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6 weeks post op removal of mesh
Hello All,
I am new to this discussion group.
I had 2 umbilical meshes removed 6 weeks ago robotically with 4 trocar sites on the left of abdomen and an additional vertical incision at the top of the belly. I had combination of bad technique/ inexperienced doctor put in the mesh and ever since I had very painful scar tissue and incision looked like he punctured through my skin to make the skin. The mesh was put in open and ever since that time I had this soreness pain sort of under the skin/nerves which radiated from the scar tissue and the incision from the previous surgeon. I had a little bit of a change sagging in this area too (softer with a horizontal crease like my muscles had split). Anyway when the doctor removed the mesh he had suggested to make the extra open incision to free up the old scar tissue from the old incision. But now I keep having those same exact soreness just left of the new incision which by the way still feels hard but has gotten smaller. The area is very sensitive to touch along the left side where I had the old pain before mesh removal. I did ask the surgeon to address this during surgery but he said the incision was not big enough for him to see the area to the left to see if there were any nerve damages or anything like that. My question is how come he with the 4 trocar sites he couldn’t see what’s going on in all the areas of my abdomen causing the soreness and sensitivity? Is this likely only mimicking the old pain since I had surgery and likely will get better once the scar tissue heals and maybe the area that it spreading to will get better over time? I am just confused and worried and really want to be done with all this. I am a Med student and I can’t focus on my studies with this ongoing soreness issue. The swelling has gone down around the belly although I still get on and off burning sensations from there too with some tightness. I appreciate some input from Dr. Towfigh on this as well. Thank you. -
3 Replies
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Hello Dr Towfigh,
Thank you so much for the reply. So the small hernia which he found through the open incision was apparently sutured with PDS dissolvable sutures but I don’t know how good this will be long term? I also didn’t question but wondered why he was not able to detect the hernia with the robot when the doctor was inside in the first place when he removed the mesh. Perhaps he only sliced the mesh off and lysed the adhesions but then decided to repair the mesh from the open cut on top? But then the question stands as to why you wouldn’t address the hernia robotically if you are already in there, and is it possible that the sutures of the abdomen were all done via open as well since the hernia was sutured that way using my own tissues. The third thing is at what point do I investigate the ongoing soreness area and what options would I then I have to deal with it? Would it require more surgery to explore nerves at that time? Does pain scar tissue resolve over 3 months? 6 months in your experience and hopefully the nerves settle? Or is it also likely that he inserted the trocar going parallel to the sore areas possibly re-injuring or re-activating the sore muscles? Finally, can’t the lights from the robot show the areas under large visualization of the whole abdominal wall to look for nerve entrapment and possible other causes of pain? I’m just trying to understand it more since my doctor said he couldn’t see nerve entrapment from the small incision that he made. But I thought you can see the whole anterior wall with the robotic inserts in the abdominal cavity? -
The saying that mesh should be removed in the way it was put in is a simplification of the recommendation and mostly pertains to inguinal mesh. The type of removal is based on many factors. Sounds like, in your situation, the mesh was placed via open incision, but it was found/placed in the intraperitoneal or extraperitoneal space. In that case, a laparoscopic or robotic approach is perfectly fine and in many ways preferred.
As for the # of trocar sites, for robotic, we use 3, sometimes 4 arms of the robot. You will have to trust your surgeon that the choice of number of trocars was a decision made to best serve your needs.
Lastly, as you are learning in medical school (and congratulations!), history is very important in revisional cases. The patient’s history is very important to help determine what exactly is causing their symptoms. Just because you have mesh in doesn’t mean the mesh is cause of your symptoms. There are a wide range of reasons for abdominal pain after your type of repair. It depends on the size of your hernia, the use of sutures or tacks, what the preoperative symptoms were, your own past medical history, and surgical technique.
I recommend you wait a bit. 6 weeks after mesh removal is too early to react. Also, how was your umbilical hernia repaired after the mesh removal? There is healing from that as well.
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And I know others have always said mesh should be removed the same way it was put in, but my doctor felt to remove it /Laprascopic/robotically and on op report it says he removed scar tissue but he did not think it was related to the mesh (which I respectfully want to disagree because I only developed the adhesions due to all the scar tissue that the mesh caused since I never had any scar tissue or adhesions from before the mesh). I don’t know why he thought it was better to remove the mesh robotically and when I asked him he said because he knows where the mesh is and felt comfortable removing it that way)but in the op report he also mentions that he removed the meshes from the incision that he made to explore and clear scar tissue from old incision. I am very confused with the op report because it’s inconsistent. What do you suspect happened and when I asked him why he made 4 trocar incisions instead of the 3 he said because the trocar was too close and he had to make one more that farther away. I don’t know what to think of all this 🤔 which is why I joined this forum in hopes that someone else can chime in. Thank you.
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