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Open vs. Laparoscopic mesh removal?
Let me just say first off what a wonderful resource this forum has been in my struggle dealing with hernia mesh pain. This site has offered honest advice and been a source of hope.
My story: 45 year-old male who had triple hernia surgery (bi-lateral inguinal and an umbilical) in December of 2017 where over 43 square inches of Covidien ProGrip mesh was installed laparoscopically in three patches. Since then my life has been all about chronic pain and an ever-decreasing quality of life. Working with the original surgeon and my PCP we’ve tried every non-surgical method to address the pain, all with no results. I have had multiple CT and ultrasound scans (no indication of re-herniation), seen pain specialists, gastroenterologists, multiple surgeons, and even acupuncturists. Pharmaceuticals that I’ve tried have been Gabapentin, Toradol, Cyclobenzaprine, Cephalexin, Duloxetine, and multiple opioids. None of this has had an impact on the diminishing the pain. The pain gets worse as time goes on and it increasingly diminishes my activity levels. I used to be very physically active for both my work and hobbies. I used to go hiking and backpacking all summer, now I can barely get up a flight of stairs because of the pain. I’ve had to start walking with a cane, and it’s getting to the point where self-care is getting difficult. If I could go back in time, I would take the hernias and all their discomfort over the mesh pain in a heartbeat.
But since time travel is only theoretical, I’m stuck with the cards I’ve been dealt. I live in Oregon and the attending surgeon who installed the mesh is not capable of taking it out. She referred me to Dr. Belyansky in Maryland, who I then researched on this site. My wife and I flew to see Belyansky last November, and it was his opinion that the mesh should be removed. Unfortunately dealing with our insurance company has been a real headache and they refuse to extend benefits to Belyansky claiming there is someone in-network who can perform the corrective surgery. [SIDE NOTE HERE: Mesh explantation is a rare enough surgery that it does not have its own CPT code I’ve come to learn. As such, it falls under what is known as an “Unlisted CPT Code” which is a catchall number for anything that doesn’t have its own CPT code. So when my insurance company searches their database for someone who might be able to do mesh explantation, they are literally pulling up a list of every general surgeon because of course they all cover the general Unlisted CPT Code. This little nuance has been such a source of frustration and delay, and I thought others might benefit from knowing.]
So with our insurance not being willing to cover Belyansky, we opted to borrow the money and just pay for the surgery ourselves in order to get me better. Belyansky’s office gave us a cash price quote in December 2018, but unfortunately his office implemented a policy in January of 2019 to not accept patients from out of state without insurance. That’s right, Belyansky’s office will NOT accept cash from out of state patients. So whomever is keeping the list of possible surgeons in the US might want to add a note about this. Don’t get me wrong, I’m not dissing Belyansky. He’s a renowned surgeon and I wish he was going to do my surgery, but I cannot get anyone from his office to even call me back to discuss this new policy. Apparently they have enough work coming in.
Anyway, in addition to seeing Belyansky, I have consulted with Dr. Peterson in Las Vegas, Dr. Brown in Freemont, CA, and Dr. Martindale at OHSU. All are in agreement the mesh is the source of my pain and should be removed, so hopefully this is enough for my insurance company to agree to cover the explantation. But of those surgeons, Belyanksy is the only one who does laparoscopic removal, with the other 3 only doing open removal surgeries.
So my question for the community is about my outcomes with open vs laparoscopic mesh removal. I’m having a hell of a time finding any research about one vs. the other with regards to mesh explantation, which makes sense as I’m looking for very specific situational information. I’ve seen it stated several times on this forum that the general impression is that mesh should be removed in the same manner it was installed, but I have yet to find any rationale as to why that might be. Obviously not being a surgeon I don’t know all the minutia and considerations involved, but I do know that I am looking at a risky surgery that may or may not bring relief from the pain so I want the best possible chance of a successful outcome. Hoping someone here on the forum can maybe offer up some reasoning, advice, or research on the matter?
And I know that statistics don’t necessarily imply outcomes as each person’s situation and body is unique, but if I can increase my odds of success by any means I will.
Thanks for reading, and thanks for being part of this forum. I cannot fully express how helpful/hopeful this site has been during this dark night of the soul.
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22 Replies
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quote Meshpain:In all honesty, the pain was much less than the original surgery. I was extremely nervous going in to have the mesh removed; worried that the pain would be as bad as the original surgery or worse but that was not the case. Some examples:- It was almost two months after the mesh was installed before I could go a day without an opioid. When the mesh was removed, I was off them within a week.
- When the mesh was installed, it was 3 weeks before I could even walk a few blocks. When the mesh was removed, I was walking a mile within 5 days.
- I had tremendous shoulder pain from the gas after the initial surgery, of which I had none after the mesh removal surgery (I attribute this to surgical style differences).
Plus in general the pain from the second surgery was different/better because it was one that I could heal from. This was not the case with the original surgery because my body was not accepting the mesh and therefore couldn’t heal.
It’s a big decision with unknown outcomes, but I have no regrets having been through the procedure with Dr. Belyansky.
Let me know if I can be of any further help.Thanks again! I guess our initial experiences were quite different. I only had moderate soreness after my initial surgery that’s I think typical for that kind of repair. None of the major pain or disability that it sounds like you had. But it sounds like the removal was maybe similar to my initial surgical experience.
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In all honesty, the pain was much less than the original surgery. I was extremely nervous going in to have the mesh removed; worried that the pain would be as bad as the original surgery or worse but that was not the case. Some examples:
- It was almost two months after the mesh was installed before I could go a day without an opioid. When the mesh was removed, I was off them within a week.
- When the mesh was installed, it was 3 weeks before I could even walk a few blocks. When the mesh was removed, I was walking a mile within 5 days.
- I had tremendous shoulder pain from the gas after the initial surgery, of which I had none after the mesh removal surgery (I attribute this to surgical style differences).
Plus in general the pain from the second surgery was different/better because it was one that I could heal from. This was not the case with the original surgery because my body was not accepting the mesh and therefore couldn’t heal.
It’s a big decision with unknown outcomes, but I have no regrets having been through the procedure with Dr. Belyansky.
Let me know if I can be of any further help. -
by the way, would you say the pain of the removal surgery was much greater than the original surgery?
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thanks! this is all very helpful info. i’m going to continue to consider things and try and make some sort of decision in the next two months or so. and see if maybe things improve even further for me in that time.
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[USER=”2051″]ajm222[/USER] Yeah, it’s a big decision to make. At times I felt like I was on some sick game show where as the contestant I had the choice to sticking with my current pain, or I could choose what’s behind door #2 (another surgery) which might or might not be better. Sounds like your mesh isn’t causing you quite the level of pain that I had, but the surgeons I spoke with all agreed that if the pain hasn’t subsided after a year then the mesh is definitely a problem. In my case it continued to get more painful and debilitating as time went on, and there was no way I was going to live like that.
Dr. Belyansky did an amazing job and got 99% of the mesh out, as well as some sutures that had balled up and were causing me pain. My original hernias were small enough that the scar tissue from having the mesh installed and then taken out meant I wouldn’t likely need any additional repairs, and that appears to be the case. Of course I requested no mesh be put back in, and Dr. Belyansky honored my request which meant he needed to put in a few sutures near the umbilical hernia instead. To which the only downside is a slightly longer recovery time (6 months) for any very stressful activity. 3 months out I can go to the gym, run, and lift weights no problem, but I won’t be flipping cars or trying out for strongman competitions for another few months. 😉
As for recovery, it has certainly been full of ups and downs, but within days of having the mesh removed there was a clear improvement. I had lots pain from the surgery, but all the pain from the mesh was noticeably absent immediately. I was able to walk a mile about 4 days after surgery and I was off of prescription pain pills about 1 week after surgery (having been on them daily for almost a year, this was a huge victory!). One thing that was an added stress is that we live on the west coast, which meant flying out to see Dr. Belyansky. We stayed in Annapolis for two weeks total to allow for a 10-day post-surgery follow up appointment, and as I said I was doing a lot better in that time, but flying back home set me back a little bit. There was no way around this and it was doable, but it certainly wasn’t a comfortable experience flying that soon after abdominal surgery. I don’t know where you are in the country, but something to consider.
Of course as with any surgery, there are always associated risks. About 5 weeks after surgery I went to the ER with severe chest pains with the main concerns being heart attack or a pulmonary embolism having had a recent surgery. I was cleared of anything life threatening but was still having the chest pains for weeks thereafter. In the end it appears I had developed a hiatal hernia, likely from having had multiple laparoscopic surgeries (oh the irony!). Fortunately it appears to have repaired itself after a couple of months of discomfort, and now I am just mindful of my body mechanics more.
As for therapy, Dr. Belyanksy did not recommend any particular therapy for post-surgery, however based on my experience I believe it is an important part of recovery a couple of months after surgery, so be sure to find a good physical therapist or talk with your primary care doctor about it. I was surprised at how much flexibility I had lost, so be prepared that there’s just going to be things to work out and that need to get re-aligned.
So did having the mesh removed make a difference in my case? Absolutely. Did it hurt like hell? Absolutely. But it was a pain that I could heal from and work through, unlike the hernia mesh which only got worse whether I was active or stayed on the couch. It sounds like in your case the mesh is more of a discomfort or annoyance, and I can definitely understand your hesitancy to have someone else cut into you, but for me mesh removal was the obvious answer. It comes down to what is the mesh preventing you from doing in life? For me it was a lot. There’s no guaranty with any surgery, but you’d be in good hands with Dr. Belyansky.
I hope this was helpful and let me know if you want any other details.
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quote Meshpain:Hey Everyone,
It has been just over 3 months since I had my mesh removed by Dr. Belyansky and the results really are amazing. There was plenty of pain from the surgery, but the relief from the mesh being removed was immediate upon waking up. He was able to get almost all of the mesh out with no complications and I feel like I have a new lease on life. Right away I no longer needed the cane to get around. Four days post surgery I was able to walk a mile for the first time in many months. Within a month I was able to lie flat again and stop sleeping in a recliner. Now I’m back at the gym regularly and doing physical therapy to work out the last remaining kinks from surgery and my sedentary “mesh lifestyle.” Sure I still have an occasional pain or some mild burning sensations, but they only last a little while and I am completely off the painkillers after being on percocet every day for almost a year. I am so very happy.Thanks to everyone here in the forums that shared their stories and insights, and offered their support. Without this site, I know my journey would have been much longer and fraught with even greater frustrations.
Guess I’m gonna have to change my screen name now. 🙂
i keep hearing these very encouraging stories. congrats! i have tentatively scheduled a surgery with Dr. B for February and still can’t decide if I will go through with it or not. unlike many of you, i no longer really have much if any pain. just tightness and discomfort that i’m quite certain is directly caused by the mesh. i don’t love the idea of feeling for the rest of my life like my hip was removed and put back on slightly crooked, or feel some discomfort while running or sleeping on my stomach. but i also can go lengthy periods of time where it isn’t totally bugging me. just need to weigh the pros and cons and whether i am ready to deal with several more months of recovery from another surgery and more holes in my abdomen. i really don’t like the fact that i spent almost 2 years in discomfort and mild to moderate pain. i kinda feel like i just want this stuff out.
if you get a chance, can you give us any more detail about whether or not he did any other repairs, or if he simply took the mesh out and expects the scar tissue to hold things? also, i’ve been wondering about the recovery and therapy needed. did he recommend that?
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Hey Everyone,
It has been just over 3 months since I had my mesh removed by Dr. Belyansky and the results really are amazing. There was plenty of pain from the surgery, but the relief from the mesh being removed was immediate upon waking up. He was able to get almost all of the mesh out with no complications and I feel like I have a new lease on life. Right away I no longer needed the cane to get around. Four days post surgery I was able to walk a mile for the first time in many months. Within a month I was able to lie flat again and stop sleeping in a recliner. Now I’m back at the gym regularly and doing physical therapy to work out the last remaining kinks from surgery and my sedentary “mesh lifestyle.” Sure I still have an occasional pain or some mild burning sensations, but they only last a little while and I am completely off the painkillers after being on percocet every day for almost a year. I am so very happy.Thanks to everyone here in the forums that shared their stories and insights, and offered their support. Without this site, I know my journey would have been much longer and fraught with even greater frustrations.
Guess I’m gonna have to change my screen name now. 🙂
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Thanks, everyone.
[USER=”2784″]Casey F[/USER], I hope he is able to help you as well and good luck with everything!
[USER=”2042″]Jnomesh[/USER] Your story has been essential in helping me keep on fighting to see Dr. Belyansky. I was already confident in his abilities and experience, and then for the cherry on the whipped cream, Martindale referred to Belyansky as “a wizard with the robot assist surgery.” I’ll take a wizard for my upcoming surgery. 🙂
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Your in good hands. If you need lapro mesh removed he is tops of the top. He will safely remove your mesh. Hopefully the pain you are experiencing will cease after removal.
i am also glad that they are looking at ways to let out of staters see him. When I had my mesh removed by dr. B 2 years ago self pay or out of network patients were seen.
Best wishes -
I saw dr belyansky in May for issues with left side of bilateral inguinal hernia lap robotic with mesh jan 29, 2019 in Salt Lake City. He Told me if still in pain in 6+ weeks he would order a cat scan since the mri I brought to him did not show anything amiss. Yesterday I had my CT for dr Belyansky and I see him on Monday. Best wishes for a full recovery!
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[USER=”2791″]Meshpain[/USER] That’s really good to hear, I’m glad you got everything sorted out. Think positive and godspeed!
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Hey there,
I know this thread is a little old but wasn’t sure where else to post an update. Just wanted share the good news that with much persistence I was able to have a phone call with Dr. Belyansky, after which I was contacted by his office staff to schedule my mesh removal!! Turns out it was a hospital policy that was preventing self-pay for out of state patients, and Dr. Belyansky’s office will be using my case as a pilot/trial for figuring out how to allow others to be able to self-pay as well! I also managed to have a follow up call with Dr. Martindale at OHSU and he agreed that my best chances for successful outcomes would be with a surgeon skilled in robotic-assist laparoscopic surgery. (Hopefully this will be adequate for my insurance company, but that is another matter…)So I am scheduled for mesh removal surgery in a few weeks! I’m nervous as hell and I know there’s going to be more pain that comes with the procedure, but it will all be worth it if it means less pain in the long run and getting back to the many things I’ve been unable to do. I will start a post surgery thread afterwards to give some details to the community on how that goes.
Many thanks to everyone who chimed in; your support and opinions have been invaluable in this time!
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Sorry to hear what you are going through. The most important thing to remember is mesh needs to be removed the same way it was put in, besides say if a plug was placed with open repair that could be removed laparoscopic/robotically. That is weird of Dr. Belyanskys office to not accept cash from out of state patients anymore because I know a lot of people were going to him for removal so that really is disappointing for patients. I know someone who was in the same boat as you with bilateral and umbilical mesh but he removed all 3 robotically so I am not sure why he would opt to remove the umbilical mesh open. The only surgeons I know of that have removed more than 1 piece of mesh in 1 procedure are Igor Belyansky, Bruce Ramshaw, Anthony Iacco at Michigan hernia surgery, and the surgeon that removed good intentions bilateral mesh on here. Do not let any surgeon talk you in to open removal such as Dr. Peterson because he has messed many people up that way when he could have referred them to a surgeon that is skilled in laparoscopic/robotic mesh removal which he is not and just performs open surgeries. Here are some surgeons that may be able to help and ill leave out Belyansky which you’ve already spoken with and Bruce Ramshaw because I think he is on a hiatus and not doing any surgeries at the moment. Dr. David Chen in California, Dr. Shirin Towfigh in California, Dr. Anthony Iacco in Michigan at Michigan hernia surgery, Dr. Randy Janczyk at Michigan hernia surgery both of them are highly skilled in robotic surgery and Dr. Janczyk had the highest volume of robotic surgeries in the United States in 2016. Keep your head up and I hope you find some answers soon!
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[USER=”2795″]bmul100[/USER] is also right. I know Dr. Remus Repta in Scottsdale, Arizona removes umbilical hernia mesh only. He also states it on his website. But I believe he only does it openly. But I think it would be better to get all done by one surgeon just to make it easier financially and physically as well. Do you know any other plastic surgeons who remove mesh?
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Have you considered breaking it up in to two surgeries? A plastic surgeon could be a consideration for removing the umbilical mesh.
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Hey meshpain. I’ve heard it mentioned that some people have had success getting past the from office of drZ Belyankski’s by fed exing their scans and operative reports to him and leaving contact info and email address. I’d consider doing this and also attaching the letter. It may double your odds.
Also that is the second type I’ve heard someone mention Belyanski say because of how the mesh was implanted he would have to fillet the person open. Not the kind of words you want to hear I’m sure and although Belyanski is a highly skilled surgeon in open and lapro removal his specialty appears to be robotic assisted lapro removal that seems to give him the edge over some other surgeons. This may matter less when it comes to umbilical mesh but will matter greatly when it comes to the inguinal mesh as the inguinal area is a far more complex and challenging area.
i haven’t heard Martindales name a lot in my research of mesh removal surgeons do please make sure you ask how many of these surgeries he has done and the success of them and I think it is imperative that you ask for some patients of his that had same procedure as yours to get some feedback as you probably won’t come across anyone online. -
Hey Y’all , Thanks for your responses.
[USER=”2029″]Good intentions[/USER] Thanks for the recommendation. I had seen Dr Billing’s name on this site a few times, but nowhere else mentioning mesh removal. I will look into him further as a possibility here on the west coast.
[USER=”2854″]localCivilian[/USER] You are correct, Belyanksy is not in-network for my insurance plan, but he is an approved provider for my health insurance company, just in a different network that I can’t get because of where I live in Oregon. (We have honestly thought of moving across the state to switch networks, but I’m guessing the insurance company will simply continue to give us the run-around.) Insurance keeps denying my surgery insisting there is someone in-network who can perform it (because of the CPT code issue) and that I haven’t had a proper evaluation regardless that almost a dozen surgeons, specialists, and other docs who are in-network have given their opinion that the mesh needs to be removed. In fact it was at the insurance company’s insistence that I see Dr. Martindale who is NOT in-network either but is in state. Which infers to me the insurance company is admitting there is no-one in-network who can perform the surgery. [Insert beating head against board here.]
[USER=”2042″]Jnomesh[/USER] Thank you for the idea about sending him a personal letter; you’re the second person to do so recently, so I am encouraged to write that letter. And thanks for sharing your experience with Belyansky. One other detail that further complicates the decision is that Dr. Belyansky was very impressed that my original surgeon was able to place the umbilical mesh where she did without using robotic-assist, and his exact quote was “I’ll have to flay you open to remove that piece.” I’ve been unable to get any clarity on what he meant by that specifically, and unfortunately his office doesn’t seem to want to let me communicate with him until I get insurance approval (which is rather disheartening I gotta admit), but my point is that I may need to have open surgery to remove the umbilical mesh even if I go to Belyanksy, which kinda defeats the purpose of flying across the country. Again, this is an unknown, but you are absolutely right: I only get one chance at this and I want to make sure I have the best odds of success.
So at this point I am looking at Dr. Belyansky, Dr. Martindale, or potentially someone else on the west coast. Dr. Peterson seemed really aggressive in his approach, which I was uncomfortable with. While I really liked Dr. Brown, if I have to go with open surgery then it makes sense to stay in my home state. Again it boils down to risks and rewards with Open vs. Laparoscopic. What you all say about the access and potential repairs makes a lot of sense, and I am trying to schedule follow up Q&As with both Belyansky and Martindale to discuss. When it comes to laparoscopic surgery, it sure seems that robotic has the best chance of success as opposed to standard lapro. And if further evidence comes in that lapro is clearly the better solution over open but Belyanky’s office won’t accept me, then I guess I’ll be looking to schedule a consult with Dr. Towfigh.
Hoping one of the forum surgeons might add their two cents here as well on open vs. lapro.
Thanks, everybody!
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Yeah maybe even longer.
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[USER=”2042″]Jnomesh[/USER] You’re right about Dr. Peterson’s method of removing mesh. I believe he also makes the length of the incision the exact same length of the mesh most of the time which is crazy.
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Hi meshpain, thanks for your post. As someone out of sate who had their mesh removed by dr. Belyanski before they instituted this new policy of not seeing out of state patients who do not have his insurance i truly empathize with you as I have been rx dr. Belyanksk to other people on some Facebook mesh forums I’m on only to learn of the same issues you are going through.
As you continue your search of other surgeons I wonder if it may be worth it to send your scans (agent copies of any cat scans and MRI’s-Belyankski specializes in reading cat scans ) and type up a heart felt letter and fed ex them to his office. Find out the name of his physician assistant and get their email address and send them a email that you are sending over your documents.
i have heard from a few people that they were able to bypass the office staff this way and have heard back from Belyanski or his PA. It is worth a shot and maybe a heart felt letter can do the trick. You were so close and had your foot al lost in the door before the policy change it is with a shot. One of his first patients had 3 pieces of mesh removed bilateral inguinal and one I’m umbilical just like you-maybe it will help maybe a exception can be made in your case-you never know.
i leave it up to the surgeons to weigh in on why same method in is the best way out. But for me it is very logical. Of mesh is inserted lapro it is placed usually behind the muscle so it’s easier to just peel it off from the backside the to enter from the front and work your way through the muscle to get to the mesh behind it.
From speaking to many people when mesh is implanted lapro and removed lapro there are usually no hernias present and often no nerves have to be cut. However, when mesh is implanted lapro is removed openly there is almost always need for a hernia repair and usually some sort of neurectomy takes place-so it can be way more invasive to do it this way and there can be 3 traumatic surgeries wrapped up into one .
One thing that seems present to the people that have had their lapro mesh removed lapro by dr. Belyanski is there is not a lot of pain in the surgical area post removal. I only took extra strength Tylenol for 4 days and no narcotics and others who I have spoken to expressed the same wonder. This isn’t the case with the people who have had lapro mesh removed openly. It’s just a way more invasive surgery. The outcomes just don’t seem as good.
As a previous responder mentioned I would stay away from Peterson as I know for a fact he makes a very large incision from breadth bone to Linux bone when removing lapro mesh openly.
My first surging who I inquired about mesh removal was Dr. brown and he was wonderful to speak to. If I wanted a no mesh hernia he’d be my guy.. or if I needed open placed meshremoved openly he’d be a top considerations Bit when he wanted to remove my lapro placed mesh openly I did not feel comfortable with that. His reasoning seemed good as he said he could see very structure as he worked his way down to the mesh. I got the feeling this was the way he felt the most comfortable doing. I sought another opinion.
Dr. Jacobs was next for me. I lived in NYC and that’s where is was located. He said the mesh should he removed the same way it was out in and this was repeated by Belyanski and Towfigh so felt reassured that my initial gut feeling about this was right. BTW Jacobs does not even take insurance so if he is someone you are considering he will take self pay patients. If you have out of network benefits it could pay for some of the costs 2 years ago I Believe his quote was about $10,000 for removal-this does not include anesthesiology and you’d have to check with mount Sainai if they take take your insurance .
dr Jacobs was great he listened and like a detective tried to osier together what was going on. His best educated guess was that it was the mesh and it should be removed. There were some things with my visit with Jacobs that led me to get one more opinion. When a guy on a FB reputed that a Igor Belyanksk removed his 3 pieces of mesh and got 100% removed with no nerves being cut I sent my info to his office for a third opinion. He got back to me and definitively said the mesh was folded and shifted and he saw this on my cat scan-the same cat scan 3 other surgeons and radiologists said looked perfects.
As I mentioned I had my mesh removed by dr. Belyanski and I have my life back.
my advice and take it for what it is worth is to avoid any Surgeons who want to remove your lapro mesh openly. If you can’t make it work with Belyanski I would focus on Towfigh, Billings and Jacobs. If you can get a consult with all three the better-then make the choice that feels right to you. It is a big decision. You only get one chance to get it right.
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