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14 months post surgery
Hi all just wanted to update how im feeling and how recovery has been.
As most are aware here ive had a few issues with my hernias and therefore had surgery at the shouldice at the end of 2018.
Prior to going to shouldice i had mesh on my right side and this wasnt removed at the shouldice and was used in the repair as if it were muscle as they said it had adhered behind the rectus muscle.
My left side was mesh free and had two hernias direct and indirect. This was repaired normally. My right was just an indirect. Both hernias only having fat coming through( bemused shouldice why DR KOCH put mesh on my indirect right inguinal hernia in the first repair) Both hernia repairs wernt primary. It was the 3rd Time and my first at the shouldice clinic.
Now in terms of recovery both sides are very strong. Im back playing football lifting heavy appliances and getting on with my activities Like before. I feel like whatever i do however hard i push myself i will not get a reoccurrence thats how strong it feels. However my only issue after the repair is the side that has the mesh. It feels like a piece of metal under my skin that tough. i feel like it restricts me with my bowel movements. Every time i press it or tap it a bit hard i Manage to pass gas easier. I get a lot of burning on that side and especially after ejaculation i get a tearing and pulling sensation which lasts for about 10 seconds.
I contacted the shouldice to discuss this and like before surgery i was told this was possible and something that had a chance of happening. However the longer it goes i feel the right side is getting tighter and tighter. I asked about what to do if i wanted to remove mesh and was told that they will not remove it unless theres a reoccurrence or infection.
I was told the possibilities before so the answers were expected to be honest.
Therefore i decided to consult DR Ulrike Muschaweck who luckily visits london every month or so and was told its my mesh causing the issue ( she instantly knew were the issue was as the area she touched is were the burning and searing starts from).
I was told to see a neurology surgeon who she works with who will check me up before she can operate as i said i get tingling also running down my Right leg. I know very well something is not right about my mesh wether its infected or my body is reacting or its the nerves running through.I’ve decided that i want it out before it causes further damage. It just doesn’t feel relaxed as if its not free. I know many doctors participate on this forum so my question is, can i safely remove a mesh (dyna pvdf) that is behind the rectus muscle? And if so would it allow for a non mesh repair to still take place? I also have my post surgery report for my right side and i will post that too.
I Will be grateful for any kind of help/guidance.On the other hand I’ve seen many people considering non mesh repairs and asking about the shouldice clinic.
I wish i went there first time.
I would never of had a problem and the repair feels very very strong.
In terms of pricing cheaper than anywere in europe ive spoke to or discussed. Facilities itself are amazing , i was actually upset that i had to leave. Felt more like a hotel experience than surgery. The fact you don’t have to consider accommodation when travelling from abroad was a big boost.
I would definently recommend especially the fact that reoccurrence rates are so low. I mean an 80 year old was there and had pure tissue repair. He was cycling the next day.
They do have specific requirements in terms of weight but thats something they help you with to prepare for surgery. So if you are looking for pure tissue repair id definently say consider the shouldice clinic.Baris
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3 Replies
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I don’t know enough to guess on the details. But I think that, basically, mesh removal involves cutting through scar tissue, wherever it is, to get the mesh out. Because the theory of mesh incorporation is that it gets covered in scar tissue. So all mesh removals involve scar tissue.
I would guess that with a laparoscopic removal the surgeon would get a good look at what happened, from inside. Then they could decide whether to go forward or not based on the odds of success. I notified Drs. Brown and Towfigh, hopefully they will reply. Yours is an interesting case, I think.
Good luck.
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@good-intentions i have my surgery report for my right side to show exactly whats been done and what they have seen.
‘An oblique right skin insicion was first made avoiding the previous high almost transverse skin scar. The incision was extended through fairly heavy scarring to reach the external oblique aponerousis which was opened in line with its fibres to gain access to the inguinal canal. Scarring was very heavy. There was an opening at the internal ring which was about 2 cm accross alowing extraperitoneal fat to come through. The spermatic cord was freed with great caution because at the internal ring when trying to split theposterior wall a piece of underlay mesh material was found densely adhered to the under surface of the rectus muscle. Over the groin, near the pubic tubercile, a few firm small lympth nodes were found, removed and submitted for pathological studies. The illioinguinal nerve was found and freed and protected throughout. The posterior wall eventually opened to pubic bone through very dense scarring. The inferiror epigastric vessels were bound up in the mesh and in order to open the posteriror wall, these vessels were divided and transfixed with 2-0 Maxon. There was a shallow femoral pocket above the area was good below and left alone. Some fatty material superficial to the pubic tubercile was also exised. The repair was done without disturbing the mesh which was densely adherent to the rectus muscle. Four continous lines of #32 gauge monofilament stainless steel wire was used to close the posterior inguinal wall incorperating the lateral border of the rectus abdomonis and the inguinal ligament and leaving a loose internal inguinal ring with no compression of the spermatic cord. Cremasterics had been found, scarred, but thin and divided doubly ligitated with 4-0 polysorb. The tissues were then infiltrated with 0.23% roplvacaine hydrochloride. A single continous line of 2-0 Maxon was then used to reclose the external oblique aponeurosis and anchor the distal cremasteric stump. Subcuntaneous tissues were reclosed with interrupted 2-0 Maxon, Michel clips appiled to the skin amd this wound covered with a sterile sheet and left alone at this point.’
My question now is although the mesh is heavily scared can it still be removed?
And also from whats been stated is the mesh in contact with my intestines?Kind regards
Baris -
@baris thank you for following up with your results. You are one of the few people who has both types of hernia repair at the same time.
For removing the mesh that you have, behind the rectus muscle, that is the normal placement for a laparoscopic implantation, and for certain “anterior” approach open methods. It’s normal to have it there. The mesh is either in between the peritoneum and the muscle wall, or it is in the abdominal cavity behind the peritoneum. I think that the short term for that is IPOM. Intraperitoneal mesh placement. The fluoroplolymers are considered to have less adhesion, in general, (like Teflon) so they have developed a product that, supposedly, is okay to come in to contact with the intestines. But yours could be either of those. Your surgery notes from the mesh implantation will tell.
https://en.dyna-mesh.com/ipom-gb/
https://en.dyna-mesh.com/groin-gb/
You can have the mesh removed by either open or laparoscopic methods. Since you’ve had an open procedure there for the Shouldice repair, a laparoscopic repair might be best, as I understand things. Probably even robotic since it will be complicated by the Shouldice repair.
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