Post-Surgery Complications After Hernia Repair: Seeking Guidance

Questions regarding the complications after hernia surgery, please provide a response. Thank you!

Dear Dr.
Hsu,
Hello! I underwent emergency surgery in mid-June this year due to an acute severe right inguinal hernia, during which a synthetic mesh was implanted.
After five days of hospitalization, I was discharged to care for myself.
However, more than a month later, I noticed that my right testicle often swelled to twice its size, and the accompanying spermatic cord also became enlarged and hardened.
Additionally, I experienced significant pain in my right thigh and lower back.

When I returned for a follow-up with my primary physician, the swelling had decreased significantly and was not given much attention.
I was then referred to a urologist, and after an ultrasound of the testicles, the conclusion was that there was fluid accumulation, but it was not taken seriously, and no medication was prescribed.
I was only advised to rest more.

Now, in mid-October, my condition remains the same, with episodes occurring once or twice a day, mostly in the afternoon, lasting five to six hours.
I also notice that upon waking up each day, I feel normal again.

I would like to seek your guidance on whether this could be a complication from the synthetic mesh and how to manage this condition.
I sincerely appreciate your advice!
Thank you very much!

Hua Bin, 70~79 year old female. Ask Date: 2018/10/15

Dr. Xu Kaixi reply Surgery

Inguinal hernia emergency surgery is often accompanied by significant inflammation, which can lead to temporary postoperative edema and fibrosis, as well as fluid accumulation.
These conditions typically improve over time, with recovery duration varying based on the severity of the original hernia, ranging from several weeks to a few months, and is less related to the use of a mesh.
In addition to adequate rest, anti-inflammatory and analgesic medications can be taken to alleviate symptoms.

Reply Date: 2018/10/15

More Info

Post-surgery complications after hernia repair can be quite complex and vary significantly from patient to patient. In your case, it sounds like you are experiencing a combination of symptoms that may be related to the surgery itself, the placement of the mesh, and possibly other underlying conditions.
Firstly, it is important to understand that after hernia repair surgery, especially with the use of mesh, some patients may experience discomfort, swelling, or pain in the affected area. This can be due to several factors, including inflammation, nerve irritation, or even the body's reaction to the mesh itself. The symptoms you describe, such as swelling of the right testicle and associated pain in the right thigh and waist, could be indicative of a few potential issues.

1. Hydrocele: The ultrasound you mentioned indicated the presence of fluid accumulation around the testicle, known as a hydrocele. This condition can occur after surgery and may not always require treatment unless it becomes painful or significantly affects your quality of life.
2. Nerve Irritation: The surgery may have inadvertently affected nearby nerves, leading to pain or discomfort in the groin, thigh, or lower abdomen. This type of nerve pain can sometimes be persistent and may require specific treatments, such as physical therapy or medications aimed at nerve pain relief.

3. Inguinal Canal Complications: Sometimes, the mesh can cause complications if it shifts or if there is a reaction to the material. This could potentially lead to chronic pain or discomfort.
4. Infection or Inflammation: Although you did not mention any fever or significant redness, it is still possible to have a low-grade infection or inflammation that could contribute to your symptoms.
Given that your symptoms seem to fluctuate, with periods of relative normalcy followed by discomfort, it is crucial to monitor these changes closely. Here are some recommendations for managing your situation:
- Follow-Up with Specialists: Since you have already seen a urologist, it may be beneficial to consult with a surgeon who specializes in hernia repairs or a pain management specialist. They can provide a more thorough evaluation of your symptoms and the potential impact of the mesh.

- Pain Management: If the pain is significant, discussing pain management options with your healthcare provider is essential. This could include medications, physical therapy, or other interventions.

- Lifestyle Modifications: Engaging in gentle exercises, avoiding heavy lifting, and ensuring proper posture can help alleviate some discomfort. However, be cautious and consult your doctor before starting any new exercise regimen.

- Monitoring Symptoms: Keep a detailed log of your symptoms, noting when they occur, their intensity, and any activities that seem to exacerbate or relieve them. This information can be invaluable for your healthcare provider in diagnosing the issue.

- Consider Imaging Studies: If your symptoms persist, further imaging studies may be warranted to assess the position of the mesh and rule out any other complications.

In conclusion, while some discomfort after hernia repair is common, the persistence and nature of your symptoms warrant further investigation. It is essential to maintain open communication with your healthcare providers and advocate for your health to ensure you receive the appropriate care and management for your condition.

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