Alloderm-surgery question

[Good intentions]

To be clear, I’m suggesting that you take extra care to avoid “the fire”. The Guidelines will tell you what most surgeons will suggest, if they believe in the Guidelines. It’s going to be more mesh. I believe also that Dr. Earle is a firm proponent of “mesh”.

The surgeons will see” trapped nerve” and take extra care that they don’t do anything to cause another “trapped nerve”. But the real problem might be that your body “over”- reacts to “mesh”. Since the medical community considers all of the various materials and forms of mesh as one thing, it will be very hard to tell if the new mesh will be better or worse than the one that was removed. The only “mesh” product that the Guidelines recommend against, if I recall right, is plugs. But their reasoning is not based on the numbers, recurrence and chronic pain, compared to other forms. It’s based on conjecture about the bulk of the plug causing too much tissue growth.

If you can get the details of your first successful mesh implant consider having that type of material used. At least you have some good information for that option. Why not find that surgeon since they got the first one right?

Good luck. The last sentence I copied means that if a hernia is found, that laparoscopic mesh implantation is recommended. Because you had an anterior repair before. Posterior is from behind, from “inside”, using laparoscopy. Today’s lap methods involve large pieces of mesh to cover all possible future hernias. Laparoscopic repairs are meant to be permanent.

“ For recurrent hernia after anterior repair, posterior repair is recommended.”

[allj]

Thank you again. I downloaded the “International guidelines for groin hernia management” and am going through it. I now have a better knowledge base by which to assess my options. Alan

[allj]

Thank you for your help. I am definitely fearful of having another surgery esp with the information provided. I had pain from the beginning of post surgery and through the 3 yrs before having the mesh removed. I have a mesh implant on the other side and had some what I think were nerve issues that resolved after a year of so. I made an appt with Dr. Earle in MA. I hope I’m not “jumping from the frying pan to the fire”. Honestly, I don’t think I can emotionally survive this if it’s worse. Thanks again.

[Good intentions]

Most surgeons will use synthetic mesh, either polypropylene or polyester. In your case, because a “trapped nerve” was defined as the cause of the pain, you could easily end up with another, bigger, piece of mesh. If you were fine for three years before the problem happened more mesh might work for you. But if you had discomfort and pain from the beginning then it might be that the mesh itself caused the “trapped” nerve due to constant inflammation. Generally, the problem solving thought process with mesh starts with the assumption that the mesh is not the problem, even though inflammation is cited as the reason for its success. Trapped nerves, erosion, improper fixation, etc. are the usual suspects for mesh implant pain.

So, if you had discomfort and pain for three years, from the beginning, before having the mesh removed, it seems reasonable to assume that your body does not work with mesh, and you’ll have more problems with another mesh implant. Something to consider. My mesh implant only felt right for a few days at the end of the 21 day wait for my second appointment. As soon as I resumed normal activity levels it never felt right again.

Problems are not really defined between the different types of synthetic mesh. All mesh is considered, or at least discussed openly, as one thing.

I am not a doctor, these are my opinions from what I’ve learned over the years. The International Guidelines, linked below, will give you a good idea of what to expect. The Americas Hernia Society endorses the usage of the International Guidelines, so most of the surgeons you visit will probably follow them. I’m not suggesting this is good, it’s just the way things are.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809582/

You would probably fit here, below, as a recurrent hernia, with a posterior implant and more neurectomies. You’ve already gone through the first part of the description.

Good luck. Find a surgeon who really understands what happened to you in the past, not just the “state of the art” today. And make your own decision. Since you had a failure, you are not normal so there is no standard procedure for you. You could start another cycle to failure.

Excerpt from Guidelines:

“Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. ”

[allj]

The original mesh was prolene with a plug. The mesh was removed and an neurectomy performed after 3 yrs due to a trapped nerve and associated pain. Any recommendations on the best type of mesh to use in my situation is appreciated. Are the porcine mesh products absorbable like the alloderm. Should I stay away from all bio mesh? Thank you for offering your help. I’m so very appreciative.
Alan

[Good intentions]

quote allj:

Dr. Towfigh,
I had a plug removed in 2006 by Starling and student for an inguinal hernia and replaced with alloderm and had a neurectomy. It’s been a real challenge managing the pain and weakness in the groin while trying to stay active and sane. I’m 72

It might be good to know more about the original repair. There are several types of “plugs” out there, different materials and designs. I think that they are usually combined with a patch. How long was yours in before you had it removed? Why did you have it removed?

It probably doesn’t matter a lot as far as getting your problem fixed. But it might, and it would be interesting, to me anyway.

Chaunce1234 collects good information about surgeons around the world, and their specialties. Here is one of his recent lists for surgeons in your area.

https://www.herniatalk.com/7800-hernia-specialist-in-boston-area

[USER=”1916″]Chaunce1234[/USER]

[USER=”2821″]allj[/USER]

[drtowfigh]

First you need the right diagnosis. I am happy to help. Also, there are great surgeons near you. You can search this forum for their names based on location.

[allj]

Thank you for responding,
It’s been a difficult 12 years. I haven’t had any faith in the few surgeons who evaluated me. They didn’t have any experience with alloderm replacement and said I had a slight hernia that needed watching. I noticed you use bio, hybrid and synthetic mesh. Is the bio and hybrid mesh you use absorbable? What would you recommend? I live in MA and would come out there but would prefer finding a qualified surgeon in my area. Do you have any recommendations? I’m so very thankful to you for your help.
Alan

[drtowfigh]

Alloderm is absorbable biologic mesh. Don’t expect to see the mesh inside you after about 8 months. Sounds like you need evaluation of your hernia repair.