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  1. #1681
    Registered User drgephys's Avatar
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    Originally Posted by naturemanmh View Post
    I’ve been blessed with my first hernia! It is a bilateral inguinal. Not sure if a direct or indirect but appears to be an indirect.

    I’m a male age 43 with low bodyfat and in very good shape, very active and enjoy working out 6 days a week. The left side hernia is very small and stays out most always. The right side is approximately 75% the size of a ping pong ball. Right side is very soft and goes in and out very easily. I experience no discomfort from the left side. I experience 15% pain which is all in the right testical…ferls like a throbbing. The right side comes out very easily with standing up to walk or immediately after meal. When it is out my right testical comes up about 1 inch. When I inhale and exhale the right side will inflate and deflate along with my right testical.

    After reading the war stories associated with mesh im convinced a pure tissue repair is best, likely the shouldice. So a few questions to help me figure out how to proceed:

    1. I’m considering watchful waiting but I’m not used to seeing my testical move when breathing like this. I’m worried waiting can cause damage to the right testical. I’m also worried waiting can give this time to get larger which prevents me the ability to have the shouldice even done. But with covid I’m scared to go to the doctor for a physical exam, diagnostic tests ( which I’m not sure which ones are best to determine if these are direct or indirect) and the fact I have no good quality hernia Doctors close by me in west virginia. General thoughts, advice?

    2. Is there a master list on the forum that has all updated surgeons who perform the shouldice repair in the USA? Would love going to the shouldice hospital but being they don’t take my insurance, united healthcare, is a pass. I know of dr Sbayi in new york but he seems too confident telling me he has performed 1000+ shouldice repairs and has a 0% reccurances and 0% complications. I’ve read good things of dr. Brown, towfigh, Grischam, and peterson. I know some of these surgeons do the repairs well but not a high volume of the shouldice specifically. Not to mention most surgeons have not been running full steam ahead with covid.

    3. Say the hernias are indirect, I believe I’m good to go with the shouldice. But confused if they are direct I’ve read mesh is best for direct bilaterals. Reading also contradicts this saying direct bilaterals are fine with the shouldice if a first time repair. Thoughts?

    General thoughts, remarks are very great appreciated! I’m close to early retirement and now spend every waking moment reading in this or holding my abdomen so it don’t get worse. Not sure which is worse, not doing my biking and workouts in fear or having this done and having complications or a recuurrance.
    Indirect hernias are more common than direct hernias. Right-side indirect hernias are more common than left-side indirect hernias. Indirect hernias are always congenital. Direct hernias are caused by aging and/or heavy lifting etc. In an indirect hernia, the hernia sac (peritoneum with intestine inside) comes through the spermatic cord, which in turn comes through a congenitally enlarged inner ring of the inguinal canal. A congenitally enlarged inner ring can cause your intestines to descend into your spermatic cord. They need to split the spermatic cord to push the contents of the sac inside and then to excise the empty sac made of peritoneum. After excising the sac, the remaining hole in the peritoneum is tied. They usually put a "purse string" around the inner ring to reduce its diameter. Then the two flaps of the mesh are wrapped around the spermatic cord at the base of the inner ring to prevent a future sac coming through. The flat part of the mesh supports the inguinal floor weakened by the indirect hernia and prevents the occurrence of a direct hernia because of the weakening. In a direct hernia, spermatic cord is not involved and the hernia sac comes through the floor of the inguinal canal where there is a tear in the transversalis fascia. In tissue repairs, tissue flaps are used instead of the mesh. Both such mesh and tissue repairs are anterior repairs because the mesh goes above the transversalis fascia (inguinal floor) or the tissue repair is done above the inguinal floor.

    It's easier to repair bilateral hernias with laparoscopic surgery because both sides can be repaired simultaneously through the same tiny incisions, whereas in an anterior repair with or without mesh, there will be two larger incisions and the procedure will be twice as long as a single-side repair. In a laparoscopic surgery, the mesh goes between the peritoneum and transversalis fascia. Therefore, it is a posterior repair.

    There is an excellent mesh made of PVDF (polyvinylidene fluoride) called DynaMesh®—Lichtenstein that doesn't have any of the possible complications of the standard PP (polypropylene) mesh, but, of course, FDA won't approve its use in USA.

    https://en.dyna-mesh.com/lichtenstein-gb/

    Surgery has always its risks, potentially serious. Currently laparoscopic surgery is recommended by the international hernia association of surgeons. It may be the best to go with a good doctor and laparoscopic surgery. A good doctor will have done at least 500 laparoscopic surgeries before he/she operates on you. At the end it's your call to choose the hernia-repair technique, and no hernia-repair technique is risk-free. If something goes wrong, you will always regret and wish you had done it another way.

    Good luck!
    Last edited by drgephys; 06-15-2020 at 10:37 PM.
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  2. #1682
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    I was diagnosed Monday with 2 inguinal hernias. After my ultrasound I went and saw my doctor. He wants to use a mesh to repair it and the surgery itself will be laparoscopic(sp)

    The one on the left is more pronounced and causes lots of pain.


    Questionsfor those who have gone through this-
    did you have testicular And lower abdominal pain?
    What other symptoms did you experience?
    If you had yours repaired with mesh-does it dissolve or is it perm?
    Do you still have pain following the surgery?
    Were there any complications?
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  3. #1683
    Registered User drgephys's Avatar
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    Originally Posted by FrankCostanza View Post
    I was diagnosed Monday with 2 inguinal hernias. After my ultrasound I went and saw my doctor. He wants to use a mesh to repair it and the surgery itself will be laparoscopic(sp)

    The one on the left is more pronounced and causes lots of pain.


    Questionsfor those who have gone through this-
    did you have testicular And lower abdominal pain?
    What other symptoms did you experience?
    If you had yours repaired with mesh-does it dissolve or is it perm?
    Do you still have pain following the surgery?
    Were there any complications?
    You probably have direct hernias, which are caused by tears in the abdominal floor.

    Pain before the hernia repair is normal, and it could happen in the hernia site or in the testicle.

    Meshes are never fully absorbed, as they are what keep the hernia in place, but some are partially, about 50%, absorbed. In a laparoscopic surgery, the mesh goes between your peritoneum and abdominal floor.

    Complications and pain after the hernia repair vary greatly, from none to severe cases requiring a second, third, etc. surgery.

    Good luck!
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  4. #1684
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    Originally Posted by drgephys View Post
    You probably have direct hernias, which are caused by tears in the abdominal floor.

    Pain before the hernia repair is normal, and it could happen in the hernia site or in the testicle.

    Meshes are never fully absorbed, as they are what keep the hernia in place, but some are partially, about 50%, absorbed. In a laparoscopic surgery, the mesh goes between your peritoneum and abdominal floor.

    Complications and pain after the hernia repair vary greatly, from none to severe cases requiring a second, third, etc. surgery.

    Good luck!
    Can one have pain right below the belly button before bowel movements due to this kind of hernia?
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  5. #1685
    Registered User drgephys's Avatar
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    Originally Posted by FrankCostanza View Post
    Can one have pain right below the belly button before bowel movements due to this kind of hernia?
    I am not sure where exactly you're referring to but pain normally happens at the hernia site and especially during bowel movement or bowel gas, when the enlarged bowel strains the abdominal-wall tear (for a direct hernia), spermatic cord (for an indirect hernia), etc. Direct hernias tend to be located higher.
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  6. #1686
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    Originally Posted by drgephys View Post
    I am not sure where exactly you're referring to but pain normally happens at the hernia site and especially during bowel movement or bowel gas, when the enlarged bowel strains the abdominal-wall tear (for a direct hernia), spermatic cord (for an indirect hernia), etc. Direct hernias tend to be located higher.
    what I mean to say is at the point where we bend forward below the belly button right above the pubis. Can you get pain when the bladder is full?
    Last edited by FrankCostanza; 07-23-2020 at 04:10 AM.
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    Is robotic more risky for pain and placement?
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  8. #1688
    Registered User drgephys's Avatar
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    Originally Posted by FrankCostanza View Post
    what I mean to say is at the point where we bend forward below the belly button right above the pubis. Can you get pain when the bladder is full?
    That sounds like probably where the hernia is. Yes, a full bladder can push on the hernia as well depending on where it is located, but it wasn't the case for my left-side indirect hernia.
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  9. #1689
    Registered User drgephys's Avatar
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    Originally Posted by FrankCostanza View Post
    Is robotic more risky for pain and placement?
    My doctor prefers laparoscopic TEP. I asked him about the robot (da Vinci), and he said he can use the robot but there is no advantage of using it. He also said the robot requires a larger incision than manual laparoscopic TEP. The robot is probably unnecessary in hernia surgery if a doctor is already experienced in manual TEP. It has some nice tools available to the surgeon though.

    I kept going back and forth between laparoscopic TEP and open Lichtenstein and finally went with the open Lichtenstein, even though he had recommended laparoscopic TEP.

    It's been about two years and two months since my surgery in early June 2018. Do I sometimes have pain? Yes, sometimes I feel slight pain in my inguinal canal when I urinate or move. I sometimes feel scared that one day it's going to turn into an horror mesh story that requires mesh removal. However, it's been mostly good, and it hasn't affected my workouts at all. I don't feel any pain when I lift and the occasional slight pain I mentioned hasn't been a significant concern. The only other thing is that my groin has never gone fully flat after the surgery. Perhaps the mesh was a little larger than it should have been and it's buckling a little.

    The difference between laparoscopic TEP or TAP and open Lichtenstein is where the mesh goes. In laparoscopic TEP or TAP, the mesh goes between your peritoneum (the membrane that contains your intestines) and abdominal floor (fascia layer). In the open Lichtenstein, the mesh goes between your abdominal floor (fascia layer) and muscle layer. Both areas (inside or outside your abdominal floor) contain the nerves, blood vessels, and spermatic cord, and both can lead to pain and sexual complications due to mesh.

    The key is to find a good doctor with a lot of experience and few failures. Surgery always carries risks, including death, and no one wants to have it, but if you have a hernia, it's not really optional.
    Last edited by drgephys; 07-28-2020 at 11:20 PM.
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  10. #1690
    Registered User KungFuFighting's Avatar
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    Originally Posted by KungFuFighting View Post
    Just checking in again at the 3 year mark here, you can find my earlier posts for more details, but essentially I had a right inguinal hernia repaired; open repair, using mesh. So far haven't experienced any pain, or adverse side effects, and it hasn't affected my activities (although I'm a little more mindful if something is likely to put excessive strain on the area). Hoping the repair remains a success long term.

    Good luck, and a swift recovery to everyone.
    A little late for my yearly comment, but thankfully just hopping in to report everything is still as described in my last comment (good). Again, good luck and a swift recovery to you all.
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    Originally Posted by drgephys View Post
    That sounds like probably where the hernia is. Yes, a full bladder can push on the hernia as well depending on where it is located, but it wasn't the case for my left-side indirect hernia.
    they didn't find any inguinal hernias. they did lysis an adhesion attached to the sigmoid colon though.
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  12. #1692
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    Originally Posted by SpanishRPG View Post
    Thanks and sorry for the late reply. I decided, finally, the Dr Koch as long as it was close to where I live. I made an appointment. At the moment with all this coronavirus thing I wanted to postpone the procedure. They replied me that they already had cancelled my surgery (they cancelled without telling me, thank god I didn't go to the clinic, after 800 km, to see they already stood me up without notice). The reason was that I was insulting the doctor in the herniatlak forum. Something I never did. I checked and yes, one of my messages had been edited saying that Dr Koch is Dr Mengele or something. You can see there, all the conversation is still there. Even though I complained in that forum asking for the reason why someone with admin rights edited my messages, I never received any answer from that forum. Furthermore, the Dr Koch clinic never replied when I told them...

    So now, I have to wait and see, at least my hernia doesn't seem to get worse. I really have to be careful to what doctor I find, I really have had the jinx so far with all this thing.
    No problem - as you can see, months go by between visits to this forum these days. I'm sorry to hear you ran into yet more trouble. Man, it's really been one thing after another for you. I don't know what you've ended up doing, but I agree with drgephys that that doctor's solution sounded pretty hardcore. Have you found someone else yet? If so, what course have you taken?
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  13. #1693
    Registered User drgephys's Avatar
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    Originally Posted by FrankCostanza View Post
    they didn't find any inguinal hernias. they did lysis an adhesion attached to the sigmoid colon though.
    Ah, I hope you get well soon. That would certainly hurt during bowel movement. Will you need surgery?
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