Doctor decision, what would you do?

[Jnomesh]

Just curious as to what you meant by not a recurrence but a new hernia? Is it a inguinal hernia?
When a inguinal hernia is repaired openly with mesh the mesh covers 2 out of the 3 possible inguinal hernias. It covers a direct hernia space and a indirect hernia. Does not matter if you have one or the other it covers both areas. The only area not covered by mesh implanted openly in the inguinal area is a femoral hernia which is extremely rare in general and even more rare in males.
So I would clarify with Jacobs what kind and where is hernia you have.
I would imagine it very rare to say have a indirect hernia have it repaired with mesh and then develop a direct hernia or vice versa.
if that did happen then it would most likely signify that the mesh shifted or moved and I’m not sure I’d want that faulty mesh to remain inside of me.

secondly you said you are not having pain in the first hernia site but in the groin and leg. Hernias are in the groin so not sure exactly what you mean.
Also remember mesh can he quite larger at often least 5×5” and can cover and extend all over the groin. So the new groin pain could definitely be the mesh as it can reach far from the actual hernia site and also affect nerves of the groin (3 major ones) which can cause burning in the thigh and groin or stabbing pain
or unless as mentioned you have been diagnosed with a femoral hernia which can cause both groin and leg pain.
Can you share which type of “new” hernia you have?
also check what type of mean you have and do some research on it. For example, a lot of people have had issues with a plug and patch type of mesh which has caused groin and leg pain for many people and have led some surgeons to condemn it.
i realize you are asking about and focusing more on the Surgeon to repair your hernia which is understandable but I think it is important to find out exactly what is going on and become as knowledgeable as possible so you can ask as many detailed questions and not just solely rely on a surgeon telling you what will be done.
Definitely get your operative report of you haven t already as it will contain important pieces of info about your surgery and mesh used.

There is a name of a hernia surgeon in NJ floating around in a lot of the mesh Facebook forums that is getting a lot of positive feedback from patients. If you would like I can try and get his name.

ill reiterate I think it is important to consult with at least 3 surgeons ask tons of questions take notes so you can make the best decision

[Good intentions]

It’s difficult. You have to know how your insurance system works if you want to stay in it.

But the first thing you have to do is to learn about what was done to you. You might find that your procedure was unusual and might be the cause of your problems.

The more you learn the better your chances are.

You relied on Dr. Jacobs for the diagnosis but his repair method might be no different than that of someone in your insurance network. Why not ask him for a referral to someone in your network? He should be okay with that. If he refuses, that’s a sign.

[Unknown Member]

Good intentions, How do you find that surgeon that isn’t so visible. Is it a gut feeling after a consultation? Is it by there specialty, years of experience? There rating on Google, Vitals or Healthgrade? All of the above?

[Good intentions]

I would not choose a surgeon on reputation alone. I would do as much research as possible and choose the one that fits your needs, for the long-term. Many good surgeons just aren’t as visible as others. Dr. Jacobs presents at the meetings and is vocal and well-known but that does not mean he is the best for your problem.

I think the fact that he does not deal with the insurance companies is a sign that he is not 100% working for the patient. The health care system is part of life for the average person. Only the wealthy can afford to pay cash or take on extra debt. Refusing insurance just cuts out the lower classes. It’s not a good quality for a physician.

[Unknown Member]

Jnomesh and Good Intentions, Thank you for your response. You both gave me things to consider. FYI the 2nd hernia is in a different spot then the first so it isn’t really a reoccurrence. I am not having pain in the spot of the 1st repair but in the groin and right leg. The real issue is the expense for Dr. Jacobs. Does his reputation warrant me to not consider any other surgeon in NJ and covered by my insurance.

[Good intentions]

I would get more details on your first hernia, the type of mesh used to repair it, your second hernia, and the type of mesh that Dr. Jacobs plans to use. You need to get in to the details in order to make a good decision.

For example, if your new hernia is actually a recurrence it might be because your body is rejecting the mesh. Not “incorporating” or being enveloped in to the body tissue. So it might do the same with the second piece. Or, if the new hernia is of a different type, indirect versus direct for example, a suture-based repair might be simpler and more effective.

When all you know is a hammer everything looks like a nail. Dr. Jacobs does laparoscopic mesh implantation and mesh removal. He seems like a good person but he has to keep his distance from your personal needs. He’s described a long path, doing what he does and isn’t sure that it will work. Nothing wrong with getting a second opinion.

You have to go beyond just “hernia” and “mesh” and laparoscopic and open. It’s much much more complex than that.

Good luck.

[Jnomesh]

If removal may be a course of action down the line after seeing how the new repair goes-And you are comfortable with Jacobs then I tho k it makes a whole lot of sense to have your choice hernia removal surgeon be the one to also do the repair of the recurrence because he will be familiar with your case and can even pull up video from the lapro procedure if he needs to reference anything.
Also best to have a well known hernia specialist tackle the repair
That being said just a few things to marinate on:
1) I like Jacobs approach in the sense that if the repair goes well and your pain goes away then your issues can be attributed to the recurrence as your source of pain and not the mesh used in the first repair.
2) on the other hand there are some other things to consider if you haven’t already:
you already have had a mesh repair that has failed and either bc of this failure and recurrent her ia have pain or it’s pain from the mesh-so you will have to weigh if you want to possibly go through this experience again with the new mesh.
Remember mesh is the “gold standard” and is primarily justified for low recurrent rates-which unfortunately in your case did not hold up.

Secondly, by having mesh inserted openly and lapro you in essence have what is termed a mesh sandwich-you will have mesh in front of the muscle and behind it. It is very hard-next to impossibly with low recovery rates should both meshes have to be removed because you would be damaging borne muscle and tissue from the front and back leaving the area very weak.

That being said I do know someone who overall had a lapro and open mesh removed successfully (not pain free but much better with the mesh out ) He has the open mesh removed first but the pain was still there and he wanted the lapro mesh out too. The surgeon credited some of the success of the open mesh removal with the fact that he had lapro mesh in there supporting/reinforcing the area. Then when he healed the lapro mesh was easier to remove.
just brought this up bc in your case it would be similar in that if you still have your pain issues after the lapro surgery and decide on removing the open mesh then at least you will have the lapro mesh in there which could help in the open removal.

That being said this is a big decision. Ask Jacobs a lot of questions-including what type of mesh he will be using and what size. Lapro mesh is often even bigger than open mesh.

As someone who consulted with Jacobs for mesh removal (ultimately went with Igor Belyankski for a bunch of reasons) I can attest to his thoroughness and ability to read MRI’s and see things many other have missed. But I know he is expensive.
if you end up needing or deciding on mesh removal you will be in for another $10-13,000
which combined with your hernia surgery can heal the bank.
i personally found through my research that Igor Belyanski has been performing robotic lapro surgery much longer than Jacobs (Jacobs was just starting to use robotics when I saw him 2 years ago) I also could not find anyone who had mesh removal by Jacobs except one person. Igor Belyanski was also way less expensive than Jacobs and my out of network benefits ended up covering everything.
i think you have a big decision on your hands and I think it is always a good idea to get at least 3 opinions and consults-ask a lot of questions get a game plan together and go with the one that makes the most sense and you get the best gut feeling from.
best wishes