News Feed Discussions inguinal hernia mesh repair and allergies/urticaria

  • inguinal hernia mesh repair and allergies/urticaria

    Posted by Alephy on January 9, 2020 at 7:40 am

    Are there possible problems with a mesh if one has allergies and/or urticaria? Any studies on that?

    Alephy replied 4 years, 7 months ago 5 Members · 14 Replies
  • 14 Replies
  • Alephy

    Member
    March 3, 2020 at 11:31 pm

    I kind of got tired of arguing my situation against mesh…every time it is the same story being told over and over again. The best I got was: I can try shouldice but I reserve the right to use mesh in the end if I feel the muscles are too weak…..incidentally two doctors claim I have weak muscles whereas one asked me what sports I do as I have strong muscles in his opinion…go figure

  • Alephy

    Member
    March 1, 2020 at 11:58 am

    Yes and of course recurrence rate should be discussed per hernia type and surgery procedure….I am starting believing that the person who will bring some light into the hernia circus should get the Nobel prize in analogy to what happened with the stomach ulcers and the discovery of bacteria being often the culprit (the doctor who discovered this I think got the prize )

  • Good intentions

    Member
    March 1, 2020 at 9:11 am

    Here is another paper from Dr. Burger, from 2017, in which he still uses the 2004 paper as his primary reference for suture versus mesh. He shows a multitude of different mesh options in the paper but uses the Prolene mesh 2004 paper results.

    The research field is very chaotic, so many unproven materials being introduced to market, and so many different ways to use them.

    This is for incisional hernias though, so not so translatable to inguinal repair.

    https://www.sciencedirect.com/science/article/pii/S2211568417300037

  • Good intentions

    Member
    March 1, 2020 at 8:57 am

    I think that the “crazy” numbers the surgeon quoted were probably about incisional hernias. Here is an old paper about mesh versus suture. It seems to be one of the first “evidence-based” papers supporting the use of mesh, at least that’s what they say in the comments. They started with evidence-based but then started moving ahead without evidence. Changing the parameters on the fly. “Educated” guessing.

    “Regarding the overlap of the mesh. Two centimeters may actually be too little. We think we may have lower recurrence rates if we increase the overlap of the mesh, and nowadays we do.”

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356459/

  • idoncov

    Member
    February 28, 2020 at 8:48 pm

    I had a major allergic reaction to the mesh placed inside of me yet the allergy skin tests were so small as to be inconclusive. Based upon the skin tests it wasn’t clear whether mesh removal would help me much. However, once they opened me up there were abscesses all along the margins of the mesh. After the mesh was removed I remained hyper allergic to various allergens for a period of about 2 years, reactions which I had never had before the mesh was inserted. So, I would not be so certain that those tests prove anything. Certainly if the tests prove positive I would be leery of mesh but even a negative result doesn’t guarantee that you won’t have complications.

  • Momof4

    Member
    February 28, 2020 at 12:16 pm

    I was tested twice, once while implanted with polypropelene mesh and once 6 months after removal, looking for a way to repair multiple recurrent hernias. The first time I had severe skin reactions to polypropelene and hybrid with some polypropelene. The second time, with a different allergist and with no mesh implanted, I didn’t react to the polypropelene and slight reaction to hybrid. The doctor said that it wasn’t a good test to see how I would react to something being implanted, but he said he Certainly wouldn’t recommend implanting something that I had a skin reaction to. He also said they just because I didn’t react on the skin didn’t mean I wouldn’t react once implanted. He was right! I have polyester mesh and am having systemic reactions and don’t know if it’s allergy related or autoimmune FBR. I wish there was a way to tell if/how you would react to an implant. Since having mesh implants I react to adhesives on my skin and I never had that problem before. Ugh!!

  • Good intentions

    Member
    February 28, 2020 at 12:09 pm

    It might be that the more honest assessment of chronic pain rates in Switzerland comes from the way that doctors get paid. In America, apparently, most surgeons get apid by number of procedures performed. There is, again, apparently, a push toward more results-oriented pay, but it’s easy to imagine that device makers would resist this effort.

    “Fee-for-service” pay is common. Hernia repair would be considered the “cash cow” of a typical surgery practice.

    https://medschool.ucsd.edu/som/surgery/news-events/Pages/How-Should-Surgeons-Get-Paid.aspx

  • Alephy

    Member
    February 28, 2020 at 11:44 am

    Yes it’s true…ah one doctor did mention a crazy number ie non mesh repair having 50% chance recurrence but I guess he might have referred to old simple stiching…or he was just young and already funnelled into a certain thought process…it’s funny to see how high a reputation the Swiss system has vs the reality of it

  • Good intentions

    Member
    February 28, 2020 at 11:38 am

    In fewer words – 15% chronic pain rate is the new “standard of care” level. If you can’t change the result, change the rules of the game.

  • Good intentions

    Member
    February 28, 2020 at 11:36 am

    The increase in lawsuits is leading to the effort to disclose more and more to the patient. So that they can share responsibility. If you read the details of some of the bigger lawsuits you’ll find that not disclosing the possibility of chronic pain or complications is often the foundation for the suit. “The doctor did not tell me this might happen”. So, I’m not sure that you actually found a more honest practice. It might just be that they’re up to date on the legal problems in the field. So, your risk is probably the same. But you won’t be able to sue them if things go wrong. Because they told you.

  • Alephy

    Member
    February 28, 2020 at 11:31 am

    The tests will be in 3 months which I might still cancel but I would be interested to know in general…it’s clear now that I cannot have a tissue repair in Zurich. Btw I was given a choice 15% chronic pain rate which at least is an honest fact. I think I will either wait and have surgery in another country or just watch it and do nothing about it. Hopefully in say 10 years some new insights might be available…

  • Good intentions

    Member
    February 28, 2020 at 11:08 am

    The results of your allergy test will be interesting. One potential problem though is that it will be passive or static test, probably. Whereas, in the body, the tissue is constantly moving around the mesh as you move and breathe. I would guess that there will be no allergic reaction and that the information will be used to convince you that “mesh” will be okay for you.

    Don’t overlook that if you get a pure tissue repair with absorbable sutures, and you get a recurrence, you can then have a mesh implantation. Also, regarding the possibility of pain, don’t get taken in by the term “minimally invasive” if you consider laparoscopy. More tissue is invaded for laparoscopy in order to create the space, than for either pure tissue, or open with mesh, which uses smaller pieces of mesh.

    Since you are going so far in educating yourself you might make a list of the different types of mesh and the different forms and try to rank them by certain characteristics. For example, the Prolene Hernia System (PHS) sounds very official and is promoted heavily but it uses a very large quantity of mesh and invades both sides of the abdominal wall, and combines that with a plug. If you were going to take all of the potentially problematic qualities of “mesh” and combine them in to one product it would probably end up looking like the PHS. It’s like they threw everything they had at preventing recurrence, with no consideration of chronic pain.

    Good luck. Get a list of the polymer types they will be testing on you, and/or the brand names. It’s possible that they will only test products that they have contracted to implant, and you might not get the full picture.

  • Alephy

    Member
    February 28, 2020 at 2:19 am

    So I will be tested for a possible allergic reaction to some types of meshes….I am not saying I will get surgery, but at least knowing if a mesh might cause me allergic problems will be helpful…
    I still wish there was some certainty on the long term outcome: I have been told/warned of a chronic pain rate of 15%, which is a lot higher than all the other numbers I was told before, so I guess this one time I got the facts and not some marketing bullshit…wish I could get numbers for chronic pain with and without mesh, although the mesh extra factor naively would make me think of a higher risk, and mounting with time…

  • drtowfigh

    Moderator
    January 9, 2020 at 2:36 pm

    Simple allergies likely don’t make you at higher risk for mesh reaction or mesh allergy. Urticaria May place you at higher risk for mesh reaction or mesh allergy.

    in situations where I feel the mesh may spark an autoimmune or auto inflammatory syndrome or allergic reaction, though rare, then I use hybrid mesh that is much less inflammatory

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