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Choices and Decisions
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quote Sicily63:It was repaired by Dr. Brian Pellini at Doylestown Hospital in Pennsylvania. He used a laparoscopic TEP repair and polypropylene mesh with no fixation.And, the actual brand of mesh would help, if type of mesh is actually a factor. Polypropylene is just a polymer that is used in many different knit patterns. the word does not really help make a decision, there are many device makers that use it. The brand and model of mesh might be important.
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quote Sicily63:Otherwise, I stand as an example that mesh repair, in the hands of a qualified surgeon can work well.
It’s good that you are one of the lucky ones. Thanks for sharing your story.
The hard part for people to understand in this mesh implantation problem, is “probability”. The odds, the luck involved. The bulk of the studies show that there is a 1 in 6 chance that a person will have chronic pain or discomfort from a mesh implantation.
One of the ironies of this is that it seems to take the blame off of the surgeon. The responsibility. They are doing everything perfectly, what they were trained to do, but the odds determine who wins and who loses. In other words, somebody else has loaded the gun, they are just pulling the trigger.
So your last comment was most correct. If a person wants to improve their odds of avoiding chronic pain and discomfort they should choose a tissue/suture repair. If it fails then they can choose a higher risk procedure, a mesh implantation.
It’s just the way the math has come out over time. One of six people will have problems. Your one of the five that, so far, apparently, will not. Congratulations, and good luck in the future. It’s still early, you’re young, in terms of the rest of your life.
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I am a 56 year old male who has been training Brazilian Jiu Jitsu (BJJ) for the past 2.5 years. I first developed a left inguinal hernia which was subsequently repaired in May 2018. It was repaired by Dr. Brian Pellini at Doylestown Hospital in Pennsylvania. He used a laparoscopic TEP repair and polypropylene mesh with no fixation. I have gathered from my research that TEP repairs are more technically difficult than TAPP or open. I prefer TEP because the peritoneum is not breached. Since the initial surgery, I have put the repair though its paces as BJJ is a demanding sport that is hard on your core. Due to the physician’s skill and maybe some luck, I have endured no complications whatsoever and was mobile and virtually pain free immediately after the operation.
I had the right side repaired by the same surgeon on 11/7/19 and so far, it has been an uneventful recovery and I’m feeling great. Some takeaways from my personal experience and research:1. Whatever type of surgery you choose, it is important to find a surgeon who has developed competence in that procedure (typically accomplished by doing hundreds of that procedure. I cannot under emphasize the importance of this factor in determining outcomes.
2. Since “new and improved” meshes are brought to market via the laughable 510(k) process, only use mesh that has been around and with proven safety profiles.
3. I was healthy and in excellent shape prior to the surgery. your baseline health does play a role in outcomes.
4. I am a firm believer in active recovery and practice a progressive method of physical activity post surgery.
5. it is my personal opinion that you can minimize mesh contraction and subsequent “stiffness” through consistent vigorous exercise once cleared to do so. My theory is that the subsequent tissue in growth will occur not only in static and contracted states, but also in stretched and expanded body positions..I’ve read some articles related to the possibility of degradation of the PP mesh over time due to oxidation as it is apparently not completely inert in vivo and am unclear as to the very long term performance of this type of repair. at this point i have no regrets.
If you want to avoid all possibilities of mesh complication, both short and long term, go with a tissue based repair in the hands of an experienced surgeon like Dr. Towfigh. This assumes that you are willing to travel to the state where your physician of choice practices (as there are only a few I would use for this nationwide) and you can pay cash as most do not accept insurance.
Otherwise, I stand as an example that mesh repair, in the hands of a qualified surgeon can work well.
Hope this helps.
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Did you find a surgeon in Minnesota? Also, who did you consult with?
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[USER=”3031″]Launcelyn[/USER]
Your best chance to find a local surgeon who can do a non mesh repair is to consult with a surgeon who is at least 60 years old. He/she would have been trained before mesh was widely available.
The weather is pretty nice in California if you wish to make the trip.
Regards.
Bill Brown MD -
[USER=”3031″]Launcelyn[/USER]
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If you choose the Shouldice method you should go to the Shouldice hospital itself. Depending on your insurance plan you might find that it will actually cost less. You might also find that your insurance will not cover a non-mesh repair. When you’re calculating costs be aware that some of the cost estimates you receive might not cover “incidentals” like anesthesia. All of the procedures I’ve had since I got involved with the medical system due to my hernia have cost more than the original estimate.
Finally, calculate the long-term cost, mentally, emotionally, physically and financially, of a low quality repair, even if it is a non-mesh repair. Minneapolis is not far from the Shoulidice hospital. If I had could start over with my direct hernia repair I would go to Shouldice, Dr. Brown, Dr. Kang, or Dr. Muschawek.
As far as getting back to working out soon after surgery, I would not even think that way. Plan for years of good life after the surgery, don’t make a choice just to save a few months of down-time after surgery. A poor decision will affect the rest of your life. At 55 that could easily be 30 – 40 years.
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