Concern about Tissue Repair -Thunder rose even concedes

Hernia Discussion Forums Hernia Discussion Concern about Tissue Repair -Thunder rose even concedes

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    • #30889
      Chuck
      Participant

      So i beat myself up about doing a mesh repair daily but a recent post by thunder rose caused me to remember why i selected mesh initially in part…and it was because nearly everyone who has a tissue repair will concede to getting pain or weakeness on occasion in some cases years after the repair….this is definitely the case with shouldice as i have seen many many shouldice patients concede that they get shooting pain and even weakness months and years after the repair was done. I have seen this reported in desarda circles as well…i shied away from tissue repair in part because of the tissue trauma needed to accomplish it…with four rows of prolene sutures…vs a piece of mesh that weighs less than a gram…i wonder who has more plastic inside when its all said and done…does anyone know? For the record i would still do a tissue repair over a mesh repair every day…but the case just was not crystal clear…tissue repairs have nerve problems and lingering issues many years after the repair is done too

    • #30891
      Good intentions
      Participant

      You can go crazy looking at individual stories. There will always be a story that runs counter to the prevailing data. Even the surgeons can use the one-off stories to make a case for mesh usage. It’s not uncommon to see justification for mesh include ventral or incisional hernia repair data, when inguinal hernias are a different type of hernia. Or vice-versa, making the case against mesh, conflating inguinal hernia repair pain with those other types of hernia.

      The rational approach is to look at the numbers, the odds of a certain result. And the type and magnitude of the pain. A word that gets used a lot is debilitating. I don’t think that Thunder Rose’s pain is debilitating.

      Anyway, I can see that you’re still trying to figure out how you ended up in your situation, along with trying to figure out what to do about it. I had the same problem. The hardest part of the decision process is maintaining objectivity, about your problem and about your own ability to make a correct decision.

      You’re in a tough spot. Take some time and be sure. Good luck.

    • #30894
      Watchful
      Participant

      A doctor friend of mine told me that once you go under the knife, you’re never the same again, so resist surgeries unless absolutely necessary. The bar for pulling the trigger has to be very high.

      My dad had a Shouldice procedure many years ago for an inguinal hernia on one side. I don’t recall that he complained about pains or other abnormal sensations, although he’s the type who wouldn’t mention anything if it was minor. The hernia did recur eventually. I don’t remember how many years it took, but I believe it was well over a decade. He is overweight, though. He has not treated the recurrence – he just lives with it.

      I’m struggling myself with what to do. I’ve been living with an inguinal hernia for decades. It didn’t give me too much trouble in the past (only occasionally), but that changed in recent times. Still, I’m not completely sure I should have the surgery done because it’s hard to say how bad things need to be to justify surgery.

      I’ll do it most likely (mine is pretty bad), but not sure with what procedure. None of them seem all that great. The more I read about it, the more depressing it gets. This is from a study that just came out. Seemed very surprising to me, and this was focused just on recurrence, not chronic pain:

      “About one in six older Americans who’d undergone an operation to repair a hernia had repeat hernia surgery less than 10 years later, Michigan Medicine research found. These rates have barely improved since the 1990s, when similar data revealed that about one in five patients underwent at least two surgeries to address the problem.”

      “Out of the more than 175,000 patients on Medicare who’d had hernia repairs between 2007 and 2018, those who’d had minimally invasive procedures were more likely to need additional operations than those who’d undergone open surgeries.”

      “Since not all patients whose hernia comes back undergo surgery again, hernias likely recur even more frequently than was shown in the study, the authors note.”

    • #30895
      Good intentions
      Participant

      I found what I think is the article. I was able to find the original source, which is actually a letter. Of course, you have to pay to see it.

      The letter conflates the different types of hernias so it is hard to translate the results to people with inguinal hernias. Even the professionals get confused.

      https://labblog.uofmhealth.org/lab-notes/more-than-one-surgery-common-for-hernia-patients#:~:text=Repaired%20hernias%20redeveloped%20more%20than,later%2C%20Michigan%20Medicine%20research%20found.

      https://jamanetwork.com/journals/jama/article-abstract/2789552?resultClick=1

    • #30896
      Chuck
      Participant

      Watchful…thanks for posting…there are studies that show 26 percent chronic pain rates for shouldice repairs…and there are studies showing lap repairs typically last 10 years. Which way are you leaning? Good intentions…i am guessin you have limited your life to prevent recurrances? Heck you told me to restrict my own activities because i have Bard 3d max???? I wish somoene could give me a decent recommendation on removal

    • #30897
      Good intentions
      Participant

      “Good intentions…i am guessin you have limited your life to prevent recurrances? Heck you told me to restrict my own activities because i have Bard 3d max???? ”

      I have written nothing of the sort for either of those.

      If I can be critical – I have noticed that you tend to misinterpret things. And often throw out veiled insults. My point about being objective was to stay away from making it “about you” or trying to find someone to blame. Take responsibility. You did the original research and made the decision to have a mesh implant. Only you know if you’re suffering pain now. Only you know what your plans are for the future. Only you can decide if you should have the mesh removed to fix a current problem or to prevent a future problem.

      Start over, do your research again, make another decision.

    • #30898
      Watchful
      Participant

      Good Intentions… Correct, the study isn’t specific to inguinal hernias. Hopefully, the numbers would be better if it was just inguinal hernias. Still, surprising results.

      Chuck… I’m leaning toward Shouldice, primarily because I’m concerned about the worst case with mesh (need for removal) which seems worse than with Shouldice. The thing is that I’m not really sure that this is smart. It seems like such problems with mesh are extremely rare in the hands of top hernia surgeons, so if I go to one of those, maybe it’s not really a valid concern, and I’m more likely to have trouble with Shouldice (even with a top tissue repair surgeon) than with lap TEP or even Lichtenstein (in the hands of a top surgeon). I’m pretty much stuck on this, and can’t bring myself to move forward. Meanwhile, I’m being very careful to get the hernia back in when it gets incarcerated, and I hope it doesn’t get strangulated on me (I know this is rare, but very bad when it happens). I often get gurgling sounds from the hernia when it comes out, so I think intestine goes in there.

    • #30899
      Chuck
      Participant

      Come on GI…you flat out said mesh can be good for older guys who sit on the sofa and walk to their cars and to church…but anyone active has to be concerned about mesh migration….I could go back and find that post if you like. Since you had mesh explanted bilaterally i have found your case to be of particular interest. Not sure why a simple phone call to discuss your experience is so hard…I am willing to pay you for your time. I just want to get better…and remember you made the decision to implant mesh too…as did Adam and many other smart folks…william bryant calls this area a minefield…you really need to sit on this forum for a year or more to really understand the issues you are facing with a hernia…its easy to make the wrong decision particularly when nearly all doctors are consipring to support mesh..so if am looking for a little compassion support and advice…i hope you would provide it…i promise i will if i get this crap our successfully/…I have already provided a good post on how to select a techiniqua and a surgeon

    • #30900
      Good intentions
      Participant

      “It seems like such problems with mesh are extremely rare in the hands of top hernia surgeons”

      I don’t think that this is true, especially not “extremely rare”. It is one of the talking points for mesh implantation, blaming problems on the skill of the surgeon. But the data do not support that problems reduce dramatically with surgeon skill.

      What I have found is that you will see many statements like that, with no supporting data. Another one that happens often is responding with recurrence data when a question about chronic pain is asked.

      I wish that I could be more positive and reassuring. But the data that is published and available does not support the comforting statements you’ll often hear from the surgeons. When you ask for the supporting data, there is silence.

      IT seems to me, that oftentimes the surgeons are trying to reassure themselves as much as the people they are talking to. They are not really confident about what they are doing either. Dr. Campanelli’s letter about the reality of chronic pain comes to mind.

    • #30901
      Chuck
      Participant

      watchful…peterson told me that the gurgling is a bad sign..but not sure he can be trusted. Why dont you have any interest in kang?? i think he is a slam dunk decision over invasive shouldice…lots of reports of chronic pain with shouldice…

    • #30903
      Watchful
      Participant

      Chuck… Dr. Kang reports amazingly good results, but I don’t know much about what he does. How is it different from a 2-layer Shouldice? Also, doing it in Korea is a bit daunting (I’m in the US.)

      Good Intentions… I agree – we don’t really have numbers specifically for “top surgeons” other than the numbers that they report themselves. However, I’ve looked at the on-line reviews of a number of top hernia surgeons who do mesh (primarily lap TEP and robotic), and the vast majority are stellar reviews without complaints of chronic pain or other issues. I would expect to read more complaints if the incidence of problems was significant.

    • #30904
      William Bryant
      Participant

      Watchful thanks for posting that you’re living with it as by chance I saw NHS surgeon today (at insistence of my doctor’s who said go and see what repairs are offered, even thougn I knew it was just mesh which was all I was offered).

      Anyway I was quite depressed after seeing him as he said it will get worse, more painful and can get incarcerated etc etc.

      On complications of mesh he was dismissive so I asked him how many cases of chronic pain. He replied “in the last year just one”…. Here’s the worst part, he then quite matter of fact said “that doesn’t mean you wouldn’t get it”!!! …. And he actually laughed.

      Unbelievable

    • #30905
      Good intentions
      Participant

      “vast majority”

      This is another term that is often thrown out when talking about chronic pain. “The vast majority do not have pain”. 80% seems like a “vast majority”, right? 70%? Still vast.

      Also, you will find many stories about how patients with problems do not go back to the surgeon that caused the problem. After you’ve been told that you will be healed, with great confidence, you lose faith in the surgeon and seek someone else.

      I could go on, as I have over the years. My basic point is “get the true numbers”. Don’t accept the vague comforting generalizations.

    • #30906
      Good intentions
      Participant

      These discussions remind me of old western stories about wanting to just go to sleep while trying to survive a blizzard. You have to stay awake and keep moving in order to survive. Don’t just give up and accept whatever happens.

      It’s melodramatic but it comes to mind.

    • #30907
      Watchful
      Participant

      William Bryant… He shouldn’t have laughed since this is serious stuff, and not a joke. I don’t know what to make of these numbers (such as 1 a year) reported by surgeons.

      Due to ignorance, I actually thought for most of my life that inguinal hernia surgery was not a big deal. I knew the recovery was painful for a while, but I thought that was about it. Still, I waited with my hernia, but mostly just because I didn’t want to go through this recovery.

      I started realizing that this is not at all the case during my first surgeon consultation. He was a general surgeon who does many inguinal hernias, and uses Lichtenstein. He told me that he himself had had an inguinal hernia which was operated using this method, and he came out of it suffering from chronic pain. He ended up having a neurectomy, and this also motivated him to start pre-emptively cutting the ilioinguinal nerve in the procedures that he does.

      I then realized that I had better start researching the whole thing more – it’s not as simple as I thought. After that, the more I read, the more I went down the rabbit hole realizing that this is actually major surgery with a lot of potential issues.

    • #30908
      William Bryant
      Participant

      I thought the same Watchful, I even naievely thought because mesh was bannec in UK for vaginal issues it wasnt used in any operations nowadays.

      The chronic pain case was just “sent to pain clinic” no idea how he fared.

      I’ve settled on no mesh but I can’t decide on shouldice, Desarda or Dr Kang…who or where. At the moment I can modify my life so hernia doesn’t bother me too much.. I dont know how long that will last.

      Like your dad, my dad has one abd has for 4 years. He just gets on with it.

    • #30911
      Watchful
      Participant

      William – There is no good way to find out which one (if any) is better. For me, it’s a process of elimination based on the limited information available.

      I don’t have much information about Kang’s method (what exactly does he do?), and it’s in Korea. I understand better the Desarda method, but it’s not as well-studied as Shouldice, and just like Thunder Rose, I find the anatomical changes involved to be a bit scary even though the procedure is simpler than Shouldice. This leaves Shouldice which is well-described and studied.

      There’s now the remaining question of the original flavor of Shouldice vs the modified flavor (cut the cremaster and nerve or not). In addition, there’s the question of where to have it done. I’m still researching these last two issues, but I pretty much decided on Shouldice.

      If my hernia wasn’t acting up as frequently as it does now, my choice would be to continue watchful waiting. I think the risk of surgery complications is higher than the risk of strangulation unless the hernia is really bad. I think mine is getting there, but it wasn’t that bad in the past. In other words, these things do get worse, but in my case it took decades. I don’t regret not doing the surgery decades ago.

      • This reply was modified 7 months, 1 week ago by Watchful.
    • #30918
      William Bryant
      Participant

      Thanks Watchful… Did you lift and carry?. I lifted 5 litres of antifreeze and think that made mine but bigger and sore for a while.

      I avoid carrying as much as I can..
      It’s frustrating and makes you feel useless.

      At this point in time I’m leaning towards shouldice and Dr Yunis.

      Any bad comments or reviews anyone know of?

    • #30919
      Watchful
      Participant

      William – I don’t lift anything heavy anyway because it triggers my lower back problems. My hernia actually doesn’t seem to come out with lifting so much. It happens more when I stand or walk for a long time, particularly when what I ate generates gas in the intestine, so I have to be careful with certain foods.

      I think what made my hernia worse was two factors. One was the passage of time and the effects of aging, and the other was that I started doing some core exercises. Not a good idea with an inguinal hernia!

      I think Yunis/Shouldice is one of the best choices you can make all things considered. Some minor caveats are that he’s done a few hundred, not thousands like many Shouldice Hospital surgeons. Also, he prefers Desarda and general anesthesia. Shouldice with local anesthesia is not his first preference, but he will do that. I wish it was his first preference because it feels a little strange to ask a surgeon to do something that isn’t his first choice. Also, he doesn’t cut the cremaster and its nerve, which may be a good thing or bad thing – hard to say…

    • #30920
      William Bryant
      Participant

      Thanks Watchful, I’m a bit dubious of general as I have “slightly” enlarged prostate, retaining about 53 to 60 urine. Which most people/surgeons say isnt much for my age.

      And I may have a nickel allergy as I tract to some metal belts or zips.

    • #30922
      MarkT
      Participant

      Chuck, you say that “nearly everyone who has a tissue repair will concede to getting pain or weakeness on occasion in some cases years after the repair” and “lots of reports of chronic pain with shouldice”.

      Those are very bold claims (IMHO, false claims) that require evidence.

    • #30923
      Jack
      Participant

      I agree with MarkT, “nearly everyone” does not have occasional pain with Shouldice, or probably any other technique (except maybe Lichtenstein with plugs, which should be illegal imho)

      I’m new to researching hernia, and it seems like people who really dig and want to get into the data and studies are the ones more apt to choose pure tissue repair, while the ones that say simply, I trust my doc or don’t really research at all go with mesh because that’s what’s the default in the USA/Europe.

      But I do find it interesting that the leading mesh docs, when they have a hernia themselves have it done (often by a partner/colleague) with mesh.

    • #30925
      William Bryant
      Participant

      Is that because not all of them are aware of tissue repairs? I ask because my nhs consultant, mesh repairs only, despite being Indian and a frequent visitor back there, had no inkling of Prof Desarda or his repair, he didn’t know about Shouldice either.

      I may as well have been talking a foreign language when I said, Bassinni, Shouldice, Desarda, Marcy. He’d never heard nor knew about them.

    • #30926
      William Bryant
      Participant

      The converse of that Jack is surgeons who used to do mesh and changed to offer tissue repairs.

    • #30927
      Jack
      Participant

      That’s definitely possible, people stick with what they know and most mesh docs may not know much or anything about tissue repair or just assume it’s yesteryear’s surgery or some boutique practice. And no doubt a mesh doc would feel hypocritical not eating his own cooking. But it is curious to me. Presumably they know first hand all the risks of mesh and they’re willing to have it implanted.

    • #30928
      William Bryant
      Participant

      Well there is one Dr who does mesh and is living with his hernia (maybe 2) and has been for years due to what he’s seen with patients and chronic pain.

      It was one of the first things I read about hernias when I first realised I had one. It may have been on Quora.

      I just looked for or again but can’t find it. Maybe someone with better research than me can. I think originally I’d have googled can you leave a hernia or similar. But I remember reading it as it put me off mesh even then.

    • #30929
      Good intentions
      Participant

      Quoted from @jackstr- “But I do find it interesting that the leading mesh docs, when they have a hernia themselves have it done (often by a partner/colleague) with mesh.”


      @jackstraw
      I hate to reflect this back at you but could you provide some references or at least a story or two about your statement? Like Chuck’s broad statement, yours is very broad also. I have not seen any stories of surgeons having their hernias repaired, by any method, except for the one surgeon mentioned on this forum (within the last few days by somebody, sorry can’t remember who) that had a Lichtenstein repair and eventually had a triple neurectomy because of the pain. But, he still implanted mesh in his patients and, apparently, did neurectomies as a prophylactic measure. The whole field of hernia repair is kind of crazy and irrational.

      The surgeon-friend who recommended the surgeon that repaired my hernia with mesh had also had a hernia, and had it repaired via open procedure with mesh. I had mistakenly assumed that the surgeon he recommended was the one who had done his. Afterward I found out that was not the case, and that he was not very happy with his open repair and had thought the lap-TEP method would be better. But he is the only surgeon that I know of who had a hernia repaired.

    • #30930
      Good intentions
      Participant

      I just remembered another surgeon that had a mesh repair – Dr. Felix. He has been around for quite a while and seems to be on the speaking circuit promoting mesh repairs and his role in developing them. He has insinuated that people who complain about chronic pain are weak and need to just toughen up. There is a youtube video out there where he actually says words to this effect. Very incredible to hear from a supposed physician.

      He gives talks about the “Commandments” of hernia repair. I think the number varies from 10 to 12 Commandments, depending on the date.

      • #30933
        Watchful
        Participant

        Right – he had tissue repair initially, and then mesh when the hernias recurred years later.

      • #30934
        Good intentions
        Participant

        Thanks @gohaiga . How do you know that? Do you know what pure tissue repair he had?

        Not sure that it matters, as far as the point. He, like Dr. Voeller, ignores the data and projects out what he wants to believe or what he thinks people should expect. People go to their doctor to have pain relieved. Dr. Felix is saying that that is not what doctors should be offering. If Dr. Felix had a sign in front of his shop it would say “Don’t expect to feel better when I’m done with you”.

    • #30931
      Good intentions
      Participant

      Do not watch this video if you are already feeling angry about the people in the hernia repair field. Dr. Felix is traveling far and wide giving talks about hernia repair.

    • #30932
      Good intentions
      Participant
    • #30938
      William Bryant
      Participant

      I’ve recently read that tissue repairs are mote likely to fail at around 10 years but that is presumably one reason why tissue repair people say you can always have a mesh repair after if necessary. But you can’t have a tissue repair after mesh.

      Mesh can fail too of course…

      But in the case of this doctor it’s interesting he choice tissue primarily. And that chronic pain came not with that but mesh.

    • #30939
      Watchful
      Participant

      He had it done by tissue repair when he was young, which was before the days when mesh became prevalent. He doesn’t know exactly which tissue repair procedure was used. If I remember correctly, Dr. Chen @ UCLA did his lap TEP when his hernias recurred, but I’m not 100% sure.

      • This reply was modified 7 months, 1 week ago by Watchful.
    • #30941
      William Bryant
      Participant

      That lasted a long time! Is it Macy/Marcy thats used or was on younger people pre puberty.

    • #30943
      Watchful
      Participant

      I believe he was a resident at that time, so an adult. It probably lasted a long time, although we don’t know how long he was living with the recurrence before getting mesh.

    • #30949
      Mike M
      Participant

      @William Bryant

      Semi-related. It is my understanding that Dr. Kang uses a repair method with the same ideology as the Marcy repair for indirect hernias but with an updated technique. Per Dr. Kang the repair has been updated and revised over the past 13 years with low reoccurrence and almost no chronic pain. However will it continue to hold for a 40 year old when they are 60 or 70? We don’t really know?

      Outside of surgeon + technique it seems to be genetics, activity, coughing, etc as you continue to age might play an important role of some sort as to whether or not the tissue repair will hold up over time. The mesh seems to circumvent the limitations of the human body and will hold regardless to an extent.

      Shouldice (and modified) has solid history, patient numbers, and case studies to support the concept that you can be fixed with no mesh but ultimately is it worth it?

      It is a hard decision as open repair seems to be incredibly invasive too with cutting or even reducing the Cremaster muscle and potentially damaging other nerves along the way.

      Laparoscopic surgery with Mesh in the hands of Drtow, Dr. Krpata, Yunis vs. Open in the hands of Dr. Kang, Dr. Grischkan, Yunis, etc.

      Does it come out as an almost wash at this point with a slight edge to Lapa with mesh for the longevity, not cutting cremaster and other things, and praying your body has the ability to manage the tissue repair without require the mesh long term?

      Do we have to determine the cause of the failure first to decide if tissue repair is even an option?

    • #30950
      ajm222
      Participant

      Felix talks about his tissue and mesh repairs on the HT video with Dr. Towfigh here at the 38 minute mark.

    • #30951
      ajm222
      Participant

      He says his tissue repair lasted 15-20 years for one and over 30 for the other. But says now there’s no way he would have had them done without mesh if it were available back then.

    • #30953
      Good intentions
      Participant

      Thanks for finding that ajm. It’s a bit funny that in the video I posted above, the “Let’s be honest…” presentation, that he shows that most chronic pain comes from young patients. Then he made a joke about how it’s best to operate on old patients like him for hernia repair because of that data, plus the fact that old people don’t complain afterwards.

      So, kind of contradictory. He implies that young people are more likely to have pain but he would still get mesh if he was young.

      He is trying to become one of the elder statesmen of laparoscopic mesh implantation.

      • #30962
        Mike M
        Participant

        Also while it might be very profitable to pinpoint and sue internal medical product based manufacturers (i.e. Mesh) the idea that there isn’t money or an Attorney to be found in surgeries with complications that do not require a product is a little disingenuous.

        Medical Malpractice lawsuits with or without an internal product placed is one of the leading causes of increases in healthcare in the United States and there are certainly big time Ambulance chasing firms willing to cash in on those cases too.

        Medical Insurance companies are big companies too that Attorneys love to collect from too. Increases in medical insurance premiums have already run many private practice GPs out of business or forced them to sell into big hospitals.

        • This reply was modified 7 months ago by Mike M.
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