Healing from mesh removal surgery

Hernia Discussion Forums Hernia Discussion Healing from mesh removal surgery

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    • #29486
      Good intentions
      Participant

      ajm22 expressed interest in my healing from mesh removal surgery, about 3 1/2 years ago.

      I kept a log, with entries almost every day, from 12 6 2017 to 5 23 2109. Looking back through the entries, it’s basically a long series of ups and downs. Feeling good, then feeling healing pains again. At times, even one full year later, I was wondering if indirect hernias were forming. There was often a feeling of pressure in the inguinal area, with gurgling and a feeling of peristalsis. But, as far as I know, no hernias have formed. So I spent a lot of time wondering, over the course of a year or more, if I was going to have to have more hernia surgery, even drafting a letter to Dr. Brown at one year after the mesh was removed. That’s how bad it was. But, no hernias today, 3 1/2 years later.

      While I was healing I was pretty active. Lots of running and light weight workouts and working around the house. One of my concerns was that since the peritoneum had been peeled off of my abdominal wall from hip bone to hip bone and navel to pubic bone, that the area would heal in a constricted fashion. There is essentially zero advice out there about how to heal from such a thing. Lots of focus on the incisions, but not much on the burned battlefield left behind from the cauterizing tool.

      I did find that sometimes rest was not a remedy for pain. Exercise was. Based on Dr. Bendavid’s theory of “toxic zones” around the tissue that grows in to mesh, I would often go out for rigorous exercise after a few days of waiting for pain to resolve. It helped a lot.

      There were a few times when it felt like something had pulled free, like an adhesion or something that was where it was not supposed to be. All I could do then was wait and see if things got worse.

      At this point, the spot where the mesh remnant is, on the right side, still gets sore after long walks. But the rest of the damaged area seems to have recovered, except that I still feel like I have a plastic bowl in my lower abdomen. But it’s getting more and more flexible as time goes on.

      When the mesh was removed Dr. Billing found that it was surrounded by edema. Basically the tissue around the mesh was in constant damage/repair mode. I would guess that I have a thick layer of tissue wherever the mesh was in contact due to the constant healing process. After three years that could be a lot of excess tissue. People who have mesh removed early might not have that.

      I tried to create a more consistent and cohesive story but it really was just a long series of 2, 3 and 4 day projects. Try to define a base, try some activities, monitor results, adjust the plan and start again. Suffer, and hope, through the times when you had to get things done despite the pains.

      I hope this helps anyone who was expecting a rapid months-only long healing process. My notes say that Dr. Brown found that it took about 9 months to get back to feeling normal and Dr. Billing said 1 1/2 to 2 years. That’s probably open versus laparoscopic, and small pieces of mesh versus large, respectively.

      Mesh removal, by its nature, requires creating more damage to get the mesh back out. What’s left behind takes time to be repaired.

    • #29489
      ajm222
      Participant

      This is fantastic, thank you so much.

      I feel the same thing in terms of worrying about a recurrence, and feeling soreness and weakness in the inguinal area, and tightness and fullness and tugging here and there all over the abdomen, at four and a half months after robotic removal. I also have the gurgling stuff as well. Sounds like I’ve got quite a bit longer before I know how things will settle. And who knows long-term what things will look like. I’ve suspected based upon Dr. Towfigh’s comments that scar tissue can only hold for so long (though Dr. Belyansky suggested scar tissue covering indirect hernias could potentially last).

      I started running regularly again after three months, but stopped recently and switched to walking as I was scared I was potentially going too fast and doing damage and possibly creating more scar tissue or adhesions. My abdomen feels kind of thick and firm and puffier than usual, and it jostles more than I’m comfortable with when I run. I still do lots of yard and house work though.

      Like you say, even the best surgeons say almost nothing about how best to heal internally. I don’t think they know, and maybe because everyone is different.

      I know another removal patient who posts here a lot suggested that movement and exercise are necessary to break up scar tissue and stay healthy.

      I need to incorporate some stretching and stay active, and try and be patient. It’s just tough to continue feeling off after so long. Occasionally exhaustion and depression kicks in for a few weeks at a time and I feel less hopeful and more anxious. It’s as much mental as physical.

      Thanks again.

      • This reply was modified 2 months, 4 weeks ago by ajm222. Reason: Spelling
    • #29494
      ajm222
      Participant

      also, for clarification, Billing said 1 1/2 to 2 years and Brown said 9 months, lap vs open. But I couldn’t tell which was which. Was the 9 months for open or lap? Would think that lap would be shorter. Thanks.

    • #29496
      Good intentions
      Participant

      The longer time was for laparoscopy. That’s the disingenuous part of the term “minimally invasive” used for laparoscopy. When it’s used for mesh implantation it is actually maximally invasive, compared to open implantation. More tissue is disrupted than for an open mesh implantation. The small external scars of laparoscopy hide the damage done. Internal tissues need to heal just like external tissues do.

    • #29497
      ajm222
      Participant

      Thanks. Yes, that is one viewpoint where I’ve done a 180 myself. I really think it was both the mesh but also the robotic surgery that has given me issues over the last few years. You are placing three or more separate holes (albeit small), in the upper part of the abdomen which is more visible and also more prone to herniating itself (though again only a small chance), and disrupting the peritoneum and fascia throughout the whole abdomen and groin, all of which will need to heal. Yes, maybe you can technically walk around the day of surgery and have less focused incisional pain, but I found both of my robotic surgeries to be exceptionally uncomfortable for a week or so at least, and the removal surgery was particularly brutal. Pain in the inguinal area was almost nothing – it was the enormous amount of swelling and discomfort in my whole torso. I just felt very ill for quite a while. And a number of my current issues are higher up surrounding the upper abdominal fat and near the trocar incisions, though I also have some mild lower abdominal discomfort as well from time to time. Just tightness and tugging and unnatural feelings. I am hopeful that with the mesh out, all of this will eventually heal up ok and feel more natural with time, but I am learning it could take much longer than expected. And of course you hear horror stories about adhesions and things that could develop years later. Less likely with lap procedure, but I’m not sure I trust much of anything anymore.

      I’ve also been reading some stories of folks who’ve had abdominal surgeries, and the internal healing seems like it can take up to two years in some cases to feel normal, mesh or no mesh. That’s just crazy. They certainly don’t advertise it this way. If I had everything to do over again I would have of course done an open tissue repair. Mesh completely unnecessary I think for a first time typical smallish inguinal hernia, and having a modest incision below my waist that did not at all involve my entire abdominal cavity would be much much more preferable.

    • #29641
      paul
      Participant

      I’ve posted elsewhere recently, but wondering if you or GI could share what you did and didn’t do 4 weeks post removal, 8 weeks, 12 weeks…..I should be able to grok the remaining increments. I’m 2 weeks and 3 days out from bilateral bard 3d max mesh removal via robotic 4 port surgery, peritoneum “quilted” back together. abdominal swelling has been reduced 60% or so from ASIS to ASIS, with reduced swelling also around where new, smaller, Progrip was placed, just on right side this time, to cover the previous inguinal and femoral hernias. scrotum swelling is down also but testicles pretty tender, right more than left. I’ve very cautious about getting in/out of bed, etc, but I making a point to walk for :15 twice a day, whether outside or in the house (due to air quality lately here in oregon). if my bladder gets full, which it does since I’m drinking loads of water, hardly a beer, then pressure on tp of pubic bone is pretty tough until I expel. so I’m wondering what the do’s and don’t are from your perspective given the timeframes I posited at the beginning. any info would be appreciated.

    • #29643
      Good intentions
      Participant

      I just looked at my notes and realize that I did not really suffer any immediate ill effects from the mesh removal beyond a few days of initial pain. The only thing really holding me back was my awareness of what had been done with worries about proper healing. I drove about 200 miles two days after the first half of the mesh was removed. I was doing yard work and light lifting about 6 days after. Eight days after surgery I ran ten laps at a local track.

      I was in very good shape when the mesh was removed. I had spent most of my time trying to live with the mesh and doing what I wanted to do, trying to “work” the mesh in, so I had been just suffering through the pain until mesh removal. Dr. Billing also mentioned that the tissue around the mesh had been very inflamed, to a level he had not seen before and that the mesh had dropped down and moved medially. So I think that my body was already “detaching” from the mesh so when it was removed as far as my body was concerned the surfaces were the same, just with some new incisions.

      Since then most of my issues have been with the damaged stiff tissues readjusting to the new mesh-free environment. Twinges and pains and pulls, and soreness at the area of the mesh remnant. My flexibility had been limited and doing things with my arms above my head would often cause soreness at the pubic bone area but that has resolved since then.

      At 2 weeks and 3 days it’s still early for you, but you’re pretty close to being allowed more activity I think. Dr. Billing suggested as much for me at just one week after the first half of the mesh was removed. I’ve mentioned before that sometimes getting out and moving was better than resting. It might be worthwhile for you to be a little more active, especially after Dr Chen says you’re ready. One thing that is often mentioned in writings about surgery is that the growth of veins in to the surgery site (vascularization) is a good sign. Meaning that right after surgery the area will be suffering from lack of oxygen and nutrients due to a lack of vascularization. If you’re only doing 30 minutes of walking per day that means you’re really not moving much for most of the day. You’ll have “stagnant” areas around the cauterized tissues that won’t be getting good fluid transfer, I would guess.
      That might be contributing to your pain.

      Our situations seem different but activity is almost always best for regaining health. Good luck.

    • #29644
      paul
      Participant

      CI….thanks, very helpful. I have a zoom with dr chen on Tuesday for a post op check-in, and I do have some recovery questions for sure. while I do go for actual walks for around ;30 every day, I also get up and around from the recliner every hour or so and walk around the house as well as doing some pelvic tilts and kegles, and some diaphragmatic breathing. I’m just worried about messing up all the peritoneum quilting that dr chen had to do after both sides of the mesh were removed as well as disturbing the newly placed mesh on right side. when I do.my walks, I feel tight in both RA’s as well as inner hip flexors, which I assume are pretty inflamed and tight. I think that this coming Wednesday, 3 weeks post, I’m going to start doing some overhead stretches, bridges as tolerated for a couple of weeks, then progress to some additional core stuff. I wish I could run, that being a no-no for a couple of years, but road cycling was my passion which I plan to get back into….as soon as my tesitcle tenderness calm down. any other feedback you have for me would be appreciated.

    • #29652
      Good intentions
      Participant

      Could you ask Dr. Chen if he plans to do anything with the knowledge that he’s gaining from these chronic pain mesh removals? Does he report the incidents to the FDA for inclusion in their MAUDE database? Did he have any comments about why you had a bad result? Did he assign cause to poor technique from the surgeon or just the nature of the mesh? Can he explain how the mesh ended up where it did? Could it have moved because of the inflammation, not vice-versa?

      Most surgeons tend to place blame on some sort of error by the surgeon who implanted the mesh, and stick with their training that mesh is inherently harmless. I wonder if Dr. Chen is one of those or if he has a more objective and reasoned view. He is one of the big names on the professional presentation and publishing circuit. His opinions could probably have a positive effect on the chronic pain problem or they could lend power to the device makers and their efforts to maintain revenue.

      https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/textsearch.cfm

    • #29656
      paul
      Participant

      GI….sorry, didn’t see your post until this minute, hence after my tele-med visit with dr chen, so didn’t posit the ?’s you asked. here’s what I know. Dr. Chen, over my 3-4 visits with him, has always been understanding, compassionate, professional, and optimistic. I choose dr chen after evaluating dr brown’s and dr Peterson’s responses to questions I posed to them and their responses. on my 1st in person consult with him, he did a thorough digital and dermatome exam, and while seeming to confirm my issue as mesh related, ordered a new set of MRI’s so HE could see them, rather than having them read by a radiologist. after doing that, he was pretty much convinced that my bilateral large Bard 3d max mesh was causing my pain, not so much a “reaction” to the mesh other than an assumption based upon MRI and palpation, that my mesh had folded at the top from ASIS to ASIS, and possibly clamshelled as well on both sides. on 7/27, the day before the removal, in his office, he again suggested that diagnosis, and said he’d do all he could to remove all the mesh and repair any hernias if found, tissue repair preferred if possible, but if not, Progrip. on op day he discovered that while the mesh hadn’t clamshelled as previously thought, it was way too high up, and while slightly folded at the top, wasn’t as severe as he thought, but very stiff and hard. he couldn’t defintively say if it was previously placed too high or it had moved since inserted 6/14/19, but given that both sides were too high, my own assumption is that they were placed too high in the first place. could have moved due to inflammation or something else, but to have both sides move, while possible, regardless, the mesh way too high seemed to be the biggest issue, as well as the hardness of the mesh…you don’t want to see the pic he showed me! turns out that on my left side, there was a small “defect” but not herniated, and he wondered why that mesh was placed there at all in the first place. on the right side, there was a small inguinal hernia still, as well as a golf ball sized, fat filled, femoral hernia covered by the Bard. he was able to remove all mesh from the right side also, got rid of the fat filled femoral hernia, but still had to use the Progrip (smaller sized) to cover both the small inguinal and the larger femoral, as he felt that both were too large for a Shouldice repair. he didn’t have to do any major neurectomies or mess with the vas or sperm cord, on either side, save for a right side paravasal neurectomy due to the cord adhering to the mesh, but was able to preserve it….he did have to “quilt” together whatever peritoneum was left from mesh on both sides.

      so, 3 weeks in today, like I said, I’m way less swollen across abdomen and scrotum, do have some hardness at the 4 port sites, some swelling still use above abdomen, when bladder gets full from all the damn water (not beer) I’ve been drinking, it does put more pressure across that area until it’s all expelled. sitting is still problematic but not as bad as it was last week, putting on socks and shoes….same same. I’ve been walking 2 to 3 times a day for ;15 to :20 to help with healing. have been off the Tramadol for 1.5 weeks, only using 2 625mg Tylenol twice a day, which may or may not be taking the edge off, if there is such a thing. I use heat/cold intermmitently over my abdomen to potentially reduce swelling/ease pain.

      dr chen said today that I appear to be doing well after just 3 weeks, suggests I wait another week or two before I start to do some stretching, another 2 beyond that before I start with planks, core stuff and then as I feel comfy, get back to my cycling….and work my way up to Tour level 🙂

      any other ?’s or comment from you or ajm are always welcomed and thanks to you both for your advice.

    • #29657
      Good intentions
      Participant

      Thanks for the detailed reply Paul. The answer is in the story that you told. Dr. Chen was looking for a problem with the implantation from the very beginning and, even when he found that his initial explanation was very wrong, he still tried to find a flaw with the implantation. Too high, misplaced, etc. but he didn’t seem to explain or understand why the mesh was hard. In principle, it’s supposed to “become one” with the surrounding tissue, remaining soft and pliable. So, in the end, he still believes in “mesh” despite what his own eyes saw. “Do you believe the device makers or your own lying eyes?” Paraphrased joke there. I wonder if Dr. Chen could explain why Progrip is better than Bard.

      Dr. Chen might not be aware that the Progrip mesh is made from the same material as the Bard mesh, polypropylene. Progrip has polylactic acid (PLA) hooks attached to it though, to give an initial grip after implantation. Once the PLA dissolves and is absorbed the mesh will be the same. But you’ll probably be fine in the long run because he covered less area.

      I don’t want to make you nervous, but knowing the facts is always good in the long run. Good luck.

      P.s. personally, I don’t know if I would do any “planks” for a while. I would avoid the things that increase abdominal pressure, especially with the PLA material on the mesh. The PLA will cause its own inflammation as it is absorbed, and probably takes longer for full “incorporation”, meaning tissue ingrowth. Which is what is supposed to keep the mesh from moving.

      https://www.medtronic.com/content/dam/covidien/library/us/en/product/hernia-repair/progrip-technology-two-million-information-sheet.pdf

    • #29658
      Good intentions
      Participant

      Sorry Paul, my post must seem like a real downer. I really do believe though that part of today’s chronic pain problem is the fact that the influencers, the device makers and the surgeons that they sponsor, are pushing surgeons to use more mesh to cover more area. “Cover as much area as you can to avoid future recurrence. Prophylactic mesh placement is good, the other side is just going to herniate too.”, which, of course, benefits the device makers with higher revenue.

      Hopefully, at least, more surgeons will realize that less might be better, and resist.

    • #29659
      paul
      Participant

      GI….ok, no planks for awhile doc 🙂

      as much as i appreciate all your comments, most all of which have been incredibly insightful and helpful to me personally, i do want to clarify some info regarding your comment about dr chen. firstly, he never at first or second or third consult or even after he read the MRI, suggested or implied that the Bard mesh was placed improperly to begin with by dr mastrangelo in 2019. nor did dr chen say he thought it migrated/moved somehow, but only that it appeared to be folded or clamshelled based on his digital exam and his reading of the MRI. it was not until he got in there did he later say to me the day after the surgery on his rounds that the mesh had not in fact clamshelled, that it folded at the top across from end to end, but not has severe as he originally assessed, and that the position of the mesh was high in his opinion, but did not put the onus of bad placement on dr mastangelo or on mesh migration. i took from that after asking him about that yesterday that it could have been placed too high, it could have moved somehow as a result of subsequent and ongoing inflammation or whatever goes on in the body during healing, a number of rounds of fascial and pelvic floor massage therapy since 2019 by recommended specialized PT’s here in Oregon and in California in an effort to quite things down, but there doesn’t appear to be any direct evidence of any definitive cause. it was high causing me suffering….it’s now gone…no suffering from it….only recovery pain from it’s removal.

      as far as the mesh establishment, i hear ya! i’ve done a wee bit of research on the institutionalization of mesh implants since i had the repair, and i see the negative stuff and risks, seen all the SAGE stuff, seen Dr T’s vids, etc., etc….but my bad that i didn’t do enough research prior to the initial placement or i may very well have gone a different direction or at least garnered 2nd, 3rd options back in 2019. but i was too trusting and naive and with me it’s like, oh something wrong, get ‘er fixed asap. a lot more to be said there, but quite frankly, from info i’ve received from dr brown and dr petersen and the good dr T here, there is an appropriate use of mesh depending on each patients history, symptoms, etc., etc.

      so for now, i’m holding dr chen harmless about his use of the Progrip, which he advised was lighter, smaller, and less subject to movement once placed….and the fact that he said that if he had found a hernia on my left side which was covered with the Bard mesh, he would most likely would have done a Shouldice type tissue repair there….but there was no hernia he could see….so i know he is an advocate of mesh use, but i don’t think he’s a zealot about it. if i have complications, i may sing another tune. as far as the right side inguinal hernia and the golf ball sized femoral which was revealed after removing the initial mesh, he felt it best to use Progrip given the situation and i’m guessing the time he was in there with mr. robot and my time under anesthesia, which was pretty close to 3.5 hours. the thing is i’ve personally known a doctor, a lawyer, a physical therapist, a fellow cyclist, and a couple of others, that have had inguinal hernias, albeit one side only, and all have had mesh of various types implanted….and none of them had the issues i had and the range of time is from 3 years to 5 years.

      again, i appreciate your insights and comments and hope they don’t stop as they are and will be helpful to me and many others on this site as they struggle with the $%^&-load of issues hernia related. and, for sure, no planks for awhile:)

    • #29673
      drtowfigh
      Keymaster

      What a great post! Thanks for this @good-intentions

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