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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Is severe chronic pain after mesh surgery for right inguinal hernia normal?

Answered by
Dr.
Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 17776 Questions

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Posted on Wed, 7 Sep 2016 in Lump
Question: In March I was diagnosed with a right inguinal hernia. I am female. It is painless. I have had it since late last year. In July I had it checked by a surgeon who says it is moderate-sized. Should I get it fixed soon? Is it very rare to have
chronic pain afterward resulting from the mesh surgery?
doctor
Answered by Dr. T Chandrakant 40 minutes later
Brief Answer:
Need to get operated.

Detailed Answer:
Hi.
Thanks for your query, albeit short and specific.

To recapitulate: Female/46 - right inguinal hernia since last year - got confirmed by a Surgeon - says moderate sized - wants to know whether to get it fixed, rarity and chronic pain due to mesh.

To answer your queries:

- Yes, it is rare to have inguinal hernia in females as there is no inherent weakness in the inguinal canal as it allows only the round ligament to pass through in females as against the passage of the spermatic cord, testis and epididymis in males.

Sooner the better, why to wait for it enlarge further and get into complications like obstruction and strangulation.

Get an appointment for surgery if you are medically fit.

Lastly, the chronic pain resulting from the mesh: This appears only if the nerves get entrapped. If the nerves are identified and separated well keeling away from stitches and possible scar formation, there can not be any pain as we see in many patients.

I hope this answers all your queries, please feel to ask for further relevant queries if you feel that there is a gap of communication.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. T Chandrakant 6 hours later
You mention pain"as we see in many patients". What type usually have chronic pain after or nerve damage? Somewhere I saw that perhaps 20% may have chronic pain after from mesh. I don't know if that pertained mainly to the other type of hernias. What do you say about that? Right now it is painless. I may want to wait longer if there is a chance of having pain after that could be chronic!
doctor
Answered by Dr. T Chandrakant 38 minutes later
Brief Answer:
Discuss the points I have given with your Surgeon. Herniorrhaphy

Detailed Answer:
Well said and do agree with you.
If the hernia is of indirect type - Indirect Inguinal Hernia- you may discuss with your Doctors to go for herniorrhaphy . In this procedure the hernia sac is dissected and tied, and anatomical closure is done if the fascia and muscles are of good strength and the nerves identifies and separated well away from dissection and while suturing. This has least chance of having post-operative pain.
Mesh repair is called Hernioplasty. - I hope you got the difference between rrhaphy and plasty.
Oh yes, most of the patients we operate have no pain if the nerves are searched for, separated and kept away during the actual procedure of repair. These are ''many patients" I wrote about.

Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
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Follow up: Dr. T Chandrakant 52 minutes later
You are suggesting I may rather have herniorrhaphy instead of hernioplasty? I think the doctor already said he wouldnt know if it is direct until operating. I don't think he mentioned herniorrhaphy, only that he would use mesh. If there are other options to consider, I may postpone my appointment until later...

Also please clarify, of the female patients you have known who have had inguinal hernias, do you advise nonmesh repairs for them if they are indirect? I think I read that with females they are usually indirect. Have you ever advised and done MESH surgery for females with indirect inguinal? Or do you just do herniorrhaphy, not hernioplasty? (Perhaps different doctors do different methods of choice?) If you have done mesh repair for females with hernias like mine, do you know if some of them with mesh had persistent, chronic pain after surgery?
doctor
Answered by Dr. T Chandrakant 3 hours later
Brief Answer:
Decision depends upon many factors.

Detailed Answer:
The decision of herniorrhaphy or hernioplasty depends upon many factors like I discussed above. The muscle mass, tone, strength of he fascia and muscles, willingness and experience of the operating surgeon, any associated problems like constipation, chronic cough, the amount and strain of day-to-day activities, Type of hernia.
The incidence of pain in herniotomy, herniorrhaphy are far less.
Hernioplasty with mesh causes more fibrosis and hence there are more chances of post-operative pain, nerve entrapment and so on.
This was in response to your 2nd query about the pain.
Putting in mesh helps to avoid recurrence.
Since you are 46 years old, mesh may be the better choice.
Mesh is avoided only in very young patients with indirect type wherein the neck of the hernia is small, is of indirect type and the muscle and fascia are strong.
In such patients also if the muscle mass and strength are poor, mesh is preferred. Hence in some cases it may be a necessary, in some optional.
So when I operate we consider all the factors mentioned above, give them iron and protein supplements if blood shows deficiency.
Most of the patients including the females also have weak muscles in the lower abdomen hence usually I had to put in mesh to support.
None of my patients complain of post-op pain as we meticulously go for the nerves and safeguard them while repairing the hernia.

I hope this answer helps you further in decision making.
I hope if your operating Surgeon takes care, there may not be any pains in post-op periods.

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. T Chandrakant 30 hours later
Thank you. This is helpful in decision making.
doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
Thanks for your appreciation.

Detailed Answer:
I am happy that the answers help you.
You may please rate this answer before closure of the discussion once completed and can certainly contact me on the below link in future, whenever you may need me.
http://bit.ly/askdrtchandrakant

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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