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Encouraging percentages from Docs please!
I am 43 and live a very active, healthy lifestyle. Exactly a year ago I was admitted to the ER for an intussusception of the bowel, which immediately led to a right hemicolectomy due to a 8 cm malignant mass. My recovery from surgery was uneventful, aside from one obstruction that was conservatively managed. I followed up with six months of chemotherapy and final scans are clear with no mets. Alas, just at the tail end of my chemo I began to notice a small paraumbilical bulge at the site of my scar. My surgeon confirmed the hernia (although my CT does not show this), approximately a 2cm x 6cm defect.
I am 5’7″, 128 lbs. I continued to exercise throughout my chemo and feel great, aside from the aesthetics of this small bulge.
I am beginning to have increased lower back pain which i associate with the compromised stomach muscles….but no other discomfort per se.
So…I have to get this repaired! I have consulted with three top Boston surgeons now, who all agree to the same method of approach. Open surgery through my original scar…Rives-Stoppa method of placement, with component separation and Polypropylene mesh.
I am not encouraged by ANY info on the internet that there is any way to move forward without the mesh. One surgeon suggested I see a Plastic Surgeon and pay out of pocket (which I am very happy to do if it means a greater success!) as the suture method may be more substantial and with an abdominoplasty, I may be able to avoid mesh placement? Is this even possible?
Regardless, I need to hear the REAL numbers from you surgeons about the success rate of mesh. I know those living pain or infection free are not posting online! I understand that there are no guarantees…but at least tell me that should these complications arise, that there are ways to FIX them? I am solely responsible for three little children and my active participation in their lives is essential!
Likewise, is there anything I can do PRE-surgery to encourage the best possible outcome?
Sincerely appreciate your responses! -
8 Replies
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Encouraging percentages from Docs please!
Botox is very new concept. Initiated by some smart surgeons in Mexico. If the hernia surgeon is not comfortable with it, sometimes pain management doctors will do the injection.
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Encouraging percentages from Docs please!
Wow! Brilliant. Botox.. Who knew? Makes perfect sense. Is this familiar practice to many surgeons or fairly new?
The options/techniques are obviously plentiful. Makes my decisions even more complex! -
Encouraging percentages from Docs please!
gretarae – First of all, don’t worry. You are fine, and a small, asymptomatic incisional hernia has a low probability of becoming worse in a short period of time. Second, the best study with long term follow-up of incisional hernia repair with and without mesh shows a 63% recurrence rate for the suture group and a 32% recurrence rate for the mesh group. This study however has many flaws. And most importantly regarding all the statistics is to know that they do not predict what will happen to you, because you are not a statistic, but an individual. The options are many, with relative risks and benefits of each option. By applying the following algorithm, you and your surgeon will make the best decision for you. You as an individual. Not for your hernia. 1. Identify what your goals are 2. Apply the clinical scenario related to your medical history 3. Apply the details of your hernia – location, size, position of rectus muscles (seen on ct scan) 4. Choose a technique (there are many) that fits your clinical scenario, hernia details, and is likely to meet your goals. 5. Choose a mesh (if using mesh) that is most appropriate for that technique. There are many choices here as well. 6. Have a plan B.
Very few surgeons know enough about the prosthetic choices, and have limited knowledge in their practice for the variety of techniques available. In my repair of hundreds of recurrent hernias, I have also seen many occasions where the surgeon and patient goals were not necessarily aligned. There are many reasons for all this, so I don’t want to sound like I’m pointing any fingers, just stating frequent observations. Given your aversion to mesh, you could even be a candidate for all absorbable material along with the adjunct of Botulinum Toxin A in the oblique muscles to allow healing before the can pull the repair apart.
In any case, you have found an excellent resource Dr. Towfigh has created, and I commend you for taking an active part in your health care. Again, don’t worry – you will be OK. Feel free to call 978 632-0123 for a formal appointment if you would like. I’m in Gardner, MA
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Encouraging percentages from Docs please!
Some of my recommendations from being in your position and what I learned.
I did what I thought was good research and asked the right questions but found out after my surgery, my surgeon was not the surgeon he or his staff made him out to be.
A few years after my surgery I found the book Unaccountable. This really opened my eyes and every issue the writer presented I could directly relate it to my first hernia surgery and why things turned out so poorly. highly recommend reading it before your search for a surgeon. I would also check out some websites. Dr. Goodyear has a great site with loads of very good information on it. I am sure there are others.
All it takes to be a quote specialist is stating you are a hernia specialist. After my first hernia surgery which had issues starting in the recovery room until my second surgery, I was told by my insurance company and the hospital of my first surgery in my search to find the next quote hernia specialist to fix the problems created by my first surgeon. They had me see five local quote hernia specialists and when I started asking the right questions and knowing what to look for in their answers I found out none of them had any special training in hernia surgeries or any experience in fixing what the original surgeon did. I lived with the pain and suffering until my insurance changed until I found a true specialist. Two of the doctors I saw just a few short years ago are now claiming that they a specialists in this field. I would not recommend them for hernia surgery and one not for any surgery. The hospital from my original surgery, basically stated that if a surgeon is licensed in the state as a general surgeon they are a expert in hernia surgeries.
Infection can happen after any surgery. Not sure if the hospital/clinic will provide that information to you on their known % of infection rate post surgery. Not sure if I have every heard of rejection of mesh but shrinkage. How and where the surgeon attaches the mesh is very important. Triangle of doom.
It comes down to the experience, skill, ability, caring and volume of surgeries of the doctor you chose and still sometimes you might be the one that has issues after the surgery, by doing your research and finding the right surgeon helps your odds. If it is a teaching hospital there is a good chance a resident will do the surgery with or without your knowledge or consent.
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Encouraging percentages from Docs please!
Thank you! This is exactly the feedback I was looking for. Yes, I am grateful to have the resources available to me and be surrounded by such an educated medical community! That said, I tend to over research in hopes of making the best decisions for my long term health. This hernia has put me in the same predicament as thousands of others, as I am told the longer I let it go, the more difficult the repair .. And yet to move forward with surgery may also lead to complications. Ironic, considering this little defect is barely visible and causes me no pain.
Question.. How soon does infection/rejection usually rear its head? Is there a window of time after which the chance of infection decreases?… Or can it occur years from surgery? How is it typically treated before removal?
Thank you for taking time to respond. I can see how busy you are! -
Encouraging percentages from Docs please!
As a hernia surgeon in the Boston area, you have options, but most of them involve the use of synthetic or biologic mesh. A laparoscopic transabdominal procedure or open or even a laparoscopic retrorectus repair (Rives-Stoppa) may be a very good option. It is difficult to make any specific recommendation with out a complete review of your history and complete physical exam. You can contact me at herniamd@yahoo.com
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Encouraging percentages from Docs please!
Hi,
I am not a doctor but my hernia original surgery was a horror story. Not sure on Doctors in Boston but if you can travel see one of the highly recommended docs on this or other forums. I met the Dr. Goodyear, Ramshaw and Yunis for my second hernia and mesh removal. I would go under the knife with any of them or ones on this website. My decision came down to having a place to stay for a week for recovery. This second surgery went great. Was active within a week with mesh. There are other great ones across the nation.
Been There
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Encouraging percentages from Docs please!
As a surgeon I smile when I hear stories like yours. A healthy patient whose life was really saved by modern care. The data is overwhelmingly in favor of using mesh to repair your hernia. Recurrence rates are over 20% without mesh in the best studies and probably approach 100% if you follow patients long enough. The Rives-Stoppa repair which puts the mesh behind the muscles and outside of the abdomen is an excellent option as it avoids doing an extensive dissection around your bowels and is easy to reoperate through if you ever need that. Also, if it gets infected, it can often be treated without removing the mesh. Mesh complications, which are abundant on the internet, are actually fairly rare in practice. If everyone had problems with mesh, we wouldn’t use it. I do mesh repairs on 10-20 patients weekly, and very rarely see a complication. Pick a surgeon who fixes a lot of hernias and you like, and you will do fine. As far as what you can do, being thin, well nourished and not smoking are the biggies.
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