MRI and ultrasound don’t conclusively show one either). I also feel the pain is a little more towards the hip flexor than deep in the groin. I am hesitant to undergo surgery to put in mesh and risk making things worse if it is not even the problem to begin with. If this surgery does not work, I will circle back with Dr. Jacobsen and re-visit the hernia. I tried to get his opinion as well, but he is booked for two months.

[wes878]

Diagnostic laparoscopy as the definitive means of hernia detection?

quote :

On this topic. I just did a case today that I completely reduced the hernia sac through TAPP approach and there was large prepetitoneal cord lipoma that was not evident intra-abdominally. This is the prime example of something that could possibly be missed with diagnostic lap alone and not taking the peritoneal reflection down. There was no evidence of this on intra-abdominal exam.

I asked this somewhere earlier, but once you take the peritoneal down, does mesh need to be placed at that point? I understand it does not have to be placed during a diagnostic lap, but it sounds like these are two different things??

[wes878]

4 years of hip/groin pain. Help!

Dr. Towfigh,

Thank you for your response. I have had two hip labrum repair surgeries (along with psoas tendon release) but no hernia surgeries. The surgery did not help the pain, but probably didnt’ make it worse either. Not much change. The pain has started to get worse this year though. Still have pain in the front, pretty close to where the psoas was attached, maybe slightly closer to the groin. Also have pain on the side/back, where the gluteus maximus tendon is. I have looked at the SI and lumbar spine, but nothing appears wrong there. I am kind of running out of options and ideas, which is why I am investigating the possibility of a hernia. I can’t decide if doing hernia surgery for a “maybe” , is worth the risk of making it worse. I asked this in another thread, but If you take down the peritoneum, do you have to place mesh at that point or can you stop at that time and do nothing? I was thinking maybe that was a possibility if no hernia is seen once the scope is in. Do you know of a good hernia surgeon in San Diego county by chance?
Thank you

[wes878]

Diagnostic laparoscopy as the definitive means of hernia detection?

Thank you for the response Dr. Towfigh. Is it possible to take down the peritoneum but not end up putting mesh in if a hernia is not seen? Or is the mesh required once the peritoneum is taken down? Also, do you know of a good hernia surgeon in San Diego county I could visit?
Thank you

[wes878]

Diagnostic laparoscopy as the definitive means of hernia detection?

quote :

These are great replies and very informative, thank you Dr. Goldstein and Dr. Szotek.

A follow up question — What happens if a peritoneum laparoscopy is performed and no hernia is found? Does that ever happen? Are other problems ever seen in that approach which warrant fixing?

I would like to know the answer to this as well. Is there always “something” that could be fixed, even if it looks semi-normal? i.e., just put some mesh in there and see if the pain is eventually reduced? Would you go that far in and then not end up doing anything, or would you always do something once you got to that point? Also, if you end up getting mesh put in, but the pain ends up getting worse eventually, is it fairly easy to remove? Thanks

[wes878]

4 years of hip/groin pain. Help!

Hi Chaunce,

1. Neither my ultrasound or MRI were done with valsalva. The anterior pain can sometimes feel like it’s around the hip flexor, and then sometimes more towards the groin. If I end up pushing it too hard by walking a lot or a short hike, I get a dull aching pain deeper into the groin that can last a couple of days.
2. I did have lidocaine injected in my hip and ran around a bit. It seemed to reduce the pain somewhat, which is why I went ahead with the labrum surgery. But considering I have had two surgeries with no improvement, maybe the pain relief was wishful thinking?
3. I’ve had PRP in the hip joint, in the gluteal area (where I also have pain) and in the hip flexor. All with no effect. I even had stem cells put in the joint which I thought helped somewhat at first for a few months, but now the pain is the same again, so not sure if that actually did anything.
3. I live in San Diego and have seen top hip surgeons and hernia specialists in San Diego, Orange County, and LA. Unfortunately, still searching for a fix!

I also have pain in the back of my hip/upper lateral thigh, which I realize is not hernia related. It’s possibly trochanteric bursitis, and/or gluteus maximus tendonosis. It’s not a burning, zapping nerve type pain, so it’s not sciatica. More of a dull, throbbing ache.

[wes878]

4 years of hip/groin pain. Help!

Thanks for your response Dr. Towfigh. I saw another general surgeon yesterday. He looked at my recent MRI and said that he did not really see anything unusual. ( The MRI was not done with valsalva) On physical exam he said I could maybe have small hernias, but nothing obvious. He suggested that he could put some mesh in, even if I did not have an obvious hernia upon inflating my abdomen. He said it would cover both the inguinal area, and any possible sports hernias. He thought there was a 50/50 chance that this would give any improvement. I also have a hip surgeon that can do either a bursa removal, or a labrum reconstruction, in hopes that this could fix the issue. The surgeons could even both do their surgeries back to back, while I was under anesthesia. (They are friends) I am not sure which avenue to purse, as I don’t have any obvious hernia, nor an obvious labrum tear. Something is wrong though, as I can’t do any kind of physical activity without pain during or afterwards. I’ve had two labral repairs that have not worked, but not a labral reconstruction yet. I’m kind of leaning toward just doing everything at once in hope that something fixes the problem. Any advice? Is it a good idea to do a hernia surgey as a “maybe”? Thank you

[wes878]

4 years of hip/groin pain. Help!

Thank you for the feedback Dr. Earle. I have been evaluated for a sports hernia, but nothing has been found. My pain is closer to the hips than in the middle of the pubic bone, so does not seem to be that. No weakness doing a sit up or anything either. The anterior pain is right in the hip flexor/groin area. If anyone wants to chime in on this, please feel free!