Chronic pain mesh and life style

[Alephy]

@drbrown can one stay on watchful waiting or should one have surgery asap for a tissue repair? I have read somewhere that the longer one waits the less likely a tissue repair can be done…

[DrBrown]

@alephy
In a recent article about the treatment of chronic pain after hernia repair, all the patients that required a second operation had had a previous mesh hernia repairs.

https://www.ncbi.nlm.nih.gov/pubmed/31668283

Do not have a mesh hernia repair.
Bill Brown MD

[Alephy]

Hi @good-intentions yes I read it, tragic and it kind of resonates with me…
I have not had any surgery yet and I am on watchful waiting. I also have no intention to get a mesh (even if all went well, it would remain at the back of my mind as a potential source of nightmares afterwards), but in case of an emergency (where pain or whatever spirals up out of control) it would end up being mesh…

My preferred course of action:
1) make it better somehow with exercise see if I can go back to some of my old life
2) try and get a tissue repair (preferably as conservative as possible, which would exclude Shouldice?)
3) try and get a bio (totally absorbable) mesh (some say it doesn’t work but yet many mesh removals end up with no further patching due to the scar tissue, so it might work)
4) still on watchful waiting if all above fails
5) mesh repair (Ovitex or some new one EU regulated in 5 years?) if all above fails and I MUST go under the knife that is

[Good intentions]

Alephy if you have not read the story in deeoeraclea’s thread, linked below, I think that you should. He is one of the rare cases of a person who has had both types of repair and can attest directly to the differences. Everybody should read the story.

Don’t relax and “accept your fate”. If you end up as one of the 15% after all of your efforts to find a good solution that would be terrible.

https://herniatalk.com/forums/topic/one-hernia-repair-with-mesh-one-repair-without-my-experience/#post-26458

One hernia repair with mesh, one repair without (my experience)

[Alephy]

Hi All,

Thanks a lot for your replies! Yes I have been on this site long enough to have taken in the whole spectrum.
I asked lots of questions at the beginning and still more questions pop to my mind. I myself have small inguinal hernia(s) (the left one is not clear and at the very least without symptoms) and a small umbilical one. I have not had any surgery yet, and I know for a fact that it would not be possible to find an experienced surgeon that would do a tissue repair where I live (I spoke to a really experienced one in the area, and even though he does mesh I would surely have him operate on me if no other option was available).
This is why I ask after mesh repairs too, just in case I have to go down that road….so I am currently on watchful waiting…

Going back to my activity level before the hernia is one motivation to go for surgery, which is why I want to understand if this would actually be possible. Many people here had the same desire/expectation, only to be faced with reality. Having surgery, only to have the same discomfort/pain afterwards seems pointless (at the moment the level of pain is not debilitating in any activity)…

One more question: I have seen Dr. Towfigh mention in one of the live streams that the EU has adopted a tougher legislation to enforce mesh manufacturers to run animal/human tests and publish results (in a regulated manner I would hope) before marketing a product: does anyone see a future improvement under the mesh sky?

Thanks a lot!

[Good intentions]

With the shrinkage that the mesh causes activities that stretch the mesh area can cause discomfort. And/or pain. There has been much discussion over what is actually “pain”. You’ll see a lot about “debilitating” pain, or chronic pain, but accounts of chronic “discomfort” from feeling the mesh implant and the tightness of the tissue, and the inability to be as active as before the repair typically gets discounted. Because it’s not “pain”. A formerly active person can avoid the pain or discomfort by not being active anymore. Which, ironically, is the very reason that is used to recommend a hernia repair.

So a doctor can honestly say that the odds of pain are not high while not addressing the chronic discomfort. You’re alive and you don’t have a hernia anymore.

Even so, the odds of chronic pain are generally accepted as about 15%. This number is even used by surgeons who recommend mesh repairs. About one in six, like Russian roulette. This could be considered a low number.

I know that you’ve seen all of this before Alephy, but it is still true. Nothing is really different today, than last year or five or ten years ago. That’s where the 15% comes from. Things are the same.

[DrEarle]

Agree with the statement all hernia repairs have a risk of chronic pain. The risk is very low, but that will not predict the outcome for an individual.
Without complications, there are no specific limitations of activity after hernia repair.

Hope this helps!

[pszotek]

Alephy,

In my experience patients should be able to return to normal activity with either open or MIS (lap/robo) repair. That being said I have not seen a correlation between type of activity and developing chronic pain. Return to normal activity can often take longer in some patients with open repairs in our experience. If you are concerned there are other options for reinforcement materials that allow you the choice and can be more comfortable in our experience for activity.

Dr. Szotek

[cj65]

I think you will be just fine, assuming the hernia isn’t ultra large and the repair is relatively straightforward. The real key is to have the surgery done by a specialist with a good reputation and who does a lot of these surgeries every year. I’ve had a botched repair for a very small inguinal hernia that should have been very routine to fix. And, I had to do have a removal and redo, after two years of the initial mesh becoming grown in, etc. etc. I still have to live with moderate amounts of pain and limitation. Soooo, have it done by someone with deep knowledge of the issues, real skill, and regular experience.

[Herniator]

all hernia repairs have a risk of chronic pain and most operations that involve an incision will have a risk of chronic pain – in addition whether you have mesh or not the incidence of you having chronic pain is the same. But will it effect you and your sports – it is unlikely, rare but possible (now I sound like a lawyer). The caveat here though is that any non-mesh repair has a much higher chance of recurrence – so back to the OR you go!
I would ask that you choose your surgeon, one that undertakes a lot of hernia repairs will be the one to go for.
Good luck
H

[Ed]

I am assuming you aren’t in chronic pain now and are just asking for FYI on activities after hernia repair, correct?

I would hope you can resume your normal lifestyle. I am 43, 3.5 months post bilateral inguinal robotic mesh repair. I had a slower recovery but am now resuming all my activities again. I am easing into some things, mostly because my fitness is not back to where it was prior. I am also working on rebuilding core strength, which will take a while. My core strength and flexibility really took a beating. That said, I am hiking and mountain biking about as aggressively as my fitness and strength allow. I still have aches and get sore (one side is worse that the other), but that does not limit activity. Best of luck to you, and be patient.

• This reply was modified 4 years ago by  Ed.

[mitchtom6]

@good-intentions is correct again. I was 95% pain free for the first five years, and then a rip occurred, and now I have daily pain that I have to take meds for. I would strongly disagree with the “no limits after surgery” mantra as that mindset assuredly contributed to my complications. In particular, soccer players tend to have complications. An olympic hurdler had his career upended and had to have his mesh removed. My complications arose after a stair running routine. I think any sort of “high knee” action puts a large amount of strain on the site and compromises the site. You won’t find “official” studies to back this up, but take my word on it and use your own deductions. Most of us on this website are part of that 15% GI was referring to. The way people talk about “just a hernia,” you’d think it would be as benign as having a tooth pulled. It’s a routine, outpatient surgery for goodness sake. My repair would probably still be problem free if not for my high-knee activities.