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Absorbable and bio-meshes for indirect inguinal hernia and recurrence risk?
I am a relatively thin, active person with a right side 30mm indirect inguinal hernia and chronically sore/painful. Feel like I am walking on eggshells not to disturb it and up and down pain – sometimes as low, sometimes high, no rhyme or reason.
I do not fancy a permanent mesh although I’ve read about PVDF meshes from Germany as being quite inert and elastic.
I have read about this Tigr matrix that absorbs in 3 years and also biomeshes made of bovine pericardium, a hybrid sheep-dissolvable or permanent synthetic mesh, and also a pig submucosa mesh. Some seem more difficult to handle laparascopically and the mesh is bigger than in the open case though and was wondering if open or lap-tep is possible with these products and if in reality the recurrence rate would be higher . Is the risk worth taking to counter the risks or possible issues of using a regular mesh?
From what I understand the problem is fatty tissue bashing up against the internal inguinal ring and enlarging it causing pain and discomfort. On the other side i have testicle that retracts upward form time to time, not sure if that is an antidote to hernia formation or just a random difference between left or right.
I also saw a japanese study that tried to use pediatric technique on adults with good results for this simple indirect case using a hybrid laparascopic-extracorporeal technique which looks even more minimally invasive then any standard method currently used. Will this work?
My concern is finding surgeons open minded or even who have used these products at all.
Are current methods good enough or is it worth pursuing some of these alternatives? -
8 Replies
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@good-intentions
Dear Good.
The hernia repairs that do not use mesh are considered pure tissue repairs. But I agree with you that it is a misnomer.
I use sutures that do dissolve.
regards.
Bill Brown MD -
Hello @drbrown
Could you elaborate on what you mean by “pure tissue” repair? I’m not sure what, exactly, it is meant to mean. In my mind, a pure tissue repair would only be “pure” if absorbable sutures or mesh were used for the repair, leaving no foreign materials after they were absorbed. But I see that even an expert like Robert Bendavid seems to describe the Shouldice method as a pure tissue repair, even though they use stainless steel sutures. I would consider this a suture-based repair, recognizing that the sutures remain forever.
I think that the term “pure tissue” might be getting improperly used because it sounds good, similar to the term “tension-free”. Can you clear things up?
Thank you.
https://slingthemesh.files.wordpress.com/2019/06/bendavid-and-iakoviev-revival-pure-tissue.pdf
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@newagehernia
Also, remember to consider a pure tissue hernia repair.
This option avoids the use of mesh and the recurrence rate for indirect hernia is about the same as mesh repairs.
Regards
Bill Brown MD -
4/23/2018…quite a while ago, coming up on two years. I don’t remember seeing this post maybe it was in the Unapproved section at the time.
Hopefully he learned that there is little reason to have a mesh implant for an indirect hernia. None of the main reasons used for using mesh on direct hernias really apply to indirect hernias, as I understand things. The tissue is probably still strong, there is no weak spot in the fascia. The internal ring is just a bit too big. The methods that Dr. Kang and Dr. Brown have described for simply making the ring smaller via sutures seems very sensible and simple. I don’t know why anyone would consider mesh for an indirect hernia, even the surgeons. The side-effects and risk are much greater than the potential for recurrence.
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Did you get the mesh in the end?
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I am thinking a surgeon of the abdomen might be better at times and oftentimes the so called specialists know only mesh or at least mostly operated with that technique….a general one will also have the same downside but may be more prone to adapt to the patient 🤔 I spoke to two specialists and the discussion always ended with mesh ie it’s inert goodo very well tested in the US no problem very low chronic pain
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@cshelter Read Dr. Kang’s posts in the link below and you’ll see the difference between a surgeon who truly specializes in a certain area of surgery, and the one-size-fits-all mesh implantation process that is being taught to today’s new surgeons. It’s sad to see how dumbed-down such an important profession can get. Mesh implantation is simple to teach.
I think that there is still hope for you in the long-term. I am two years plus a couple of months out from mesh removal and I am getting closer and closer to being fully healed. Once the mesh was out the true healing started. It’s taken a long time but the body will just keep trying to get things back to the way they were designed to be. I can’t remember the details of your situation I think that I was confused with your initial posts. If you have mesh it can still be removed. If you don’t have mesh a doctor like Dr. Kang or Dr. Brown can probably get you to a baseline that you can really start healing from. Keep trying, there are true experts out there.
Here is the post where Dr. Kang goes in to great detail about his methods and why they are different.
https://herniatalk.com/forums/topic/no-mesh/
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@good-intentions – This is just stunning the more I read. It is incomprehensible to me that, for instance in my case, I had an indirect hernia to your point, that was also small, and yet neither surgeon I saw — one wanted to do lapro w/ mesh, and the other does desarda — attempted to even determine the type or mention that there even are different types. Neither shared any information about the importance of that, or matching it to the proper repair technique. They knew I was strong though, and didn’t have much pain and still: They were were a hammer, I was a nail. I always wondered why I could lift things etc without a problem.
Previously an avid hiker, I can’t walk for any distance, am in constant pain. Sometimes I am literally on the floor writhing. I cannot fathom how people work this way. As a business owner I trusted that other professionals would show the same respect as I do for others, especially (if not even moreso) those operating on others. That trust was a mistake I and my family will live with likely the rest of my life.
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