[wilfred]

Thanks Chance123 for the reply. What I meant was if the x-rays used in the CTScan can distort or effect the mesh used. Somewhere I read that the x-rays used in CT scan can distort or deform the mesh. I don’t know how much that is correct.

[wilfred]

Hi Ajm222
I had only right inguinal hernia which was repaired laparoscopically. I had pain on the three small incisions made but very surprisingly more on the left side where it was simply probed and no hernia was found. I always thought it was still in the healing process for the first few weeks. I had little pain on the right testicle and groin also but not much. Most of the pain was where the incision were made and also further down from the incision area in the abdomen. But as weeks went by and now I am at almost 11 weeks post op my pain on the left side from umbelical down to pubic tubercle became quite intense that I had to go to see the doctor. It was only after I found out later from x rays that he has placed two tacks on the left side also. God knows why. Only rationale I can think of to close the peritoneum on left side. In addition there are 11 tacks on right side where the actual hernia was. My main concern after surgery was parsthesia of right leg from butt down and burning. Now I am more concerned about my pain in left side on the pubic tubercle area where there was no hernia but there is a tack there. All my tacks were titanium. It is not a rocket science to figure out why I am getting pain on the left side even when I walk. It is just the tack which moves with muscles when I move. I am getting an MRI done today. But to recap your question I would say I had very little pain in the groin after surgery which became more intense as weeks passed by even today. I hope you heal fast. I also didn’t do any exercise or any lifting for first 5 weeks.

[wilfred]

Good intentions
you have hit the nail right on the mark. It is soooo true what you said about insurance. They did the same thing for me by rejecting my MRI approval related to hernia surgery. Finally on my suggestion to my GP I requested to change the language and finally it was approved. It is so frustrating when you are suffering and you have to fight with some one in the insurance sitting far away giving decision just by the stroke of a pen having no concern about your pain and suffering. I don’t think in our lifetime this attitude of insurance shall ever change. I myself a provider and I know from my personal experience when I file for my patients with certain appropriate codes it gets rejected. When you twist it with slight different codes with lots of explanations then it gets approved. Sad but true this is what the current affair of insurance industry is and we shall have to live with it.

[wilfred]

Thanks Jnomesh for the reply. Yes I am only getting MRI and not CATSCAN so I think I should be fine.

[wilfred]

Thanks Good Intentions for the response. He used titanium tacks as he told me. Also x-rays show the titanium tacks. Absorbable tacks won’t show up on x-Ray. I shall try to go with your recommendations to see if I can shrink the pictures to upload. Thanks

[wilfred]

Hi Clbesr
Sorry to hear about your pain on other side than the repaired side. I have almost same problem like yours but my symptoms are more on the repaired side. But I do get some pain on the other side which has no hernia. The surgeon told me before surgery that he would probe on the non hernia side to rule out any hernia. He fixed my right hernia and found no hernia on left. But I was surprised that I was getting pain on the left side also after surgery. I got some x-rays taken and was surprised to see that on my non hernia left side there are two to three tacks ( as in your case they are staples) and on the hernia side there are 10 tacks. I think when he probed my left side to find any hernia he had to dissect the peritoneum and then closed by tacks. I never knew he would use so many tacks. I think it is the tacks causing this pain due to inflammation. I hope you feel better with time.

[wilfred]

NFG12 Thanks for words of encouragement. Your explanation is great. I have started taking some oral steroid s to see if it helps. I shall give it a good few months before deciding on mesh removal. Thanks again.

[wilfred]

Hi everyone
I went to my GP to request for an MRI. I gave him a copy from Dr Towfig’s protocol for MRI. His initial request 2 weeks prior were denied by my insurance due to lack of proper reasoning for MRI need. Hopefully with his refiling for MRI with my insurance with the proper language it should be approved. I need some feedback on the following:
Out of desperation and with no help from my surgeon I went to the local urgent care to get some x-rays of my pelvic area to see what was going on. I was surprised to see on the x-ray that my surgeon has used 13 helical titanium tacks. The clinical notes says 3 were used to fixate the mesh. There was no mention in the report about the number of tacks used to close the peritoneum. The report only said the peritoneum was closed with tacks. So I counted on the x-ray and it turned out to be a total of 13. Is that not a lot of metal in my body ? Is this normal to use so many metallic tacks for a small hernia on a thin patient? To add more mystery he has used an extra large size 3Dmaxx mesh. My waist is only 32 inches and I am completely at loss. Also I am confused how those 10 helical tacks are going to stay in the peritoneum long term? Don’t they get loose while doing exercises or any other vigorous activity? I wish I could upload the X-ray on this forum for some expert to look into that.. On the x-ray some tacks look horizontal (shown as circle) whereas other are vertical showing the full helical form. Some look like anchored to bone whereas most of them look as simply floating ( I guess those used to close the peritoneum will show as floating in empty space on the X-ray. This is just my guess. What I am worried is if any one or more tack has come loose? How would you know if any tack has come loose? Will it show on X-ray or MRI? My symptoms of constant testicular pain and heavy feeling of pressure and pull is not going away. This combined with pain in the glutal muscle and in the leg all on the right side where the hernia was is driving me crazy. If any of the 13 tacks were to impinge on any nerve should I be getting moderate pain (the way I have it now) or excruciating pain? I would highly appreciate if anyone has any advise or know anything about the tacks. I just want to rule out that these tacks are not the reason for my symptoms. I just can’t rationalize how tacks can stay and not get dislodged specially those are used just to connect soft tissue. I am not only concerned about my current symptoms but also about my long term prognosis with these tacks. Please advise. Thanks

[wilfred]

Thanks Jnomesh and NFG12 for the reply. NFG12 how are you doing after your mesh removal? I am just too concerned that life should not become completely devastated after removal of mesh whenever I decide to do that. Even in best hands there is no guarantee of a complete pain free life or at least better than with mesh in your body. Knowing from the experiences of those who went through that procedure could be very helpful. Is your life better than before as far as pain is concerned? Please advice . Thanks again. Jnomesh I was surprised that you had no pain after mesh removal from the surgery. I hope and pray that coming months you would improve from this difficult ordeal. I just wish I should have waited more.

[wilfred]

Thanks Jnomesh for the reply. Could you please tell me how are your symptoms after you had your mesh removed ? Did you symptoms improve, same or more after the mesh removal. Would you recommend mesh removal if done by good hands as mentioned in this forum? If my symptoms did not improve then I may get the mesh removed but worried that I should not be in worst situation than now. Thanks

[wilfred]

Thanks Jonomesh for the reply. I just don’t understand about my surgeon who boasted that he has done 3000 hernia surgery and I being thin would never have any complications. Finally he places an extra large mesh, places three titanium tacks and closes the Peritoneum with more tacks. This is what the report said. I watched Dr Shirin Towfigs’s presentation on u-tube in hernia society meeting which clearly said that non use of tacks can reduce the post op pain. I don’t have debilitating pain but this constant dull ache in groin and other area is just driving me nuts. Cannot concentrate in my work and don’t know what to do. I never had high blood pressure and now constantly I am having this high blood pressure because of being stressed out so much. I am thinking about getting an MRI and cat scan to see if it shows up something. I shall contact Dr Shirin Towfig after I have all my documents. At least we are lucky to have pioneer like her who can help remove the mesh if needed. There are people outside USA who do not have any access to any surgeon who can remove mesh. I hope I get better with time. I thought they had done lots of improvement in the mesh design since you had your surgery 6 years back. But who knows what improvement in design they did. Everyday I wake up and cannot turn back the clock. So frustrating.

[wilfred]

Hi neumannb
this is Wilfred. I just sent you a private message. I would appreciate if you can please respond. Thanks
Wilfred

[wilfred]

Hi everyone,
i have posted earlier about my numbness and pain on my right leg from my butt down. I had only occasional pain on my right testicle and groin after the surgery which for most purposes I thought was a part of healing. But my main concern was my right leg numbness and burning at the butt down to the leg. Having found no help from the surgeon and having no improvement I went to a chiropractor 5 weeks after my surgery. He was little aggressive in manupulation of my gluteal muscles and legs. Since I saw the chiropractor it has been 3 weeks and I saw some improvement in my numbness but now my right testical pain which was intermittent is almost there all the time including light burning in the groin area. My right testicle feels like heavy or pressure or pulling kind of sensation. This was very intermittent after the surgery but now has become almost constant. I went to the surgeon last week as I was worried that the repair might have been damaged by chiropractor manupulation of my legs but he checked and said the repair looks fine and my symptoms should go away. When I take Motrin it reduces or goes away but comes back immediately if I don’t take Motrin. I was most concerned about the pain on my butt and now on my right testicle. Can it be that the manipulation by the chiropractor made the mesh to move? I am really concerned. My testicular pain is about 3 and sometime 4. My surgeon told me that I had a small hernia but he always uses extra large mesh to rule out reoccurrence. I looked into the surgical notes and it says he used XL3Dmax mesh. I am only 5 ft 7 inches tall and weigh only 148 lbs. I don’t see the rationale to put extra large mesh on a thin patient like me. Could this be the cause of my symptoms? I don’t know what else to do. Very depressed whether it will ever go away. Please advise me if I should go for an MRI or Catscsn? I don’t expect anything further from my surgeon as he can only verbally console me that it would go away. Please advice me.
Thanks

[wilfred]

Thanks Momof4 for the reply. I also feel some encouragement from others that it shall go away with time. But I wake up with very depressing feeling. Sone time I wonder why I didn’t fly to South Korea or to have it done by a handful of US surgeons who do without mesh or tacks. My burning pain has now changed to intermittent throbbing pain and that is what bothering me. Why did you go for mesh removal? Was there lots of complications with the mesh? Let us hope for the best.

[wilfred]

Hi Ajm222
Thanks for the response. Bring a dentist myself I like reading journal articles. Are you from Virginia? I graduated from medical college of Virginia (VCU) dental school in Richmond. I still remember during the gross anatomy days while disecting cadaver the instructor showed us the inguinal canal and all the nerves in that area which I never paid much attention as I thought I should only concentrate in head and neck which is my area. But overall I do understand and know the basic anatomy of that area though never had to use in my practice. My surgeon called me today and told me that he never had anyone complained about the kind of symptoms I am having. But all those journal articles or even forums are full of these post op symptoms in the leg or groin. I explained to him clearly that my symptoms are mostly in the area where lateral cutaneous femoral nerve innervates. But in addition I am also having some symptoms at the calf muscles and sole of the foot. Anyway with great difficulty I managed to get an appointment for tomorrow with a neurologist for EMG and nerve conduction test. I was told it is ok to get physical therapy started which I am starting from Friday. I hope and pray that I am out of this saga of post op pain and numbness and can enjoy seeing my own patients and give them 100% of myself the way I used to.

[wilfred]

Thanks ajm222 for the reply. I am still worried. As I read some scholarly journal articles saying that if the numbness happens immediately after surgery as in my case then it may not go away as compared to happening few days after surgery which shall go away as that is due to inflammatory response of the body. Once the inflammation stops the numbness goes away. It makes sense. If the nerve is trapped it shall never go away. But if it is due to inflammaory response it should settle down with time.I also read that this complication is more common in laproscopic and not that much in open procedure. Thanks for sharing words of some hope.

[wilfred]

quote LeviProcter:

Still pretty early in the postoperative course. Need to give it at least 6-8 weeks.

B9781416054740000424_gr4.jpg

Gluteal nerve sensation is supplied by any nerves in the region of an MIS inguinal hernia repair.
See above link for skin sensation region based on the nerves at risk in an MIS inguinal:
– iliohypogastric
– ilioinguinal
– Genital branch of GFN
– Femoral branch of GFN
– Lateral femoral cutaneous nerve

The femoral nerve itself would be very difficult to in-advertantly injure. It’s difficult to even find and is often deep to psoas

Your symptoms don’t sound tack related.
Your symptoms seem to be pressure on some of the groin nerves (lateral fem cutaneous) related. If it occurs in a seated position it can be mesh pressing on the nerves but is relieve with moving. Your mesh is generating lots of inflammation as its intended at this time frame.

The gluteal down to the foot can imply lumbar nerve root impingement vs muscle spasm related issue.

Nerves are not sought typically to prevent injury. Tacks are avoided in the triangle of pain (where the nerves primarily are).
Fixation often not needed unless large direct hernia >= 3cm.
If fixation is used it’s based on anatomy and landmarks.
Stretching is fine.

Way too early to jump to conclusions.
Be active.
Give it 6-8 weeks before digging further.

Thanks Dr LeviProcter for replying. It makes lot of sense to wait and see as you rightly said the natural inflammatory process due to mesh will take some time to settle down. Thanks again.