An Overview of Surgery to Treat Pain After Mesh Hernia Repair
Most patients who need surgery to treat pain after mesh hernia repair are experiencing damage to the nerves, shrinkage of the mesh, and scarring of the spermatic cord. All these components of the pain have to be treated to provide full relief.
The operation cannot be rushed. Dr. William Brown routinely plans on an operating time of three hours.
The operative notes from the previous operation must be read carefully so that Dr. Brown knows where the mesh is located. The mesh will usually be laid on the inguinal floor or just deep to the inguinal floor. But sometimes two layers of mesh are placed. Sometimes a plug is inserted.
The first step of the operation is to find the spermatic cord. It can usually be found as it passes over the pubic bone. Gentle tugging down on the testicle will often help to find the spermatic cord. The cord is often scarred to the mesh. Separating the cord from the mesh without causing damage to the testicle’s blood supply is difficult. (This part of the operation is why Dr. Brown has gray hair.) If not done carefully, the testicle will die.
The inferior epigastric vessels will be scarred to the mesh and are very easy to tear. So, Dr. Brown is ready to treat major hemorrhage should that happen. To avoid damage to the femoral artery and vein, it is sometimes wiser to leave some mesh behind rather than risk damaging those vessels. Bleeding from a tear of the femoral vein is especially difficult to stop.
The nerves can be difficult to find, so Dr. Brown uses magnification and special lighting. The ilioinguinal nerve usually runs along the anterior superior aspect of the spermatic cord. The genital nerve usually runs along the posterior aspect of the spermatic cord. The iliohypogastric nerve usually runs just deep to the external oblique aponeurosis about 2 cm above the internal inguinal ring. The nerves have multiple interconnections, so if only one nerve is cut, pain will still get back to the brain from one of these interconnections. Because of the interconnections, three nerves should be excised.
If the major component of the patient’s pain is the testicle, then Dr. Brown also advises skeletonization of the spermatic cord.
Finally, any hernia that is caused by removal the mesh should be repaired without mesh.
Preparing for a Long Recovery
Dr. Brown tells his patients that the healing will take nine months. A 100% reduction of pain is rare, so he informs patients that if 80% of the pain is gone after surgery, then that is a good result.
Learn more about Dr. Brown’s approach to hernia repair without mesh. Contact Dr. Brown today.