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Mesh removal question
I had a bilateral TEP repair for a left indirect hernia and a right femoral hernia that caused no pain at all and 3dmaxxx mesh was put in on each side with 2 big tacks put in to fixate the mesh in 2015. I had weird pains right after that I never had before and numbness also. The pain never subsided and got worse and worse so I got both sides removed robotically and the tacks removed also in 2016 and the surgeon cut the genital branch nerve also because he thought it would get entrapped in scar tissue after the removal.
I had an ultrasound done and it showed dilation of the ring and it states that scar tissue may be compressing the spermatic cord.
I was wondering if anyone on here can give me an insight of what can be done if the spermatic cord is being compressed by scar tissue? I know another surgery will just cause more scar tissue in the area so I am wondering what other treatments can be done.Also I was wondering if my mesh was put in with the TEP method that when I got it removed robotically does that mean it is more invasive because the mesh is placed outside the peritoneum? Would that mean you have to go through more tissue to get to it rather than if it was done with the TAPP method when the mesh was put in?
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7 Replies
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And homeboy fuck off! Bet you fell fron that lie bitch!
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Anthony Iacco at Michigan hernia surgery.
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please could you share who did the removal?
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Thank you all for your replys and explaining how TEP and TAPP are different. I figured the dilation would be from the surgeon having to shave the mesh off so it made the ring dilated afterwards. The surgeon that removed the mesh I know is an expert in robotic surgery and I know his partner had the highest volume of robotic surgerys in the US in 2016. I asked them if the hernias were still present that if they could just suture them up from the inside after the mesh was removed and they said that that usually never holds up for very long and nerves are at risk also but I did not want more mesh put in at all. On my op report it states there was quite a bit of scar tissue around the ring on my left side where the small indirect hernia containing fat was. It also states that after the mesh was removed that there were no hernias on either side.The surgeon removed all of the mesh. They also stated that there will always be some residual pain from what the mesh had done while inside.
Dr. Towfigh what takes place then when the mesh is removed? Wouldn’t scar tissue fill that area, especially since the mesh created a lot of scar tissue already? And the mesh lays on the spermatic cord so when it starts the inflammation process and the scar tissue starts growing in the tissue can attach to the spermatic cord and nerves. Can a liposarcoma form after removal of mesh, especially if the spermatic cord was really attached to it and if so would an ultra sound find it? The ultra sound states that the left epididymis is slightly larger than the right and this finding suggests compression of the spermatic cord, probably at the inguinal region.
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Good Intentions is very correct: TEP and TAPP place the mesh in the exact spot, between peritoneum and muscle. Getting to that spot is how they differ. Removing the mesh is no different if the original repair was TEP or TAPP. Removal is typically performed in TAPP fashion, but I have also been able to do it as a TEP in some cases. Robotically, all techniques are TAPP.
How was the hernia addressed after the mesh and tack removal? Also, was 100% of the mesh removed, or was some mesh left behind, especially on the spermatic cord?
Perhaps your pain is related to a) hernia recurrence or b) mesh on the spermatic cord. Scar tissue is usually not able to compress the spermatic cord.
A careful review of your symptoms and what was done during your operations will help determine the next plan of care. E.g., do you need your hernia repaired? Does the spermatic cord need to be released from its surroundings?
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quote NFG12:Also I was wondering if my mesh was put in with the TEP method that when I got it removed robotically does that mean it is more invasive because the mesh is placed outside the peritoneum? Would that mean you have to go through more tissue to get to it rather than if it was done with the TAPP method when the mesh was put in?
I think that both TAPP and TEP place the mesh in the same are, between the peritoneum and the fascia. TEP apparently avoids the possibility of injuring the abdominal contents, I believe, by leaving the peritoneum completely intact. But, if healing goes well, the end result is about the same, with a sandwich of peritoneum, mesh, and fascia, all bound together. Mesh removal is the same for both, either TAPP or open, because the TEP approach is not possible anymore as everything is too tightly bonded. The T in TEP stands for “Totally” and it’s only possible because the peritoneum easily peels off of the fascia on the first surgery. After that first surgery the tissues get all tied together. That is my understanding. With TAPP the surgeon still creates a space between peritoneum and fascia but starts from the inside, instead of the outside.
A good surgeon can tell you what to do about the spermatic cord pressure. It sounds like the MRI doctor is describing the scar tissue pulling the deep ring open, the dilation, and applying some sort or pressure as well. More surgery might just be used to relieve that pulling. I recall reading about injections to break up scar tissue also. Seems like the surgeon who removed the mesh would have some advice and also find the followup information useful for future patients. Have you contacted him/her?
Good luck. The annual SAGES conference is coming up in April so maybe the forum surgeons are too busy to visit the site. Hopefully, these mesh problems will be a very active topic this year.
http://www.nmcsurgery.ae/laparoscopi…tepp-and-tapp/
Edit – here’s a more descriptive explanation of TAPP. The one above is not clear about mesh placement.
https://www.laparoscopyhospital.com/transabdominal_pre-peritoneal_(tapp)_vs_totally_extraperitoneal_(tep).html
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PARTIAL ANSWER REGARDING TESTICLE. THIS IS A COPY AND PASTE FROM DR. BROWN’S WEBSITE; [h=2]Testicle[/h]
The spermatic cord can become scarred to the mesh. Within the spermatic cord there are multiple, very important and sensitive structures: the genital nerve that innervates the testicle, the genital artery and veins that supply blood for the testicle, the vas deferens that transports the sperm, and the cremasteric muscle that retracts the testicle.If the genital nerve is injured or damaged, you will have pain in the testicle (not the scrotum), and:
- The pain is constant and gets worse with activity or pressure.
- The pain can be debilitating, and sex is often impossible.
- There is severe pain in the testicle.
If the blood supply to the testicle is damaged:
- There is severe pain in the testicle.
- The patient is debilitated
- The testicle slowly shrinks and dies.
- An ultrasound can help confirm the diagnosis.
- The testicle may have to be removed.
If the vas deferens is damaged, then sperm cannot get out of the testicle. There will be:
- An ache and a swelling of the testicle.
- Intercourse is painful.
- The sperm count may be low.
- A steroid injection may help.
If the cremaster muscles become attached to the mesh, then the testicle will no longer retract upward in response to cold and sex. Surgery can help.
Learn more about about William Brown, M.D. go to his website: sportshernia DOT com
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