How long can inguinal hernia repair be expected to last

[drtowfigh]

I love reading all of this exchange. Im so impressed with the knowledge that is being shared.

I have little to add. WasInTN pretty mich said it all:

– synthetic mesh is permanent
– the intention of hernia repair is a permanent repair, however reality is that there is a certain hernia recurrence rate, somewhere between 0.25% and 5% for inguinal hernia repair with mesh. Most of us specialists have recurrence rates under 1%
– a recent paper showed that half the recurrences occur at 1 yr and 75% within the first 3 years.
– cause of recurrences are technical and related to patient’s own risk factors.

[ajm222]

I’m 5’7″ and 160 lbs. right now, but I am very thin at 160 (I guess everyone carries their weight differently). I actually lost roughly 55 lbs. last year. I was between 200 and 215 at one point and finally managed to lose the weight. I may have had the hernia longer than I realized but didn’t notice it until I got thinner. Then again, I’d swear the bump wasn’t there until a couple of weeks ago when I sneezed after doing very strenuous yard work. Felt a sharp pain then noticed the bump later that evening. Perhaps it had already been developing and that was the last straw. At any rate, I think I’ve done a fair amount of due diligence regarding my surgeon. He has very good ratings on various sites that come up in a Google search, and he was recommended by my PCP. He’s been doing this for a long time as well, is known as the ‘hernia guy’ it seems locally, and I liked his personality and demeanor and the things he told me. Just need to decide now if I will put this off until I’m more symptomatic or just get it over with. Might make another appointment with him at a later date to ask some follow-up questions once I decide for sure to get surgery. Might ask him more about pure tissue repair and the mesh he plans to use and if he’s had to remove any before etc etc.

And yes, I think the stuff about not being 100% after any surgery or bodily damage and repair is absolutely true. Nothing seems quite exactly the same afterwards. There’s always something noticeably different with any surgery I have had. Usually nothing I notice regularly or that causes any issues for the most part, but always something. Certainly as we travel through life we get bumped and scraped and scarred. I realize as I get older that’s unavoidable, but you CAN minimize this to some degree through moderate exercise, a good diet and generally trying to take care of yourself. And of course doing your homework before rushing into any surgery 🙂 But in the latter case at the end of the day you do have to relinquish some control to the surgeon and then just hope he’s having a good day and all goes well.

Thanks!

[WasInTN]

ajm222: Quick note on waiting. As I said earlier my PCP said the same thing back in 2008 – hernia was small and I go with watch and wait. I ignored it. Never even considered losing weight (I am 5′ 6″ and 145 lbs). And continued to do things like lifting heavy stuff (not weight lifting but others in day to day life like lawn mower etc). I also continued jogging, basketball and yoga. No pain felt and I totally forgot about hernia until one day bam! The bump showed up.

I regret ignoring that advice by PCP. In a way I dug the hole myself for surgery. Once the bump showed up I feared I would die of the hernia or on surgery table since I never even had any kind of cuts by doctors before. All gory thoughts came up and I even wrote a secret will and apology letter to all those people who I thought would have to excuse me. 🙂 BTW I tried losing weight just before surgery and it was going nowhere. I incidentally gained weight a bit after surgery – now @149 lbs. I think once the hernia pain stopped after surgery, I lost my willingness to lose weight. Since all other blood work results are normal I am ignoring it for now. Time to start again I guess.

Anyways, losing weight is a good thing for you. It puts less stress on the pelvic floor and makes you better. To my knowledge nobody died by eating less but people definitely kill themselves by overeating. Unfortunately our system is set up such a way that killing myself by suicide is considered illegal but killing myself by eating junk food is perfectly legal and all insurance companies will pay all the bills. 🙂

And about surgeon – I will start with Google, back ground ratings, your ins company ratings, and if possible ask the nursing dept. in hospital where the doctor does surgeries. Also the nurse phone line of your ins company if there is one. Yes PCP too. And finally if you are really going for surgery, before you set up the appointment ask surgeon directly if you can talk to any of his old patients; You can say you are scared to death and that’s why you are asking. Yeah why not, if you are going to car mechanic to fix the transmission you have the right to find about his skills. No question is useless when you are facing surgery. A good surgeon understands that and will never object to any question.

Let me close this with a great surgeon’s advice to me. The body has its own mechanism and can protect itself mostly. It is built for defending itself and can withstand attacks. Once damage happens you can fix things but it will NEVER be the same. It is like wearing glasses to restore eye sight for myopia. You can see perfectly with glasses but if you compare your original eye sight (before myopia) with the eye sight with glasses, how do you feel? With glasses it may be 99% or may be even 99.99% but never be the same as original eye sight. You have to live with that fact. Instead of myopia, it can be with heart valve, a rod inserted in your thigh or anything else. Unfortunately we all have a shelf life and within that time, we all decay. It is inevitable. Everyone – you, me, your surgeon, mine and everyone living now – will be gone ultimately. That’s some soul food philosophy, Huh?

Take it easy and be well.

[Jnomesh]

Totally agree-and love the Seinfeld reference. Unfortunately these days the patient has to be their Own advocate and really do their due diligence and research before going ahead with all a lot of things-surgery, prescription drugs etc.

[ajm222]

The surgeon I planned on using said no rush and definitely did not push into surgery. Said that it’s small and I probably wouldn’t have even noticed it if I hadn’t lost a bunch of weight recently. Said essentially I could wait until it bothers me. The other surgeon effectively said the same thing, though he said they don’t really recommend watch and wait anymore.

If you all have any advice about how to research a surgeon beyond word of mouth please feel free to share. I’m not really aware of any great resources that will tell you anything useful about the skill and experience of a surgeon beyond recommendations from PCP, word of mouth and the surgeon himself. And I have no intention of traveling for surgery. I don’t have that kind of money unfortunately. Surgery out of state would likely be considered out of network and I would have to pay substantially more for it. The surgeon I plan on using was not at all pushy and he’s been doing these surgeries for at least 30 or 35 years I imagine. No loans left to pay off 🙂

[WasInTN]

Jnomesh
Excellent insight into robotic part. Yes I agree with you. I did not have robotic surgery. I went with the skill of surgeon. I did go to local surgeons and talked to a few people but did not feel comfortable. With Dr. G I did not even see him but with experience he had, his web site and what people were talking about him, I felt good. I spoke to him on phone first. Fixed apt and went to surgery room straight away. He examined me 30 min before surgery, I was given an operating toom dress, pulled in, within 2 hours I was back on feet. Did not even know I had surgery. In the operating room they put nasal canuli and it was not fitting well but before I started saying “wait, let me…” I felt asleep and woke up when my family was patting my hands to wake me up. I woke up and asked “what happened?” LOL. Dr. G came after a few minutes and showed a sign “Thumbs up!” and said you are good to go! That simple. A couple of years later I had colonoscopy in the local hospital (this time the local gastro who is known to be very good) and worried that mesh might interfere. The gastro said it won’t since he will never push the scope that hard to even tear the intestines and the support tissue below. LOL. I laughed at my own ignorance for asking that question.

ajm222
Do not repeatedly keep saying about FACS of the surgeon. Those are normal qualifications of a surgeon I guess. Like “board certified pediatrician,” etc. Even if it is not, a FACS surgeon can screw up too. I cannot stress anymore than jnomesh said it. Skill of surgeon is the most important. May be your surgeon is very good but still, if I were you I will research more about that surgeon. A skillful and good surgeon who is interested in your welfare will tell you whether you really need surgery or if you can wait. OTOH a surgeon with a hammer in hand looking to drive nails, will say you must have surgery immediately or else! Else what? I know what. Else, he will miss your payment. LOL. That is all. You will be fine.

The other day (means 2/3 years ago) my dentist told me – you have a spot on tongue that needs to be checked for cancer or else! And here is the guy you need to meet. Ha. So I go back home worried and look in mirror pulling my tongue out. I cannot see a thing. I ignore THE SPOT and I am still alive. Nobody ever has said anything about cancer – either my PCP or anyone else. Now that the same dentist sold her practice to somebody else, we have a new dentist. So I ask what is wrong with my tongue. The new denty (recall Michael Richards’ saying hey Dentee!, to Seinfeld?) says – there is no spot on tongue. So here is the way they work together. The denty scratches that other doctors back and the other doctor scratches the denti’s back again. You know how this works – you scratch mine I do yours. So as long as your insurance pays, they are fine and will be merry happy to bill them. May even do a biopsy and take your deductible, and all. Yes of course if you cannot pay they will even put you on a payment plan! It is all great set up and plan.

These days it is hard to find a caring guy. It is all business. Otherwise how do they pay off their college loans pal? Sad truth but many in medical field do this every single day. Yeah, the regulations are there but if surgeon screwed up inside how do you prove actually that he screwed up? You have time to go with another surgeon, lawyer and all that pain for three years around the courts and finally be awarded with $2 million? And when you get that $2 million what part of it is yours? The attorney will eat may be 70% of it and will you finally still have the pain with $30K check in bank? Is that what you want?

So do your research, go slow and decide well. In the end remember this age old saying I think I read in Reader’s Digest, “God cures you, doctors take your money!” Just kidding. All the best.

[ajm222]

Again, all good advice. I think I had confused open vs lap hernia mesh placement and thought open would put the mesh closer to vital structures and lap would be further away. I’ll keep that in mind. I do believe the surgeon is the expert, especially if they’ve done thousands, and their advice should be carefully considered. but I obviously also believe it’s vitally important for patients to be very informed about all of these things prior to something as serious as surgery. the second surgeon I saw said it sounded like I knew more about hernias and hernia surgeries than most doctors, and sadly that might be true. but I don’t expect I know more than a FACS surgeon who performs them regularly 🙂 I plan to send a follow-up email to this surgeon and ask a bunch of questions related to what we’ve discussed. will see how he responds. thanks again.

[Jnomesh]

I’m glad you have made the decision to wait and also came to a decision on how to proceed if/when you need surgery.
my last 2 cents will be when you take any advice from anybody make sure they are apples to apples. WasinTn was very nice to offer his experience and knowledge concerning his hernia repair journey-although I don’t understand the genetic statement-yes if family members have had hernias there is a greater chance you may have one too but that doesn’t in my opinion have anything to do with recurrences-a hernia by definition is due to weakness. But i degrees.
WasinTn had an open procedure I know this Bc this is what doctor Goodyear does-open procedures. Yours if/when you have it done will be robotic assisted laparoscopic surgery. They are very different and recovery is very different.
i have had both procedures my first was open placed mesh on the right side and my second was laparoscopic on the left side and my mesh removal on the left was performed by robotic assisted laparoscopic.
recovery from open repair is longer and more painful in the area of operation-you are being directly cut open with muscle dissected in the area laparoscoic repair the recover and pain is easier at the site of the repair but three small incisions are made in the abdomen and your stomach is inflated with Co2. With robotic asssisted repair these incisions are bigger. The biggest issue with recovery is recovering from the bloating from the gas-it is not fun. It can also mess with you appetite, indigestion etc. in 2-4 weeks if all goes well you will be fine with either type of repair. Laparoscopic repair has to be done under general anesthesia which carries more risk although minimal. Open can use local anesthesia.
so why do I bring this up? Bc it is important to know that these are two very different surgeries albeit with the same goal in mind.
laparoscopic places the mesh at its deepest level and almost always uses a bigger piece of mesh than open. When your stomach is inflated the repair is done from behind the abdominal wall and incision is made in the perotineim. With the mesh being placed this way it is very close to many other structures, the bladder and your intestines to name a few. This can be a disadvantage if something should go wrong-as I mentioned my mesh had to be peeled of my bladder, spermatic cord and the colon was pressed up against it causing bowel problems and urinary problems.
When I was having my mesh removed I met another man who also was having his removed Bc the mesh had attached to his appendix. The only thing separating your intestines from the mesh is your peritneum.
Again I bring this up Bc WasinTN had his done openly and your surgery will be a different surgery. Statistically you should do fine with either but I bring this up Bc this is another detail you should research and look into-the pros and cons of open vs laparoscopic hernia repair.
finally robotic assisted laparoscopic repair has a lot of advantages including as you mentioned a 3D camera-but again your surgery will only be as good as your surgeons experience-as how many robotic surgeries he has done and decide which procedure you think will be best for you based on your research. There are pros and cons to both.
i just think too often hernia surgery is passed off to the consumer as no big deal and we jist usually go with whatever the surgeon says and does.
WasinTN did his research and has had a good outcome-he went with a expert who only does one thing and does it well and traveled to accomplish this.
So I encourage you since you have the time to continue to do your research and ask as many questions as you can. I know that the north penn institute where dr. Goodyear is from they do mesh removal (only open removal Bc that’s what they specialize in)
so as you can see this isn’t just about mesh or no mesh but method-open vs laparoscopic vs robotic assisted laparoscopic

[ajm222]

quote WasInTN:

ajm222
If you do go to surgery (or not) read the post on top of this forum (what to expect post surgery. It is a sticky and second one from top). I have posted notes of what to do when one goes to surgery. Those were my own experiences. Dr Towfigh was kind enough to keep it visible on top. Thanks to her.

I think I did read that actually. Good write-up, and always good to hear positive experiences.

I definitely plan to take it extremely easy after surgery, but active enough that I heal well. I’m actually looking forward to an excuse to lay back for a while. And until then, I definitely won’t be doing anything too strenuous. I’m still jogging a few times a week, but I’ve slowed my pace. I figure the light cardio will actually help keep my muscles toned and my overall health in a good place so that when the time comes to have surgery it will be an easier recovery. I was hoping it would be a similar recovery to my recent vasectomy. But I imagine this one is definitely at least a little more painful.

Will definitely keep you posted. Still not sure when it will happen.

[WasInTN]

ajm222
If you do go to surgery (or not) read the post on top of this forum (what to expect post surgery. It is a sticky and second one from top). I have posted notes of what to do when one goes to surgery. Those were my own experiences. Dr Towfigh was kind enough to keep it visible on top. Thanks to her.

[WasInTN]

Quick note.. If you are considering and waiting for surgery, in the mean time do not do anything like heavy lifting. Make sure you have a easy bowel movement. Indigestion, lots of greasy foods, cheese and forcing the bowels makes the hernia worse. I think you may already know that part. 🙂 And if you do go for surgery, relax, it is very simple and you will be back on feet same day but will have some surgical cut pain for a few days. This is because doctor can fix hernia but surgical cut is what it is. He will give pain medication and use it nicely. Do not think you are superman and can tolerate pain. No it is not tolerable that easily. It is like pinching hard at your sensitive area and the pinch pain remains 7/24 for 2 weeks. Best thing to do is to use that medication and sleep well and may even catch up with all the DVDs you want to watch. Ha ha. In 4 weeks you will be back to normal. In the first week or two you will feel down and depressed – may even think you may never be normal etc. It will all pass. I had gone through it. It is all normal. So relax and enjoy life. Best of luck in everything.

[ajm222]

quote WasInTN:

ajm222
What I said when I said 8x stronger was the mesh, not the surgery area or your tissue after repair. The mesh is 8x stronger than the tissue. So it is unlikely you may get hernia on the same side after surgery but like everything in the world, anything is possible if you hurl a mountain to mars. After reading your surgeon experience I want to share this. I was first told of the hernia back in 2008 by my PCP in the annual physical. I did not feel a thing and never even had an idea what it was. I ignored it and continued to live as before and nothing was wrong. During 2013 I had an overseas trip and carried heavy bags. No problems at all. But by Summer 2013 I had a bump just below the belly button towards right side. It was painful. I could drive, play basketball and do all but pain was there. Research on google and other sites showed me I indeed had the IH and it needed surgery. Then I you tubed for some videos that claimed to cure your IH without surgery. I learned these exercizes actually make it worse since it progressed to a bad stage.

Going forward, I learned that my dad had IH (never had surgery but died with it and then my brother had both sides of belly button – two hernias and was living with it daily). So I understood that it is genetical. It runs in the family and the pelvic floor is weak. My first appointment was with FL surgeon who does without mesh and claimed good results. I had everything ready until someone pointed to me that since it is genetical, without mesh my chances are very high for recurrence. I had to agree. So I canceled the FL appointment and spoke to Dr. G on phone before going. I read and researched about his technique and felt comfortable going to him. I had a local surgeon look at me and give promise of easy surgery with mesh. But the way he spoke, his dress (his pants were about to fall off etc) and all that made me uneasy. May be he is good surgeron but I did not want to put my sensitive parts in someone’s hands who cannot even dress well. When I asked him what was the name of mesh he could not recall. I backed out and flew all the way to PA with family. Ins paid most but hotel, and all that I had to pay. I flew back in 3 days and in 2 weeks back to work.

About people who discourage mesh and had pains. Yes for some people mesh is indeed a problem. Some reaction, some bad surgeon skill and everything else goes wrong. Can it happen to you? It depends on how you react to the mesh material. I do not have any allergies and never had any problems. How many mesh problems do you find with a skilled surgeon like Dr. G? I found almost none. So I trusted him. Every case is different and each person reacts differently. So you have to trust your own instincts. For me there were hundreds of stories on google that said people cannot pass urine due to nerve blocks and catheter had to be inserted (via penis hole) to make him well and all those gory stories made me sleepless. I did ask Dr. G if I would have that problem after surgery. His answer was “unless you have some kidney or such problems and have difficulty passing fluids, there is no reason to believe that.” So after surgery by 11 or 12 noon they gave me a soda and some cookies to eat and within 30 seconds I had to ask to go to bathroom. It hit me when I was passing urine that I asked that question to Dr. G and I felt relieved. No such problems happened to me.

So if you have genetic defect in family mesh is the way to go. Ultimately all said and done do *NOT* go to a general surgeon who claims to do “several” hernia surgeries. A general surgeon mostly does other surgeries and might have done one or two hernia surgeries. Go to a hernia surgeon who is a specialist and who knows what he does. If you go to a man with hammer in hand, he is looking for nails to drive. That’s the reason I took time to research and go to Dr. G.

Like I said above I waited 6 years for surgery and if you want to go on the wait and watch list, yes you can. How to find when to go for surgery? Your own body will tell you. So in the mean time do all the research, find a good and well versed skilled surgeon. Mesh is not the Satan ready to pounce on your. There are dozen other reasons that will cause trouble. All said and done, does a mesh cause trouble for you in particular? Unlikely, if you choose a good surgeon and if that surgeon follows a great technique. Dr. Goodyear has a website and you can read about his technique. But he is in PA.

For a mesh to fail there are a dozen reasons – not just the mesh material itself. Even with the greatest safety mesh an unskilled surgeon can screw up everything and can cause problems that will last forever in a person’s life. Choose well. And how to do that? See the Indiana Jones movie where Harrison ford picks up a dirty cup to drink from the pool and the knight next to him says “You have chosen well.” Just kidding 🙂 All the best

Thanks for the more detailed follow-up. Very helpful. I have some family members who have had hernia repairs (grandfather had inguinal hernias, aunt has had umbilical hernia) so probably some genetics involved. Which as you say is another reason I am considering the mesh. And thanks for clarifying about the 8x comment.

The surgeon I believe I have decided on is known around here as ‘the hernia guy’ – it’s probably what he does the most. And he’s skilled with the laparoscopic technique and the use of the robot to aid the laparoscope. So I don’t have any qualms about his experience or skill. He also has extensive experience with all manner of abdominal wall repairs as well as cancer surgeries. I like this because he is very familiar with the sensitive anatomy of the torso, and also doing prostatectomy and understands the critical nature of all of the nerves and structures in the groin. He’s a fellow with the American College of Surgeons as well. I actually specifically asked him about prostate surgery because there is some concern that a hernia or double hernia repair with mesh done laparoscopically can create problems if someone needs their prostate removed later on, and my father had to have his prostate removed due to cancer. He clearly explained how he does the surgery in a way to avoid these sorts of issues.

So I think I’m good when it comes to a surgeon. Just a matter of when to get it done. No major issues, and very little if any pain, but the area feels sensitive. I feel confident at this point it’s definitely a hernia on the right side. There is a very clear bulge, and I can feel and push back a squishy substance into a small cavity that will come back out. But very small. Possible it hasn’t broken through the very last bit of fascia, but it’s definitely through the muscle wall I think for sure. And I’d swear I remember the moment it kind of ‘broke through’ a couple weeks ago. Hadn’t noticed the bulge before, had just finished aerating the lawn with a giant piece of equipment I was moving all over the place, which kicked up a bunch of dust, and when I sneezed I felt a very quick but sharp pain in that spot and then felt a little sore and nauseated later. It was later that evening I noticed the bulge. So we will see how long it takes to progress and become more symptomatic.

[ajm222]

Thanks! I do appreciate all the good advice. I will certainly inquire with this surgeon about his experience with mesh removal. As for the Bard product, I am aware of the lawsuits and the issues people have had. But I also know that many surgeons prefer this product as it’s one of the most popular and as such one of the most tested. It seems even Dr. Towfigh has spoken well of it here. Perhaps its popularity actually has something to do with both its negative and positive reputation. But I can also ask about the folding issue. I did mention that to the other surgeon and he said he actually feels its less likely to fold in his experience than a flat mesh.

I’ll likely be holding off on the surgery for the time-being, but I can’t let this linger if it progresses or gets painful.

[WasInTN]

ajm222
What I said when I said 8x stronger was the mesh, not the surgery area or your tissue after repair. The mesh is 8x stronger than the tissue. So it is unlikely you may get hernia on the same side after surgery but like everything in the world, anything is possible if you hurl a mountain to mars. After reading your surgeon experience I want to share this. I was first told of the hernia back in 2008 by my PCP in the annual physical. I did not feel a thing and never even had an idea what it was. I ignored it and continued to live as before and nothing was wrong. During 2013 I had an overseas trip and carried heavy bags. No problems at all. But by Summer 2013 I had a bump just below the belly button towards right side. It was painful. I could drive, play basketball and do all but pain was there. Research on google and other sites showed me I indeed had the IH and it needed surgery. Then I you tubed for some videos that claimed to cure your IH without surgery. I learned these exercizes actually make it worse since it progressed to a bad stage.

Going forward, I learned that my dad had IH (never had surgery but died with it and then my brother had both sides of belly button – two hernias and was living with it daily). So I understood that it is genetical. It runs in the family and the pelvic floor is weak. My first appointment was with FL surgeon who does without mesh and claimed good results. I had everything ready until someone pointed to me that since it is genetical, without mesh my chances are very high for recurrence. I had to agree. So I canceled the FL appointment and spoke to Dr. G on phone before going. I read and researched about his technique and felt comfortable going to him. I had a local surgeon look at me and give promise of easy surgery with mesh. But the way he spoke, his dress (his pants were about to fall off etc) and all that made me uneasy. May be he is good surgeron but I did not want to put my sensitive parts in someone’s hands who cannot even dress well. When I asked him what was the name of mesh he could not recall. I backed out and flew all the way to PA with family. Ins paid most but hotel, and all that I had to pay. I flew back in 3 days and in 2 weeks back to work.

About people who discourage mesh and had pains. Yes for some people mesh is indeed a problem. Some reaction, some bad surgeon skill and everything else goes wrong. Can it happen to you? It depends on how you react to the mesh material. I do not have any allergies and never had any problems. How many mesh problems do you find with a skilled surgeon like Dr. G? I found almost none. So I trusted him. Every case is different and each person reacts differently. So you have to trust your own instincts. For me there were hundreds of stories on google that said people cannot pass urine due to nerve blocks and catheter had to be inserted (via penis hole) to make him well and all those gory stories made me sleepless. I did ask Dr. G if I would have that problem after surgery. His answer was “unless you have some kidney or such problems and have difficulty passing fluids, there is no reason to believe that.” So after surgery by 11 or 12 noon they gave me a soda and some cookies to eat and within 30 seconds I had to ask to go to bathroom. It hit me when I was passing urine that I asked that question to Dr. G and I felt relieved. No such problems happened to me.

So if you have genetic defect in family mesh is the way to go. Ultimately all said and done do *NOT* go to a general surgeon who claims to do “several” hernia surgeries. A general surgeon mostly does other surgeries and might have done one or two hernia surgeries. Go to a hernia surgeon who is a specialist and who knows what he does. If you go to a man with hammer in hand, he is looking for nails to drive. That’s the reason I took time to research and go to Dr. G.

Like I said above I waited 6 years for surgery and if you want to go on the wait and watch list, yes you can. How to find when to go for surgery? Your own body will tell you. So in the mean time do all the research, find a good and well versed skilled surgeon. Mesh is not the Satan ready to pounce on your. There are dozen other reasons that will cause trouble. All said and done, does a mesh cause trouble for you in particular? Unlikely, if you choose a good surgeon and if that surgeon follows a great technique. Dr. Goodyear has a website and you can read about his technique. But he is in PA.

For a mesh to fail there are a dozen reasons – not just the mesh material itself. Even with the greatest safety mesh an unskilled surgeon can screw up everything and can cause problems that will last forever in a person’s life. Choose well. And how to do that? See the Indiana Jones movie where Harrison ford picks up a dirty cup to drink from the pool and the knight next to him says “You have chosen well.” Just kidding 🙂 All the best

[Jnomesh]

And one last thing-it is almost inevitable that you will end up with mesh put in if you have the other side explored. Most surgeons will do this Bc A) there is a good chance they will find some weakeness however great or small on the other side and just decide to repair it. You will now have mesh on both sides and some will just implant a huge piece of continuous mesh that basically wraps around you lower groin/abdomen.
another reason there is a good chance mesh will be implanted on the other side is that when he explores the other side he has to take down a wall (as my original surgeon explained it) to gain access to the area and that intself might need some reinforcement.
My two cents would be to hold off surgery with mesh as long as you can unless you plan on getting it repaired without mesh and then there is an argument for getting it repaired while it is small.
There seems to be no conclusive consensus whether you truly even have a hernia.
if you aren’t in pain I would just wait and line the earlier poster mentioned just be very conscious of the things you do.
you need to stay away from things that cause a lot of intra abdominal pressure-like
jumping
chronic coughs
excercises like squats
constipation and straining to pass bowels
and lay off Strenous activities like lifting etc.
surgery should be the last resort-take a wait and see approach and slightly modify your lifestyle it may be well worth it

[Jnomesh]

Hi. Was debating whether to respond or not Bc I feel you’ve done so much more than most people do when looking into hernia surgery and you have listened to both the good and bad arguments and have come to a decision and that’s really all you can do. My experience as I’ve mentioned was a nightmare and the mesh had to be removed and this was a very very painful, psychologically and emotionally and financially draining ordeal.
so I will leave you with two thoughts that you can think k about and follow up with your surgeon:
1) please ask what would happen if down the line the mesh causes you major pain and issues?
Does he remove mesh? Can he read MEI’s and Cat scans to see if there are issues with the mesh? Please ask if he says yes how many mesh removals he has done and don’t let him get away with oh about one or two a month-ask for a ball park figure. Ask him if he gets all the mesh out and if the groin nerves routinely have to be cut (called neurectomies ). Ask how long he will make you wait to see if symptoms disappear before considering mesh removal. 3 months 6 months a year? Remember you mentioned that it was mentioned that mesh is supposed to permanent-and it is and that is why removing it is so hard.
2) one point that I would definitely run away from is the use of the Bard 3D maxx hernia mesh. It is a disaster. Please don’t let him put that in you (whenever you are ready for surgery). Don’t take my word for it-but please just google it! There are numerous lawsuits in this brand. It folded up inside of me and in the process attached to things it shouldn’t have. It had to be peeled off my bladder, removed as much as possible from the spermatic cord and some pieces of mesh had to be left on the illiac vein and illiac artery Bc I could of bled to death if something went wrong when removing it. There is a huge design flaw-it is concave which is supposed to help with the 3D aspect of the inguinal canal region but this makes it highly susceptible to folding over.
The surgeon who removed my mesh said it is also a heavier mesh and does not do well in thinner people. This is why I implore you to please find a hernia specialist and not someone who says they are just Bc they do a lot of hernia surgeries. The surgeon who did my original surgery also told me he does many many hernia surgeries but yet he used this crap piece of mesh in me and I was a thin guy.
find a surgeon who only does hernia surgeries-they are out there but harder to find. They will know which mesh is best for YOU! Not just use a mesh that he soley uses for everyone.
You are moving in the right direction and seem determined to use mesh-if so please make sure you give yourself the best odds of s successful long term outcome. There are a good number of people I’ve come across who had mesh removed and had the Bard 3D maxx mesh.
best of luck!

[ajm222]

quote Good intentions:

Good luck. I really do hope that you’re lucky enough to have a good experience. Your story is essentially exactly what several people have been describing. Reassuring words, from the same playbook, but no direct evidence. Did he describe any patients that he worked on who he’s been in contact with, confirming the things he was telling you? What you were told is what everybody is told. I hate to be cynical but it really is, almost to the word. Also, you’ve chosen the surgeon who said the most comforting words.

You’re going to wake up and find that he did find a small defect on the other side and placed some mesh there. It really doesn’t make sense, for those believing in the power of the mesh, to dissect that large area of tissue, then just leave it with no mesh placed. There will always be a lipoma or a small stretched area, that is a “defect”. Again, this is my cynical view. But there really is a “wave” of mesh apostles out there.

Can you remember the “certain things” that he told you about people who have mesh problems? The “skinny people tend to have more problems” meme is out there, but it seems to be used after the fact, to explain problems, rather than as a screening tool for patients. Curious to know what he told you.

Again, good luck. But you’re on the well-worn path. It’s hard to get off of it.

He really didn’t explicitly say anything on this topic. It was honestly more me saying it and him nodding his head. That was a very short and minor part of the conversation. I had already made assumptions on this topic based on the other conversations I had and my research, so I didn’t make this a primary focus of this visit and didn’t dwell on it. I would summarize his comments as basically saying that with the robotic laparoscopic surgery (which allows a much clearer and focused picture of the tissue and all of the nerves etc.) and the placement of the mesh in that type of surgery, that the incidence of pain and complications with smaller hernias is low.

And I would actually say of the two surgeons, on balance it was in fact the first one that was more reassuring (though neither was doomsday about it). I chose this surgeon 1. because my main PCP recommended him, 2. because hernias are one of the operations he performs the most and he has extensive experience with the laparoscopic robotic tools and 3. his demeanor and patience and thoughtful answers (though again, I liked both surgeons). He also does surgery on cancer patients routinely. Obviously a surgeon who performs hernia repairs routinely with mesh is confident that it’s a good way to repair a hernia and isn’t likely to suggest that a potential patient has a good chance of having complications or pain. And I gather given that one of his primary surgeries is hernia repair and he’s been practicing for decades that he has likely performed a couple or several thousand at least, and has a sense of the success rate and continues to do the surgeries because he believes they work well. I don’t think many of these surgeons though have very detailed reporting they share with patients about follow-ups, but I can certainly ask if there’s anything they can provide.

[Good intentions]

quote WasInTN:

ajm222
I had right IH repaired by Dr. Goodyear of PA and it was 3+ years since and I have had no worries. An occasional dull twitch happens once in a while for a few minutes when I sit in wrong posture or twist my legs, and then it goes away. I think it is kind of nerve irritation. I am happy with what I had. If I remember correctly (yes I do), Dr. G said the mesh will stay for a life time. And it is 8x stronger than the original body tissue. I think the mesh is Ultrapro or something like that. Not sure of that exact name but you can find it from Dr. G’s office or website. He even said that when a person with mesh dies, it can be retrieved intact. Anyways…

As I have been saying on this forum and elsewhere, this much I know about IH repair. It happens due to a weakness in your tissue that holds the internal organs. Once that tissue is weak and a bulge forms you have IH and it can get worse over a time depending on your activities. Does a surgery fix it? It is immaterial to know what type of surgery but does it fix it? Sure it does but does it fix it FOREVER? The answer is “Nobody knows.” Why? Because it depends on what you do after surgery.

Lasting a lifetime, and the strength of the mesh are not the real problems. Anyone who talks about the strength of the mesh as a consideration is really just dissembling.

A lifetime of limited activity, with discomfort or pain if you try to do more, doesn’t seem like something to look forward to.

[Good intentions]

quote ajm222:

I had tons of questions for him and he basically reassured me that though nothing is guaranteed, the incidence of chronic pain is related to certain things that I am personally pretty low risk for, and it’s also related to experience and skill of the surgeon.

Good luck. I really do hope that you’re lucky enough to have a good experience. Your story is essentially exactly what several people have been describing. Reassuring words, from the same playbook, but no direct evidence. Did he describe any patients that he worked on who he’s been in contact with, confirming the things he was telling you? What you were told is what everybody is told. I hate to be cynical but it really is, almost to the word. Also, you’ve chosen the surgeon who said the most comforting words.

You’re going to wake up and find that he did find a small defect on the other side and placed some mesh there. It really doesn’t make sense, for those believing in the power of the mesh, to dissect that large area of tissue, then just leave it with no mesh placed. There will always be a lipoma or a small stretched area, that is a “defect”. Again, this is my cynical view. But there really is a “wave” of mesh apostles out there.

Can you remember the “certain things” that he told you about people who have mesh problems? The “skinny people tend to have more problems” meme is out there, but it seems to be used after the fact, to explain problems, rather than as a screening tool for patients. Curious to know what he told you.

Again, good luck. But you’re on the well-worn path. It’s hard to get off of it.

[ajm222]

quote WasInTN:

ajm222
I had right IH repaired by Dr. Goodyear of PA and it was 3+ years since and I have had no worries. An occasional dull twitch happens once in a while for a few minutes when I sit in wrong posture or twist my legs, and then it goes away. I think it is kind of nerve irritation. I am happy with what I had. If I remember correctly (yes I do), Dr. G said the mesh will stay for a life time. And it is 8x stronger than the original body tissue. I think the mesh is Ultrapro or something like that. Not sure of that exact name but you can find it from Dr. G’s office or website. He even said that when a person with mesh dies, it can be retrieved intact. Anyways…

As I have been saying on this forum and elsewhere, this much I know about IH repair. It happens due to a weakness in your tissue that holds the internal organs. Once that tissue is weak and a bulge forms you have IH and it can get worse over a time depending on your activities. Does a surgery fix it? It is immaterial to know what type of surgery but does it fix it? Sure it does but does it fix it FOREVER? The answer is “Nobody knows.” Why? Because it depends on what you do after surgery. Since surgery fixes the tissue it does *NOT* mean it makes you a superman. It makes you fit for day to day life and usual activities. If you think you can lift the mountain and hurl it towards the moon after surgery, do not even try it because now that the fixed hernia is 8x stronger and since your tissue was weak in the first case you will have hernia in another location (usually the other side). What if you fixed both sides and try to hurl the mountain? The answer is, I do not know and my suggestion is not to try it 🙂 But if you still want to try, I can guarantee you will have hernia elsewhere.

So does the mesh last forever? The answer is “usually yes” but will it break? Yes it can, depending on what you do. Even the most difficult things in life can break down. Like everything else in life, all items have a life span. You can buy a wall clock that will work for 40 years or even 80 years but ultimately it will die and catch up with Murphy’s law. So is the case with mesh. It all depends on what you do after you get the mesh.

My point is this – surgery makes you feel good and makes you almost normal but yes there are limits. How to find the limits? Listen to your body. That’s my 10 cents. And of course I am not medical professional though I have a doctoral degree in biomedical Engg and I do understand from my research how the mesh and the body works. The bottom line is, it helps you but will NEVER make you a superman. There is no such thing as superman BTW. Even the guys who act as supermen in movies are vulnerable to disease and may be even hernias. Even the strongest athletes in Basketball and NFL have the hernias.

Thanks! I really appreciate this perspective.

I actually have had two additional follow-ups since my original appointments and I think I am getting a much better understanding of inguinal hernias, mesh and surgery now. I had two PCPs tell me that I do seem to have a hernia developing at least on one side, but that it is still very small and may not have even broken through yet completely. Neither recommended bothering with surgery yet as I’m mostly asymptomatic. I had one surgeon tell me he thought I had one indirect inguinal hernia on one side, and likely the same on the other side. He recommended robotic laparoscopic surgery with Bard 3D Mesh as soon as convenient. Finally, today, I had a last surgeon tell me that I do for sure have the one hernia on the right side, but he thought it was direct rather than indirect, and small. And he said it doesn’t seem like I have one on the other side yet, though he can’t be 100% sure. He also recommended robotic lap surgery with likely the same type of mesh as the other surgeon. But he said no rush. Whenever convenient. Next month or next year or whenever it bothers me.

I liked both surgeons but I know that the latter surgeon does tons and tons of hernia repairs specifically. And knowing he can also do the robotic lap as well, I will probably use him and go with that. He can do pure tissue repair as well I think but did state that though results are good short term, in all likelihood years down the road I have a higher chance of recurrence. I had tons of questions for him and he basically reassured me that though nothing is guaranteed, the incidence of chronic pain is related to certain things that I am personally pretty low risk for, and it’s also related to experience and skill of the surgeon. The robotic lap surgery behind the abdominal wall by a skilled surgeon seems to be a great way to avoid most potential issues. It’s all about skilled placement and avoiding infection and avoiding critical nerves and other tissues. He also reassured me like you did that the repairs and the polypropylene are effectively permanent. While anything that comes into contact with anything else will influence it, the rate at which poly is affected by the body makes it essentially permanent (assuming no complications like infection or folding over or damaging nerves and other tissue etc requiring removal). I was worried it would weaken during ones lifetime and need replacement every so often. But it seems that’s not the case. And my understanding is they usually use a piece large enough to cover the area that has the most possibility of future tears, so as to strengthen the region even more. He said he’d look to see if the other side showed a similar weakness and would put mesh in there if he thought it would avoid inevitable surgery in a few years, but said he wouldn’t bother if everything looked normal.

It’s interesting you mention they told you it makes the area 8x stronger. The first surgeon suggested things will never be as strong as before (maybe 99%), but then again the area tore in the first place. So maybe I misunderstood exactly what he was suggesting. Maybe he meant the general area compared with the strength it had when I was younger before weakening it with certain regular activities.

I think at this point I’ve decided to get the mesh repair (I have to get some kind of repair eventually one way or another) because of the statistical likelihood of recurrence if I don’t use mesh, and because it’s a skilled surgeon with a great rating who does lots and lots of hernia surgeries and uses a technique and a mesh that in the right hands minimizes the chances of complications. Again, nothing is guaranteed, but I feel better and more informed now about my decision after talking with four different people including two surgeons, and I will hope for the best. I also feel better knowing that if all goes well, the material should hold under normal circumstances and permanently fix a problem that must be fixed. Tissue repair MIGHT be a permanent fix without the concern about a foreign body, but I’m only 41 and anticipate many years of activity ahead of me and I would worry that a pure tissue repair might find me back in the surgery room eventually, and a second repair after a failed pure tissue repair sounds like it would be more complicated. I also hope that I only need it on one side but will trust his instincts when he gets in there.

Thanks again for sharing your experience. It’s good to hear the bad stories and the good stories and everything in between. I’m in no rush to get this done but do expect I will probably schedule something within the next year or so at most. I don’t like the idea of this getting worse and having a larger part of my insides potentially bulging out. I lost about 55 pounds in the last year and a half and two doctors suggested I might not have even noticed anything if I was still that heavy. So I think it’s small enough to be patient, and he said unless it gets huge (which he said he wouldn’t expect for a long time) there is no major advantage to getting this fixed today versus say next year.