Choices and Decisions

[pinto]

[USER=”2531″]Feuermann[/USER], Excellent account. Watchful waiting is often used as the default but much depends on how stable. You might have done well by what you did. Pretty frightful is the thought of going to the local emergency ward for surgery, even if pure tissue repair (of course very unlikely). Whatever the method, however successful, most patients will never be perfectly immune from further complications. As I wrote elsewhere, we are all enslaved for life to the prospect of hernia.

[dog]

I would like to put a final point to this very emotional topic .We truly happy for everyone who tells us their personal success stores with mesh surgery. !
They took risk and it worked for them . We also believe that there is some cases that definitely required mesh because these cases cant be done reliably otherwise,so mesh would be the best choice
We also know that some doctors who does excellent work with mesh like drtowfigh. We all hope that as technology will be developed …soon those surgery with mesh will be truly risk free or low risk

However problem with inserting any implants cares non calculated risk..you never know when it going to hit you …starting with undetectable without test
“elevated marks of systematic body inflammation” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413778/ measuring C reactive protein and other inflammatory marks . Do you know that so many degenerative disease even cancer https://www.ncbi.nlm.nih.gov/pubmed/23604537 has one root case inflammation, inflammation create overactive malfunction immune system and many thinks along the line. Now here is a big problem if any cosmetic implant doesn’t work it can be removed safely ,removing hernia mash is extremely difficult and you will never be the same.

To summarize Yes here is the experts and cases that you better of to do the mesh .We are just against to do hernia mesh as routine surgery blindly to do to everyone because of well know reasons, needlessly for me to count them again.
We love you all!!

[Feuermann]

I think it is important to understand that surgery of just about any kind is a calculated risk and that there are no guaranteed outcomes. This is why, in most areas, it is a last resort. Hernia repair, however, seems to be an exception. It was represented to me as a routine procedure that would make my life more comfortable. The risks were mentioned, but only in passing. My surgeon told me that he had done over 2000 repairs over nearly 2 decades and that only two patients had come back to him with chronic pain (and in both cases they resolved with time or treatment). I don’t think he was lying, but I doubt he followed up with his patients about long term outcomes in any systematic way.

I am two and half years from my repair, and doing much better after an 18 month period of gradual improvement in pain and discomfort. I do consider myself lucky – so far. I do not believe I would opt for a mesh repair if I could go back in time knowing what I know now. I may have even continued with “watchful waiting” since the odds of incarceration or strangulation appear to be much lower than chronic pain rates after this surgery.

I am active and engage regularly in weight lifting and cardiovascular exercise. I do worry that at some point I will have a problem. Mesh represents just one more variable that can go wrong with an operation in an area that is loaded with nerve fibers.

Anyhow, I wanted to weigh in and make it clear that it is possible to have a reasonably good outcome after this surgery while still having concerns and being highly sympathetic to the views and circumstances of those that have had their lives turned upside down by this ”routine” procedure.

[pinto]

@Sicily63 thank you for the good laugh. I am glad you are healthy and hope you will continue to be so. Sometime if you are able, it would be nice to hear from you what most led you to do mesh and if your surgeon had really informed you about the issues some of us raised. (Or if even you had been aware of them.) Best of luck to you all the same.

[Unknown Member]

You and Good Intentions parrot the talking points of hernia mesh litigation attorneys. I wish to thank the both of you for making me realize that “Misery loves MISERABLE company” and therefore, there is no reason for me to further participate in this forum of check for new posts. You only want to hear info that confirms your bias and refuse to believe that surgical technique, surgeon experience, etc. impact outcomes. I will pray for both of you in regards to continued emotional and psychological healing.

[pinto]

@Sicily63 seems you speak of yourself as “Holding onto the bitter feelings?” (Sorry to hear that.) The emotional/psychological is as important if not more so than the physical. I completely agree. That is why many of us are mutually supportive here. However, this site is titled, “Hernia Discussion,” in which you yourself actively opined about how great mesh is.

So if you expected you could opine without a reply, then you should be aware where you are. (The OED tells us that “discussion” is not a soliloquy but dialogue.) Yes, I expressed support of you, but again as this is discussion, I also replied to your claims. You seem unprepared to hear counter views? Perhaps my observation rings true. Perhaps also your mesh claims might be less solid than you think.

[Unknown Member]

We couldn’t disagree more Good Intentions, Soccer Again, Soccer +

[Good intentions]

The comments up to this point have been rational and reasonable. Numbers based. The message is – be very careful, do your research, it’s easy to take the easy decision but there is a well-defined risk to that decision.

Ad hominem attacks, attacking the person instead of addressing their words, are what is used when the argument is failing. There is no “zealotry” here. Just people supplying numbers to accurately describe the risk. For the sake of future patients, so that they will realize that there is undisclosed risk.

Don’t feel guilty or offended because people think that you are lucky. You did not control your fate with your efforts to find a good surgeon. You increased your own personal odds of a bad surgery, but the overall odds of a mesh reaction are still the same. An ~one in six chance of pain or discomfort. If you can find data that shows certain products have been confirmed, over the long-term, to cause less chronic pain, please show them.

Here’s a sample of one surgeon’s actions. He is in the middle of the whole mesh device scene, developing new products and methods for sale on one end, then suggesting pain management methods on the other. A person would think that stopping the action that causes the pain would be the first decision, but, somehow, creating the pain then managing it, is the new norm. I can’t imagine what it must feel like to be in the middle of this mess, as a physician.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896652/

https://www.ncbi.nlm.nih.gov/pubmed/24756905

Here is his attempt to fix his product that was delivered to market with no long-term testing. The patients were, effectively, the test subjects, apparently.

https://pdfs.semanticscholar.org/345c/018e3c2e7c54e723ca8e6d6f99b74a696501.pdf

[Unknown Member]

Are you sure that you are glad I’m doing well??? It feels like some frequent people contributors on this sight have this you are lucky now, but just you wait and see attitude. This type of attitude only serves to confirm anti mesh zealotry as any positive experiences are dismissed as luck or marginalized. I hopi think it is important that people heal not only physically post mesh removal, but emotionally and psychologically as well. Holding onto the bitter feelings is not healthy.

[pinto]

@Sicily63, I’m glad you are doing so very well. But I can’t help but think you’ve done more wishful thinking than anything else. I’ve read the literature too, and my understanding is that mesh is a ticking bomb. You can go completely issue-free for years, but suddenly mesh can become problematic. The body continually readjusts to the presence of a foreign object, a process that can unwind. Can you really be sure your short experience ensures no problems in the future?

[Unknown Member]

Thanks for the clarification. We are in complete agreement. Without a registry (and stricter FDA protocols), we are left with anecdotal information, biased estimates, etc. Many people do suffer in silence and this is an avoidable shame. While there is greater awareness about the potential and real adverse consequences from mesh based surgery on the part of consumers and surgeons, I believe that mesh based repair will remain the predominant choice for years to come. Not because it is the “gold standard”, but for the reasons many have outlined in prior posts.

Given that reality, I think it makes sense to not only educate people who are considering surgery about tissue based repair options, but also what questions to ask their surgeon about hernia mesh repair in order to find the most qualified surgeon. we all know that the learning curve for a surgeon is greatest with TEP, TAPP coming in second, and open coming in last. Given that, I would only go to a surgeon that does TEP on a weekly basis for many years if that was the recommended procedure. My surgeon uses Bard 3D Max and 3D Max Light for direct inguinal hernia repairs (I know some of our contributors have had horrible experiences with this product). No fixation with the standard weight and a single point of fixation via permanent tack wit the lightweight version. During his career, he used Progrip for a year, but stopped because patients were “feeling” the mesh too much.

My last repair on 11/7/19 was of a small direct inguinal hernia with healthy surrounding tissue. I would have been a great candidate for a tissue based repair, but went this way based on my positive outcome (so far) from my first surgery on the other side 1.5 years ago. Since I have no pain to speak of on this surgery 15 days post op, it looks like no nerve or spermatic cord damage has occurred via the surgery and fixation. Following 6-12 months post op, we will see if I develop and “mesh based” issues once most of the contraction and tissue in growth has occurred, whether it be from meshoma or rare but possible infection. I say rare because single filament polypropylene mesh has an apparently lower infection rate.

[Jnomesh]

Absolutely. My point was simply that I wouldn’t advise people to trust say the chronic pain %’s of mesh that is quoted out there say 5% because based on my experience and many others their complaints get brushed off so there isn’t a way to get honest numbers especially without a registry. I personally believe the %’s off mesh pain and issues is much a higher then reported in the literature. That’s all I was trying to say.
Maybe I misinterpreted what you were trying to say.
I certainly have my own opinions on mesh and it’s use and over use but also understood there are many that do well with mesh and others where a pure tissue repair may not be the best course of action.

[Unknown Member]

Well, I didn’t just say transvaginal if you go back and read my post and of course, due to the 510(k) process, there aren’t even clinical trials prior to marketing of a new mesh product. So there definitely have been and probably continue to be defective or substandard mesh products. There are some that have been used for 10 years plus and have good safety profiles. If you are of the opinion that mesh should never be used as a first line treatment option, then nothing I say will make a difference. It is my opinion that in the hands of a very experienced surgeon, mesh can and does produce good outcomes (both short and long term). This forum is an EXCELLENT resource for people looking for qualified surgeons who perform tissue based repairs, general information, or for surgeons who can do removals, etc. thanks to people like you and others who are frequent contributors. as a reminder, this forum is called Hernia Talk implying that all experiences and opinions are welcome.

[Jnomesh]

Sicily63
As someone who has had there mesh removed and had the awful experience for 6 months of having the top NYC surgeons, doctors and medical facilities and scans say all was well with me only to learn at removal that my mesh was completely balled up and rock hard and on all sorts of structures it shouldn’t be on your statement if I understand it is very inaccurate that if transvaginal cases were factored out mesh issues would be say in the normal range of all surgeries
As someone who stays active in the mesh forums trying to help people who have had issues post hernia mesh procedures there is one common theme that prevails-they aren’t helped by the medical community, their surgeon etc. there complaints fall on deaf ears. They are told it is something else and passed on to other doctors in a endless merry go round. So there is no way to tell the true number of mesh related complaints bc they aren’t getting reported-they are being denied and passed off.
There is no registry! No way to tell the true numbers!
Again I was someone told everything was fine with my mesh, scans showed this, physicals showed this-but my life was ruined. No one believe me and my mesh was found to be completely defunct.
if I didn’t travel out of state-pay my own way-had a supportive family and finances unlike so many- I would of never known. I Woolf if Laid In bed suffering-believing want the medical community told me.
if no one thinks it’s the mesh causing the issues then the stats will reflect this

[DrBrown]

[USER=”3066″]Sicily63[/USER]
insurance companies routinely pay for pure tissue hernia repairs. So the cost is not the major issue. The major issue is whether or not you can find a local surgeon who still familiar with the classic techniques.
Regards.
Bill Brown MD

[Unknown Member]

Just trying to give people who are considering their options a balanced perspective, particularly the ones who cannot afford to self-pay a tissue based repair. You should be really happy that you were one of the lucky ones who found a caring and qualified surgeon who listened to your concerns (and not dismiss them) and then skillfully remove your mesh. I wish you continued luck in the future as well.

[Good intentions]

Got blocked –

You are parroting the talking points of the mesh repair industry. By insinuation, blaming chronic pain/discomfort on the lack of skill of the surgeon. That plays directly in toe pockets of the mesh makers.

Here’s a question for you – who are you trying to convince, and why? You pulled the trigger and hit an empty chamber. Why hand the weapon to the next guy, assuming that they will hit an empty one also? The odds don’t change. There’s still a chronic pain bullet in the weapon.

You should really just be happy that you are one of the lucky 5 of 6. There is no way, yet, to predict who will be lucky and who won’t.

Read ajm222’s post, from his first to his last, recently. He went through the identical process you describe. But he, apparently, is not one of the lucky ones. Same situation, different result. https://www.herniatalk.com/member/2051-ajm222

You put some good research, but, in the end, it’s still luck. I hope you stay lucky, but I don’t think that you should be trying to convince people that they can control the outcome of their decision. The evidence says it’s not possible, where mesh is involved.

[Unknown Member]

Dog:

Agreed. if mesh goes bad, it goes really bad. The problem is a availability. We can all agree that there are only a few (less than 25?) across the country that are significantly experienced with tissue based repairs and many of them don’t take insurance. A lot of people cannot take off work and incur the travel and surgery costs to do it this way. They must go to a more local in network provider. I know you are gonna say that spending the money is worth avoiding many years or a lifetime of issues, but its not that simple.

Also, the statistics are misleading in both directions. When one looks at the estimated overall rate of hernia mesh related complications across the U.S. in any given time period, we are including ALL cases done by any surgeon. This means patients with prior pain issues, poor surgery candidates, complex cases, good doctors and bad doctors with sub par surgical skills, hospitals that cater to medicaid populations, etc. Plus the sample size (n) is huge. My point is,that if we factored out the unfortunate transvaginal cases, cases where the mesh was defective, only operated on good candidates (like Shouldice Hospital) and sent these patients to ONLY the top surgeons in the county, the outcomes would be greatly improved and the adverse consequences would fall within the limits of any other type of invasive surgery.

Another issue is that people who have positive outcomes in the immediate, short and long term with a mesh based repair, rarely post on a forum like this or any other. Why would they? They just move on with their lives. At most, they thank their surgeon and post a positive Google review for that provider. There are many people who fall in this category.

I’m trying to say that in the hands of a very skilled surgeon, using mesh with a good track record, one can achieve a safe and lasting repair. Particularly if you are into contact sports, power lifting, etc, where the repair is expected to withstand continued and repeated stress.

Yes, if my mesh goes bad, it was inserted via TEP method and will be even harder to remove. I just think one can drive themselves bonkers playing the “what if” game.

[dog]

The only differences if something would go wrong with mesh even theoretical 1 % { we all know that the real numbers probably about 25% in long term } People will be no way out ..you will be left alone with your problem .Your doctor most likely will drop you off …but actually nothing he can do ..once it is there.. it is there. . No loving Dr.Brown on your side like it was in my case . You can loose everything ! So think and think again ..Read this forum ..listened to Good intentions and other senior members. Don’t make the mistake that you will regret for life!

In my humble opinion of mesh cannot be safely remove it cant be used at all ..Not Worth it… Golden students in plastic surgery.. implant can be put in,if you can’t safely remove it……

[Unknown Member]

Good intentions:

Thanks for your comments. I have a follow up with the surgeon on 11/19 and will find out what mesh brand was used. As for the rest, I agree that mesh repair is somewhat of a crap shoot as I believe the frequency of chronic pain, for example, is grossly under reported in the literature.

I will say that many of mesh related issues dealt with:
1. Trans vaginal mesh placement, POP or SUI related repairs.
2. Defective mesh products.
3. Surgeon error.

Do not mistake my comments for me being a die hard promesh exponent. I’m simply saying that one can have a successful inguinal hernia repair, both in the short and long term.