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right laproscopic inguinal hernia surgery with numbness and pain on right leg

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  • right laproscopic inguinal hernia surgery with numbness and pain on right leg

    Hi everyone. I am new to this forum and need some advise from experts and other forum members. So please help. I had an inguinal hernia diagnosed on right side about 4 years back. Never bothered me until last 6 months when it seems it would come out very often and pushing back sometime would give trouble. But still no pain just sometime pressure feeling. I was scared to death after hearing so many horror stories about the mesh that I kept putting it off as it was not bothering me. Gave many thoughts to find a surgeon who would do without mesh but never materialized that search. Finally wanted to get it done this year as my wife told me to get it done. I had it done laproscopic right hernia repair about two and half week earlier. For most part my post op pain was well tolerable. I don't have any groin pain or testicular pain other than some slight pain while passing stool. But my biggest concern is right from the day after surgery while sitting on the toilet seat my right leg completely went to sleep (Like sometime you wake up with one of your arm gone to sleep-that kind of feeling). After I got up from toilet seat and walked around that feeling disappeared. This type of symptom has happened atleat 3 times. But what has stayed consistently is the heaviness on my right leg starting from my right butt and going all the way to my heal of the right foot and also on the toe. This is combined with light burning on my anterior thigh and also on the lower calf muscles. Most of the time I feel the pain is mostly coming from the back of the upper thigh and spreads down the lower calf muscles and heal. Sometime I also feel burning on my sole of the right foot. Two weeks post op meeting with the surgeon I was told surgery went fine and I should take Motrin for 7 days which I am taking with no improvement. I asked him what did he use to fix the mesh and he said he used 3 tacks only. Here is my theory and I hope if some expert can clarify me please.
    I have no groin pain so I presume illioinguinal nerve is safe as otherwise I would have testicular pain and also the medial thigh pain where this nerve innervates.
    I have a doubt that either genitofemoral or more appropriately femoral nerve is slightly pinched while either placing tacks or mesh or is it normal to have these feeling by simple manipulation of the nerves while doing the surgery? I have heaviness and burning feeling at a level of 2-3 on a scale of 10. Reason I think more of femoral nerve because it passes through the same inguinal canal and because this nerve supplies the cutaneous area of the thigh and all the way down to the heel. My biggest concern is if it will ever go away. While doing laproscopic surgery do they always identify these nerves before placing the mesh or tacks or do they use just landmark and guesswork before placing tacks? If it is simple manipulation of nerve in that area then I have some hope that this will go away but if either genitofemoral or the femoral nerve is pinched by the tacks or mesh then I am worried this will never go away and I shall fall in those chronic pain cases which I dreaded the most. Can some form of physical therapy would free this entrapment ? Should I wait or go with EMG and nerve conduction test to identify the culprit nerve? Are light stretching exercises safe to do it now? I would highly appreciate any feed back from anyone undergoing similar symptoms or from many experts in this forum
    Thanks
    Wilfred

  • #2
    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.


    Comment


    • #3
      Originally posted by LeviProcter View Post
      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.

      Comment


      • #4
        I have a good friend who had lots of numbness after a second inguinal hernia surgery, and it took a couple of months for things to improve (i think this is unusual and his situation sounded worse - constant leg numbness). but it eventually went away completely. he was told this is not an uncommon complication and that usually resolves without issue.

        Comment


        • #5
          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.

          Comment


          • #6
            Well, best of luck. And hopefully Dr. Procter can chime in again with some hopeful words. It can be tricky to review scholarly articles as a layperson and fully understand them without catastrophizing. I know many times I've read them and come to certain conclusions that were totally off-base because I didn't fully comprehend the context or the lexicon. Not to say you read things wrong, but almost hoping that maybe you did :-) Regardless, I think over time many of these things tend to sort themselves out. Hopefully that happens in your case. In the meantime, probably good to follow the doctor's advice and stay active and do moderate stretching and some walking/running or whatever you can. It could be nerve entrapment, but I am guessing it could be a dozen other things as well that have a great long-term prognosis. Again, I have several friends who have had inguinal hernia repair with mesh and almost all basically said they had lingering issues that took several months to completely resolve. For the most part they were fine shortly after surgery, but several had things that persisted for quite a while. All report they are 100% better today except for one person who has an occasional twinge once in a while. But even he says he's satisfied with the surgery and would do it again.

            Oh, and I believe I have read here that there are definitely ways to remedy a trapped nerve. So even if it's that, and even if it doesn't go away, you do have some recourse. Not to say it would be a simple matter, but a trapped nerve isn't impossible to deal with. Really depends on the situation I think.

            Comment


            • #7
              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.

              Comment


              • #8
                I am going to have to chime in on this topic. I had a large mesh removed 3 months ago and ever since that surgery I am having trouble with my lateral femoral cutaneous nerve on my right side. I never had any problems with it before the surgery. My skin is numb to the touch and I have tingling and burning pain that goes from the crease of my leg to just above my knee. I have had a nerve block by a pain management specialist, after mesh removal, and that didn’t help. I also had a re-exploration looking for nerve entrapment but that wasn’t the issue. The nerve may have been compressed in a tight repair and it has been loosened up. I also still have lots of inflammation and swelling that may be contributing to the problem. I am going back to pain management and perhaps a neurologist for help. It is the kind of pain that is hard to ignore, I feel it all the time. I am hoping it is something that will resolve with time. It gives me hope to hear that others have had the problem resolve over time. Wilfred, I hope you find resolution to your problem. I certainly know where you are coming from and it is not fun!!

                Comment


                • #9
                  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.

                  Comment


                  • #10
                    Originally posted by wilfred View Post
                    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.
                    Sent you a private message about RVA and dentistry :-) Good luck with the appointments, and hope things continue to improve. Maybe I'll actually reach out to YOU if I have questions about articles I come across or the anatomy of the area in question! Will be interested to see your progress.

                    I am trying to plan an inguinal hernia repair (possibly bilateral) myself in the next month or two in town and obviously worried myself about possible complications. I personally know about five people who have had the surgery (all with mesh), including my grandfather decades ago. All but one suggest they recovered 100% (and the exception says he's still satisfied) but several did have some issues. And oddly enough most said open repair was easier recovery than laparoscopic. Was thinking I'd go with robotic laparoscopic repair but I also know the cost will be ridiculous. I have insurance, but I am certain that would max out all of my deductibles, etc. Wondering if it's worth it.

                    I don't currently have a ton of issues with discomfort and pain, but it seems on the weekends when I am more active and standing a lot, I do have problems. And when I overexert myself or cough or sneeze, it's uncomfortable. I have a small bump and could probably just wait, but it seems wise to just get it fixed sooner rather than later. I've basically come to terms with the fact that non-mesh repair is very hard to come by and almost never done here in the states. And all the surgeons have said they'd have mesh if it were them, and that non-mesh can have complications of it's own and somewhat more likely to need repair at some point down the road. And any surgeon doing a non-mesh repair isn't going to have a lot of experience doing it, unless I travel somewhere, which is cost prohibitive.

                    Comment


                    • #11
                      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

                      Comment


                      • #12
                        I really don't want to worry you but wanted to chime in that I had the 3D maxx mesh implanted 6 years ago and had issues from day one. They weren't debilitating but occasional flare ups were.
                        about 10 months ago I did experienced debilitating pain and after much exhausting journey found out that the mesh had folded. The only surgeon to see this on a cat scan was dr. Igor Belyanski in MD. I ended up having to have the mesh removed.
                        i have spoken with a good number of people on a mesh forum who also had the same 3d maxx mesh and are either in pain or had to have the mesh removed. For them to the mesh had folded over. Unfortunately this type of mesh Bc it is concave (this the 3D) it had a tendency to fold over. Not saying this is happening to you but just so you know that this particular mesh has a tendency to do that.
                        your local surgeon will most likely be of no help, they only check for recurrences and then it's off ti pain management.
                        im sorry for the pain you are going through and I hope in time it will dicipate. I'm the meantime please layoff stressing the area-no lifting excecing etc. give the area time to heal and then go from there p

                        Comment


                        • #13
                          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.

                          Comment


                          • #14
                            Dr. Belyanski said the 3D maxx is a heavier mesh and isn't the best for thin people. Yes definitely get the tests-a cat scan may show better if maybe the tacs/screws got dislodged or are hitting a nerve (although it doesn't sound like it) it could also just be inflammation. Unfortunately it can be such a myriad of things it's dizzying. Praying with time it resolves itself but arm yourself with knowledge in the meantime. I went back to my original implanting surgeon 3 times over the course of a year Bc I would have these unbearable flare ups-and all 3 times all he did was check for a recurrence. So definitely seek out a specialist there are a few out there (Towfigh, Ramshaw and Belyanski )

                            Comment


                            • #15
                              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

                              Comment

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