Good intentions or other removal patients

Hernia Discussion Forums Hernia Discussion Good intentions or other removal patients

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    • #31797
      Chuck
      Participant

      Does the fact that i had TEP surgery make re
      moval more difficult or destructive? Did any of you consider the systemic risks of mesh imp;ants as part of your decision? some say these risks are speculative…but 48 square inches of plastic seems like a ton…Bard 3d max is known to ball up too…so it just makes sense to me to bite the bullet and get it out at the one year mark…i have seen so many stories of people having problems down the line as the mesh starts moving around like a snake in the body–to those of you that got it out…were you constantly worried about reherniating? or did you just say screw it…if it happens again i will go to kang? another major issue is that many tissue surgeons will not do a repair on mesh removal tissue… Tomas told me he would not do a desarda on me if i reherniated…. i love lifting weights…part of what got me into this…but i doubt i will ever be lifting again nick S and Marc T had smooth removal surgeries with no real complications…but neither of them had a hernia to begin with…i had a large indirect and possible a small direct…

    • #31798
      Chuck
      Participant

      I guess my inclination would be to go forward with removal…if the hernia would come back in the same way it originally came…gently and with time to see a good tissue repair guy like kang….my main concern about removal is that i am left in a situation where reherniation simply means you have to put more mesh in…..thoughts appreciated

    • #31800
      drtowfigh
      Keymaster

      – mesh balls up or has a risk of moving early postoperatively. That is, the first few days to weeks. It does not move or ball up afterwards. So if it hasn’t caused meshoma issue so far, it will not in the future.
      – the surgical approach for the mesh placement, TEP, TAPP, onlay does not have a bearing as to the ability to remove it, as long as it is done by a specialists who does this frequently and with good success.
      – if you had a large indirect, you will most likely need some type of hernia repair at the time of mesh removal. Options include open tissue based repair or use of a hybrid mesh laparoscopically. That’s a discussion you must have with your surgeon prior to mesh removal.

    • #31804
      Good intentions
      Participant

      Chuck, I’ve written about it before but it was very clear to me that the mesh needed removal. I was on a steady downward path. For me mesh removal was at least a chance to get better, versus certainly getting worse with no bottom in sight. There was never really a point after getting the mesh implanted where I had more than a day or two that I thought the mesh might be tolerable. It was about a year and a half of trying to find a way to live with it, followed by months trying to find a solution, then months of suffering before I could start the search again and find Dr. Billing to remove the mesh. I was pretty much in for whatever anyone could do to help me, at whatever risk level.

      Dr. Belyansky seems like a very competent and caring surgeon. I do worry though about his holding on to the meme that mesh is “safe”, without, apparently, acknowledging the realities of the situation, supported by years of publications describing chronic pain from mesh implants. Subconsciously, if he feels that he is removing something that is “good” he might not take the care necessary to get a good result, for the patient, from the removal. If his removal patients are better after the mesh is gone that creates a major cognitive dissonance for him. How can they be better if mesh is “safe”?

      I can’t get past the illogic of choosing mesh as a first choice over pure tissue, for a rational physician who cares about their patients’ welfare over their own. It just doesn’t make sense.

    • #31806
      Watchful
      Participant

      Good Intentions,

      The part you seem to be missing is that someone needs to perform the procedure, and their skills have to be part of the picture. Who would be performing all these tissue repairs?

      A Shouldice procedure, for example, is truly hard to learn and perform well. Even experienced surgeons have a hard time with it. Dr. Burul, for example, started performing it at Shouldice Hospital after decades of experience as a surgeon, and he said it took him a year and a half doing hundreds of surgeries to be fully comfortable with performing it on a variety of cases. There is no hope in training massive numbers of surgeons to do these types of procedures, and results were indeed far from great in the days before mesh; the recurrence rates were high. It’s just not a practical solution when considering the very large number of hernia surgeries that need to be performed per year. It can’t be a black art that requires supreme training, talent, and skills, and with results that can be reproduced only by a select few.

    • #31807
      Good intentions
      Participant

      I’m not missing it, I am fully aware. My basic premise is that the teaching of the necessary skills has been willfully withheld from surgeons coming through medical school and residency. Whatever the reason, corporate profits or streamlining this high volume part of the healthcare system, the fact remains that the best solution for the patient, in my opinion, is not the one that is being offered.

      You seem to be rationalizing that there “must be a reason” that things are the way they are today. Your premise seems to be that laparoscopic mesh implantation is easier than a pure tissue repair. If you research the training time necessary to build proficiency in laparoscopic implantation you’ll see that that is not the case. I have never seen it explained that lap or open mesh was better than pure tissue because it was easier. As a matter of fact, there does not seem to be any justifiable reason that mesh implantation is prevalent today except that nobody has been taught pure tissue methods. Every argument for mesh falls flat once you dig in to it.

      I am saying that the reason for mesh’s dominance is more insidious and not illuminated. Even the surgeons that support it don’t really know why they do. They can’t make a cogent argument for it. The chronic pain numbers just don’t support today’s “standard of care” for hernia repair.

      You have to look back at the past and follow the trail to today. The big picture. The hernia mesh business is very similar to other businesses. The purpose of a business is to generate consistent revenue. The mesh suppliers are supporting the training methods, the societies and their tutorials. Pure tissue repair is competition. The mesh suppliers are doing what businesses do, they are not run by healthcare professionals.

      I wanted to “believe” way back when I chose to have mesh implanted, even though there was enough data available to suggest that I should get a tissue repair, that mesh was risky. But instead I rationalized that the problems I had been reading about, from just a few years prior, “must have been solved”. Surgeons would not do something that was obviously high risk to their patients if there was a better way. I was wrong.

      There would be nothing wrong with starting a “reasons to use mesh” Topic and posting up some solid links that support the use of mesh implantation over pure tissue repairs. Ideally they would have conclusions more detailed than “mesh has been shown to be safe”, which is how most attempts end.

      I appreciate your taking of the other side of my argument. This forum and others like it, and the various lawsuits that are still in progress, show that there is a big problem though. One that did not exist in the past.

    • #31808
      Watchful
      Participant

      I know that lap mesh is also hard, but most surgeons perform open mesh. The learning curve for that is much less steep than for tissue repair, or lap/robotic mesh. In my area of many millions of people, I think there’s only one robotic mesh surgeon, 4 or so lap mesh surgeons, and many surgeons who perform open mesh.

      I’m not a mesh fan as you know, and I’m planning to have tissue repair. I just hope that the few remaining tissue repair surgeons don’t all retire by the time I finally pull the trigger on this surgery 😉 Tissue repair has its own challenges, though. Even the big experts at Shouldice reject overweight people.

      Recurrence was a very big problem before mesh. If you have carefully and extensively trained surgeons performing surgeries on people of normal weight, you do ok with tissue repair. The Shouldice Hospital is proof of that. The issue is with scaling it to something that would work across the general population of surgeons and patients when hernia is such a common problem. Mesh appeared as a solution to a real problem.

      Tissue repair is definitely the better approach in some cases – not sure what percentage, but it’s not small. The fact that these cases are pushed to mesh currently is indeed bad. However, I don’t know what could be done about this. It’s not realistic to ramp up enough surgeons to do tissue repairs well because of the skill level required.

      I know that when mesh goes bad, it’s really bad, but tissue repair can be problematic as well. I have read pretty much all the reviews, blogs, and other accounts provided by patients who had Shouldice and Desarda procedures done. They’re mostly good, but there are a lot more cases than I expected with various problems, including chronic pain. Even Dr. Netto at Shouldice mentioned that they now believe there’s a higher incidence of chronic pain than they had expected, and was estimating it at 5%. If something gets botched in your tissue repair, it’s not necessarily easy to diagnose and repair that. Having surgery of any kind is not to be taken lightly. Yes, good candidates for tissue repair should be offered that ideally, but that would require widespread expertise in something that’s pretty arcane and that didn’t have a good track record in the past when mesh didn’t exist and surgeons who were not highly specialized had to do it (at least in terms of recurrence).

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