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Dr. Andrew Rynne

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Suffering from lower abdominal pain after bilateral hernia surgery. Any advice?

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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5770 Questions

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Posted on Mon, 17 Dec 2012 in Abdominal Pain
Question: My grandfather is 80 Years old. He underwent a Bilateral Hernia Surgery about 5 years ago. Since then he is suffering from Lower Abdominal Pain. It was an open surgery and not through Laparoscopy. This has reduced his quality of life. We have consulted a lot of doctors but no one is able to diagnose the problem and just prescribe medicines like Isabgol, NSAIDs etc. I am attaching his Colonoscopy and CT Scan Reports. It is a belief in the US that if post-hernia pain continues for more than 8-12 months and medicines like Analgesics, NSAIDs, Nerve Blocks do not work, another surgery is needed to be done to solve the issue.

Please advise.

Thank you
doctor
Answered by Dr. Grzegorz Stanko 2 hours later
Hello!

Thank you for the query.

Was this hernia surgery made throughout abdominal cavity? Or with groin incision?(More simply where is the scar, on the abdomen or both sides of groin?)
Where is this pain located? On the left side of lower abdomen or whole lower abdomen is aching? Does this pain persist all the time or appears after a meal? Does you grandfather suffer from constipations? Any blood in stool or mucus in stool?
Any nausea, vomiting?
Such pain can be caused by partial intestines obstruction due to intraabdominal adhesions. But this can be explained that way only if hernia surgery was performed throughout abdominal cavity. If so, there will be no test that can show the source of it and the only way to diagnose it is laparoscopy.

I`m looking forward to hearing from you.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 18 hours later
Thank you very much for your reply. The answers to your questions are as follows:

1) Was this hernia surgery made throughout abdominal cavity? Or with groin incision?(More simply where is the scar, on the abdomen or both sides of groin?)
Ans.: Hernia Surgery done with Groin Incision on both sides i.e bilateral as per the doctor who operated.

2) Where is this pain located? On the left side of lower abdomen or whole lower abdomen is aching? Does this pain persist all the time or appears after a meal?
Ans.: Pain on lower abdomen below the operation scar persists - more felt after meals and bowel evacuation.

3) Does you grandfather suffer from constipation?
Ans.: Constipation for many years past with hard stool and diverticulam of colon.

4) Any blood in stool or mucus in stool?
Ans.: No Blood or occult blood or mucus in stool.

5) Any nausea, vomiting?
Ans.: No

Please advise.
doctor
Answered by Dr. Grzegorz Stanko 53 minutes later
Hello!

Thank you for the query.

So your grandfather has Stoppa operation for hernia. I assume that the mesh was inserted. The most probable reason of your grandfather symptoms is hernia recurrence. It happens very often if bilateral hernia is repaired with Stoppa operation. Your grandfather should have groins ultrasound to rule this out.
The other possible reason of such symptoms can be nerve irritation caused by surgical suture of the nerve. In the surgical area of the inguinal hernia there are 2 nerves which can get accidentally catch by surgical suture causing very disturbing pains.
It is necessary for your grandfather to have General Surgeon consult after groin ultrasound.

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 2 days later
A lot of Ultrasounds were done in the past. The last report is attached for your reference with the Plate, Report and General Surgeon's observations are uploaded. The following are the links for your reference.

http://www.wwww.www
http://www.wwww.www

http://www.wwww.www

We have consulted a lot of doctors in India but no one has observed Hernia Recurrence. Can the nerve irritation pain continue even after 5 years? As I told you, he underwent the Hernia Surgery 5 Years Back. Does he require another surgery to solve this problem or any other medications you can suggest? The NSAIDs, analgesics, nerve blocks prescribed in the last 5 years have not given much relief.

This pain has reduced his quality of life. Please advise.
doctor
Answered by Dr. Grzegorz Stanko 1 hour later
Hello!

I`m not surprised that many of ultrasound were done in the past. But I assume that all of them were abdominal ultrasound. And your grandfather should have groin soft tissues ultrasound. With regular abdominal ultrasound, inguinal hernia can not be visualized.
Nerve irritation is the most common reason of such long lasting symptoms and it is possible that it can last for 5 years or longer. As the mesh was inserted, it can irritate this nerve again and again.
So if the life quality is poor another surgery might be the only solution.

Hope this will help.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 18 days later
The soft-tissues ultrasound has been done as per your advise. The photos and the doctor's report are attached for your reference. Please advise. Thank you.
doctor
Answered by Dr. Grzegorz Stanko 9 hours later
Hello!

According to performed ultrasound there is something more important to be explained than nerve irritation.
There is significant urinary bladder wall thickening and large intestine wall thickening. It can has one reason and be associated with each other or this can be two separate findings.
I know that the colonoscopy were performed in 2009 but it seem another one is necessary. If no findings in large intestine, you should visit urologist and have cystoscopy performed to explain urinary bladder wall thickening.
It looks like some inflammation process in the large intestine is causing such symptoms.
Nerve irritation is still possible, but with such ultrasound results, wall thickening has to be diagnosed at first.

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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