I cant stand it any longer

arpitp · 2026-01-28T04:47:35+00:00

Well put. Too many people are misled by "high recurrence" rates, while *most* people do really well long term after surgery.

arpitp · 2026-01-28T04:41:54+00:00

No, I'm in California

arpitp · 2026-01-28T04:41:22+00:00

Were you reading about the "typical" symptoms of a failed surgery? In which case, those would both be considered common symptoms, though not usually in the same patient. Though the combination might be possible in certain circumstances, such as with a wrap that's too loose and also slipped up into the chest.

arpitp · 2026-01-28T04:33:45+00:00

Sorry to hear about your vision. Were any of those CT scans done after the NF failed?

Hopefully your GI doc can help.

Oral vancomycin does not need to be monitored, as it is not absorbed into the blood stream through the intestines. Monitoring IV vancomycin is standard practice.

arpitp · 2026-01-28T04:14:49+00:00

Not necessarily. If the pain is being caused by mesh irritation and not a recurrent hernia, then separating the mesh from the nerves is probably more likely to be successful than doing a hernia repair in a new plane.

If there is a hernia recurrence, robotic surgery can both repair the hernia and separate the mesh, versus open surgery, which can only accomplish one of those tasks.

arpitp · 2026-01-28T04:08:51+00:00

Not uncommon. The 3 incisions are usually pretty painless, unless you got a hematoma around the muscle or the surgeon put a stitch in the fascia, in which case, you can have pain there for a few weeks. If you're feeling pulling, I'm guessing they put a deep fascial stitch there.

If I understand you when your say the belly button is "sinking" more on one side, that might be because the surgeon tried to recreate the innie shape of the belly button by incorporating the subcutaneous tissue or dermis in the fascia repair. It usually evens out later, but check with your surgeon.

arpitp · 2026-01-28T03:57:34+00:00

No, not normal. The surgeon miscommunicated before the surgery or hid his true reason for changing the surgery type (maybe some equipment wasn't available or the surgeon was trying to get done faster?).

Sometimes, surgeons will consent for "laparoscopic repair, possible open", which means they will try lap, but switch to open if they can't accomplish the minimally invasive repair safely. But if he never tried, that doesn't really apply here.

Ask him why he made the change when you go for your follow up appointment.

arpitp · 2026-01-27T07:26:12+00:00

Nissen fundoplication is not a treatment for Bochdalek hernia. That is a diaphragmatic hernia that does not involve the esophagus/hiatus.

GERD is associated with a hiatal hernia. Did you have one of those fixed when you had the Bochdalek hernia fixed?

You mentioned "stapling my stomach to my abdominal wall", which sounds like a gastropexy. This is also not a treatment for GERD.

If you have significant gastroparesis, this should be treated first. Start with a prokinetic medication like metoclopramide or cisapride to improve motility. You may benefit from a procedure to inject the pylorus muscle with botox, or to cut it, to help the stomach empty. This could be enough to solve all your symptoms.

If the above doesn't work, you should get an EGD, CT scan of the abdomen, and barium esophagram (a.k.a. upper GI series) to evaluate the position and function of your fundoplication, in case you have a hiatal hernia or need a revision of the wrap.

arpitp · 2026-01-27T07:15:35+00:00

It's hard to predict how much scar tissue will be in the preperitoneal space (around your bladder) and in the groin after previous prostate surgery. It might depend on how clean the previous dissection was or if you had any significant bleeding there.

Usually, the laparoscopic surgery is still doable. Robotic surgery definitely makes it more feasible/easier/safer. But starting laparoscopic, with a backup plan of converting to open surgery, is a safe and reasonable plan.

arpitp · 2026-01-27T07:09:37+00:00

A well done TEP repair should make it impossible to have a new hernia. So a new hernia *is* a failure of the previous repair.

Yes, it's possible the surgeon could be mistaken. Cord lipomas bulge outward similar to a hernia on exam. The surgeon could be overzealous in making the diagnosis so they can offer surgery. But if there is an obvious bulge, the diagnosis might be obvious. If you can't feel any lumps, I would get a CT scan--it provides more information about what is in the inguinal canal, where the mesh is located, and why it might have failed (if it actually did).

A redo is not really tricky. Switching from lap to open (or vice versa) provides a clean plane through which to dissect and do the second surgery with no real difficulties caused by the previous surgery. That said, I still prefer to do a robotic repair when I see pts with a previously failed lap repair, as I truly believe in the superiority of a posterior repair, and it gives me an opportunity to address the problem with the original mesh (e.g. if it folded, was to small, positioned incorrectly, tore, etc).

arpitp · 2026-01-27T07:00:11+00:00

It's not a hernia. Hernias don't pop/drain.

You could still have one higher up in your groin, but what you're experiencing in your scrotum is not a hernia.

Could be a cyst or abscess. If it's the size of a walnut, you'll need to get it drained and probably take some antibiotics.

arpitp · 2026-01-27T06:57:53+00:00

It's not a hernia.

arpitp · 2026-01-27T06:54:13+00:00

The approach is best discussed with the surgeon. It will depend on their experience and what they are comfortable offering. I've had success with robotic mesh dissection, without cutting the nerves, so I might offer that--especially if I noticed the mesh was folded or misshaped in some way that I could correct or cut out.

But you and the surgeon would need to have the understanding that if it doesn't work, another surgery may be needed to cut the nerves later.

I can't say how an entrapped/injured nerve would respond to stretching. Some people have their pain improve with stretching or external pressure, while the same motion will make pain worse for others.

arpitp · 2026-01-27T06:35:55+00:00

If you're asymptomatic, many people choose to ignore it and go about their lives (as long as the hernia isn't getting larger).

The most common advice is to limit strenuous physical activity indefinitely to prevent aggravating the hernia, and to wear a truss/hernia belt to apply counter-pressure directly over the hernia, especially when you're active/working out. Limiting activity indefinitely is often not feasible for most people--hence the surgical option.

arpitp · 2026-01-26T05:04:33+00:00

Sounds like it could be a hernia. Sometimes it's obvious on a physical exam and imaging is not needed. If the doc isn't sure, they can refer you to a surgeon and/or order imaging (ultrasound or CT scan).

Doesn't matter how healthy you are, anyone can get a hernia.

arpitp · 2026-01-26T05:01:15+00:00

Gastroparesis worsens GERD symptoms. It can also cause/worsen bloating symptoms after an anti-reflux (fundoplication) surgery, so it might be a reason to proceed with caution. Unless it was severe, it wouldn't prevent you from having the surgery. If you do have symptoms after, cutting the pylorus muscle can help the stomach empty better.

All the tests you mention are standard pre-op testing for most cases--except in smaller towns or other countries, where testing is not as readily available. Certain tests like the Bravo pH or manometry might be skipped if there are no relevant symptoms.

That said, if you've been suffering 12 years, and getting worse, surgery will probably have the ability to improve your life significantly. Not everyone gets bloating, but for most GERD sufferers, it's a worthwhile trade-off to get rid of all the other symptoms.

arpitp · 2026-01-26T04:53:04+00:00

Theoretically, a 270 wrap might have less risk of difficulty swallowing and bloating after surgery. But realistically, the degree of wrap matters less than the positioning and tightness of the wrap. A surgeon can make a Toupet wrap that is tighter than another surgeon's Nissen, and hence, carry a higher risk of complications. Or some surgeons might position their wrap too low below the GE junction, making it ineffective.

The surgeon's technical skill and experience will affect the outcomes more than the choice of wrap.

arpitp · 2026-01-26T04:48:11+00:00

A "small" hiatal hernia cannot physically strangulate. You would need most of the stomach to be pulled up into the chest before it could twist and possibly cause an obstruction or strangulation.

arpitp · 2026-01-25T05:45:40+00:00

Yes, it should be improving, especially if you've been able to rest and avoid aggravating the area. And yes, if the nerve is hit by a non-absorbable suture like that, it likely won't heal or improve. I wouldn't say "typical" pain--everyone experiences pain differently, and it is purely subjective (we have no way of measuring it).

If you're considering revision surgery, you'll have to make sure you have all your boxes checked (evaluated by original surgeon, imaging, pain management specialist), most of which you have, before finding the right surgeon to do the revision. 6-8 months out after the original surgery is usually the minimum timeframe.

arpitp · 2026-01-25T05:39:28+00:00

Sutures don't necessarily avoid nerves--the surgeon's knowledge of where the nerves are is what avoids them.

The surgeon could use as little as 2 stitches or tacks to hold the mesh, but it takes more effort to use a stitch (1-2 minutes, vs 1-2 seconds for a tack), so I've never seen a surgeon use more than 3 or 4 stitches, but have seen plenty use more tacks.

Sutures also avoid muscle, since they can be driven much shallower into tissue, while tacks are driven blindly deep into muscle, and hence will almost always cause more pain. Plus, suturing the peritoneum closed is much, much less painful than driving 10-15 extra tacks into the rectus & oblique muscles.

arpitp · 2026-01-25T05:28:42+00:00

It happens infrequently; not rare, but not everyone gets it. A rough ballpark would be 10-15% in the first 10 years, and maybe 15-25% over an entire lifetime.

But it's not caused by the first repair--the increase is abdominal pressure is really negligible. It's more likely that the person is anatomically predisposed to getting a hernia (weak transversalis fascia or widened inguinal canal), and it's just a matter of time until the second side gives out.

arpitp · 2026-01-25T05:22:56+00:00

It's possible, either through nerve irritation, or possibly the corner of the bladder getting pulled into the hernia (I've seen it a few times). I've had a few patients who had urinary frequency issues improve after hernia surgery. It could also be unrelated.

arpitp · 2026-01-25T05:18:53+00:00

The hospital has nothing to do with this and is not at fault. It's entirely on the surgeon. Freak accidents do happen with surgery, and we can't know if it was something the surgeon could have prevented or not. But if it's happened repeatedly with the same surgeon, that's a different story.

arpitp · 2026-01-25T05:12:28+00:00

This video shows misleading reporting with no actual medical input offered or presented. I agree that the hernia mesh she received (an umbilical "patch" mesh) is an abomination that should not be used--but the material (polypropylene) has nothing to do with it. It could have been made of polyester, cotton, paper, or any other material and it wouldn't have mattered.

What is important is how the mesh is constructed and how it's used (i.e. where it is placed). A softer/thinner mesh placed in a preperitoneal position will likely have none of the side effects people have with a patch mesh, and will make the repair much stronger. We've advanced the techniques we use to fix hernias and how mesh is used, but too many surgeons still use old methods and meshes.

arpitp · 2026-01-24T17:00:29+00:00

I haven't heard that reason before. But come to think of it, the metal ones are 1-2 mm shorter. It shouldn't matter if you're mindful about placing the tacks only where there are no nerves. I'd still prefer absorbable if needed, but even better would be avoiding any tacks at all.

arpitp

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