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  • Advise on tacks used

    Hi everyone,
    i posted about my symptoms after my right inguinal hernia done laproscopically about 10 weeks earlier with immediate right leg parsthesia and burning on the butt down my leg. Talking to my surgeon was of no help as he consistently denies that my pain is not in the dermotome of what the nerves innervates in that area. I completely disagree with him and went to neurologist for EMG and nerve conduction tests which came out to be normal for everything except lateral cutaneous fomeral nerve parsthesia. His diagnosis was paratheca myralgia of lateral cutaneous fomeral nerve. 5 weeks after my surgery I went to a chiropractor who manipulated my back and leg ( but nothing in the groin). Subsequent to the visit to chiropractor I started getting symptoms which used to be intermittent after the surgery but now almost always there.
    1. Continuous low level pain (2-3/10) in the groin like a dull ache which at times feels like a prick and needle and burning including the pain in the right butt area like a burning pain while sitting for even 20 minutes.
    2. Right testicle feels like a pull or heavy feeling. Intermittent pain shooting to the testicle (8/10)
    3. left side there was no hernia and it was only probed during surgery. But I had always more pain on the left side after surgery. I always thought that it was related to the small incision made during the laparoscopic procedure and should go away but I was wrong it has not gone after 10 weeks. Pain level on left side is 2-3/10 and it spreads to the groin area on the left side intermittently.
    what I am concerned is about the tacks used and I was wondering if those tacks have moved or dislodged. I am including 2 X-rays. First x Ray is taken on the second day after surgery when I had to go to ER because I was throwing up. The second x-Ray was taken about 6 weeks after surgery when I went to urgent care to find the cause of my pain. Can some expert on this forum please comment on those x-Ray if any tack has moved? Also I was told only three tacks were used to fixate the 3dmax mesh, one in the pubis tubercule, one medial and one lateral. If that is true then I see 13 total tacks used, so the rest of the 10 tacks are for closing the peritoneum? Why I am seeing two tacks on the left side where there was no hernia. One I see on the left pubis tubercle and one on the middle space on the left side. Are these for closing the peritoneum in the left side? I am so confused with all my symptoms. On the left side I always feel like something is poking me even when I move or bend down. There is no mesh on the left side so the only rationale could be because of the 2 tacks used I may be getting those pain or abnormal feeling. Is it possible for the tacks to move or dislodged? My surgeon says no it cannot be dislodged or move. His own research shows that tacks can cause more chronic pain and despite that he uses these tacks randomly. When I questioned him about his research about tacks he said that his later research on a large number of patients showed no difference in the pain level in the use of tacks vs no tacks. This is totally contrary to some other research papers I read which showed tacks causes more post operative discomfort. Can someone please give me a feedback. Is it possible to do an exploratory surgery to just take the tacks out and not the mesh as that should not have much risk involved? Please advice.
    Note : I could not upload the snapshot picture of my x rays as the maximum size of file is restricted to some 24 MB on this site. Any suggestions how to upload a simple snapshot picture from my iPhone? If not I would still appreciate if some experts can give me a feedback on what I have described about my symptoms.

  • #2
    Maybe he used absorbable tacks and they show up on the X-rays. Your surgeon's denials are probably just from a lack of a path forward. He put the mesh in as Bard directed and doesn't know what to do now that you have problems. A common situation for those who have post-procedure pain, as you can see from other posts on the site.

    As for uploading pictures, some image handling programs, like Google's Picasa program, have an "export" function that allows you to shrink the image size down to a useful level, with no significant loss in quality. I can shrink 1 Mb down to 800 kb. You might check your iphone settings or see if there's an app. I don't know iphones.

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    • #3
      Thanks Good Intentions for the response. He used titanium tacks as he told me. Also x-rays show the titanium tacks. Absorbable tacks won't show up on x-Ray. I shall try to go with your recommendations to see if I can shrink the pictures to upload. Thanks

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      • #4
        Hey there Wilfred! Tacks can cause pain. Surgeons I had remove my mesh said tacks always cause problems so that never ever use them. Surgeons can use glue which has less chronic pain or the can not fixate it at all. When they fire the tack in can hit a nerve. The tacks can move, they can make the mesh tighter and cause pulling. I had 2 big tacks, 1 started driving into my pubic bone and they caused me a lot of pain. Everytime you move they pretty much move with you. Or say when you have sex that will push them deeper like hitting a nail with a hammer. You can have those just removed and the sooner the better. Ct scan showed mine. I wish you the best and keep your head up.

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        • #5
          Tacks can cause pain. Tacks, however, do have acceptable indications. Nothing is ever black and white accept alive or dead.

          Before applying causality to the tacks you need to see a surgeon that deal with chronic groin pain relating to hernia repair. You need a thorough physical and history, dermatome map testing, review of operative report(s) and imaging. Without all of that you will go down numerous rabbit holes.

          Where do you live? We can help find you someone that can assist you in this workup.

          You can send me your images if you'd like and I can look at them. levi.procter@vcuhealth.org

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          • #6
            Dr LeviProcher, I am in the same situation. Can you recommend a surgeon in MA?

            Comment


            • #7
              I had a hernia mesh implanted in 2002 and soon afterward started having burning sensation. I've had problems ever since that get worse. My opinion is to find a surgeon and get it removed. I'm trying to find a surgeon to do it now and have located a few outside of my state. There is no warranty on mesh. Most of the time it shrinks. If you do Google or Youtube searches on infected mesh or mesh allergy you will find the percentages all over the board. As to infection alone the SAGES medical group in its Youtube video states it to be 4 percent to 12 percent based on a review of 42 studies they looked at. I assume that is only gross infection and not including sub-clinical infection which are virtually impossible to confirm by testing and does not even address allergic response. Other results, including National Institute of Health will show the percentages all over the map. As to diagnostic imaging: THE GOLD STANDARD FOR SEEING MESH IS ULTRASOUND. MESH IS ECHOGENIC. Sometimes CT or X-ray can see mesh. Sometimes MRI can see mesh (some mesh manufacturers have added metal flakes to aid detection). Professor Dr. Raz who has removed over 900 meshes only uses ultrasound. Professor Dr. Elizabeth Mueller only uses ultrasound to see mesh. As she says: "Its the only modality we have that sees mesh." Do a Google search and a youtube search with these terms: Dr. Mueller mesh ultrasound. Also do a Google search using these terms: Dr Raz mesh ultrasound imaging. I have hernia mesh. As these two doctors work on females they use 3D ultrasound, but ordinary 2D ultrasound works. I had a CT scan done and it showed nothing. I then had a standard 2D ultrasound done and it showed the mesh instantly. Just make sure the sonographer is experienced and ask them to show it to you when they find it. If you have a CT scan or MRI that shows the mesh your lucky. And, the CT scan and MRI might be of some benefit in at least showing the surgeon your structures and locations. During surgery to remove mesh, or right before, doppler ultrasound can be used to see arteries and veins. If its an open surgery that is of less value as the surgeon can see structures directly. The risk for men in hernia mesh removal is that the cord to the testicle can be damaged and you end up having to have your testicle removed. I've been told a few times by surgeons and assistant's to them that is a 50/50 chance. The problem is that when it was installed the mesh was wrapped around the cord. So, it takes some skill to remove it without damaging it. However, for the few surgeons that do hernia mesh removals on a regular basis I've been told the rate is much lower, in the single digits. One surgeon has stated that you have to remove 50 meshes before you really know how to do it.

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