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How much mesh?
No doubt this topic has been discussed here before, but I haven’t found it: When surgeons apply the patch of mesh in an I.H. procedure (mine was open) is it common practice to spread it beyond the edges of the actual hernia?
If so, is the idea to cover a larger space, to prevent a possible recurrence?
Any idea how large an area they will typically cover?
Thanks for any input. -
10 Replies
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Everyone is “reassured” by what looks like a good idea. It’s the unintended and unaddressed side effects that are the problem.
Good luck.
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Thanks for all this information. For those of us (like me) whose main concern is the possibility of a recurrence, it’s reassuring that the mesh is extended beyond the actual site. On the other hand, of course, there is the thought that we have more mesh (maybe a lot more) inside than we realized. Something to think about.
Thanks again for sharing all this. -
Not all, just some. There is a very wide variety of procedures and mesh materials, that all fall under the category of “open repair”.
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Thank you. I thought I had researched thoroughly before my surgery but I was unaware of all this. So two pieces of mesh are inserted in all mesh procedures? I am surprised-I was under the impression that a single piece of mesh was laid in, then the incision was sewn up. Thanks again.
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They have to go beyond the edges of the hernia to find good tissue to attach to. How far they go can depend on the type of repair. Some of them use quite a bit of extra material. The Onstep repair (BD) pushes mesh all the way down to the pubic bone, for example. Here are a few of J&J open repair materials. The center pillar represents the hole and the two large pieces are the overlapping mesh, for the tissue to grow in to. The plug and patch pushes the plug in to the hole and uses the flat mesh to hold it in place.
“Anterior approach” means open repair.
https://www.jnjmedicaldevices.com/en-US/product/prolene-polypropylene-hernia-system
https://www.jnjmedicaldevices.com/en-US/product/ultrapro-hernia-system
https://www.jnjmedicaldevices.com/en-US/product/prolene-3d-patch-polypropylene-mesh
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Thank you again. Your reply is in reference to lap repairs- can we assume the same policy is used for open repairs?
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He said that it was larger than he thought it would be. But he only found a small lipoma on the other side, yet still used the same 6″x 6″ piece of mesh. For a lipoma, a blob of fat stuck to the spermatic cord.
Mesh is viewed as some sort of magical material and they want to cover as much area as possible. It is all about recurrence, still, even after it is shown over and over that mesh can and does cause discomfort and pain. Something is stopping them from believing what they know must be true. It is very much like today’s politics. It’s kind of frightenting.
Here is another thread about Dr. Felix. He, apparently, really wants to be known for pushing laparoscopic hernia repair. He is a true “believer”, but it’s really not clear why he believes. If you watch his presentations it’s almost like he sees the patients as competition, to be subdued, for some larger purpose. What that purpose is, is unclear. “For their own good”, maybe.
https://herniatalk.com/forums/topic/the-state-of-teaching-hernia-repair-dr-felix/#post-26636
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This reply was modified 3 years, 8 months ago by Good intentions.
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This reply was modified 3 years, 8 months ago by
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Good Intentions: Thank you very much for this. six by six (!). Was your hernia unusually large? Mine seemed big to me, considering the bulge, but I don’t suppose it actually was (1/2-1 inch ?), I don’t know. Were you informed how large your I. H. actually was ? Thanks again.
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Here is a presentation from one of the surgeons mentioned in that paper, where he describes what to say to a prospective customer, and how to reduce the surgeon’s liability. It is a shocking presentation to watch, but Dr. Felix is a popular presenter, an “expert” in the field. He is training the surgeons of the future.
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Yes. Here is a very recent paper, essentially summarizing the “state-of-the-art” of “minimally invasive” surgery for mesh placement. Once they get in there they try to cover all areas that might herniate in the future. Technically, it is prophylactic mesh placement, which is supposedly not correct or ethical, but it is standard practice now. I had two very large pieces of mesh placed, 6″ x 6″, for a single direct hernia repair.
This paper is from February 2020. Chronic pain is mentioned, but only in vague terms of how to avoid its possibility. The main focus is how to get the mesh in.
Chronic pain is standard practice now also, with pain management clinics and a series of procedures to follow when a patient presents with chronic pain. It’s not the surgeon’s problem anymore, it’s a whole new class of medicine.
https://link.springer.com/article/10.1007/s00464-020-07449-z
Excerpt –
“Rule 8: A large mesh (usually at least 10 cm craniocaudally?×?15 cm medio-laterally) may be placed covering the MPO (Indirect, Direct and Femoral triangles) with overlap of at least 3–4 cm (Fig. 9).”
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