Is it easier to remove the mesh when it’s inserted via open method

[aldpeev]

Hello everyone!

After 2+ years I’m here again.
The last time I wrote was about pain after squats that resolved over time. Well, it happened again, this time after moving some boxes.
And I’m doing research about mesh removal again if pain doesn’t settle.

So I have bilateral inguinal hernia repair with open surgery and progrip mesh and I’m based in Europe.

Some of the best options for removal in Europe are Dr. Muschaweck and Dr.Koch as far as I know. Both remove mesh only if it is inserted openly.

Does that mean it’s safer to remove mesh when it’s openly inserted and have less invasive surgery for removal?

I know removing the mesh is no joke and I won’t do it just like that, but that pain sucks and i can’t just wait it to resolve..

[Good intentions]

You probably had a Lichtenstein repair. So the mesh is actually in the inguinal canal, not behind it. That’s why it would be removed by open methods, from the front. It would make no sense to enter the canal from the back of the abdominal wall via laparoscopy.

If you have your surgery notes they might have more information about the procedure that you had. Covidien (now Medtronic) also makes a plug and patch mesh, but it is not a Progrip product.

Here are a couple of links that show the material and the probable procedure.

https://www.medtronic.com/covidien/en-us/products/hernia-repair/mesh-products.html

https://www.touchsurgery.com/simulations/lichtenstein-tension-free-mesh-repair-for-a-direct-inguinal-hernia-1#:~:text=A%20Lichtenstein%20repair%20of%20a,fixed%20to%20bridge%20the%20defect.

[aldpeev]

@good-intentions yes, I had Lichtenstein repair with the progrip mesh, no plug and patch was used.

Maybe I didn’t ask my question clear enough.

I wonder if it’s easier/safer to remove mesh that is in the inguinal ligament(Lichtenstein) than if the mesh is in the extra-peritoneal(TEP) or peritoneal cavity(TAPP) since well-known Drs. remove mesh only if it was done by Lichtenstein method.

Quote from Dr.Muschaweck website:

Mesh removal is always necessary in patients with chronic pain after open mesh insertion, but unfortunately it is rarely possible in patients with laparoscopically inserted mesh.

[Good intentions]

I think that only a surgeon who does both could say if one was “easier”.

It seems like you’re trying to compare the risk of your situation to somebody like myself who had laparoscopic implantation and removal. I think that laparoscopic removal is inherently riskier because of the general anesthesia, the need to cut through the peritoneum (potential for adhesions), and the fact that laparoscopic mesh is laid on top of nerves and vessels and becomes attached to some of them over time. For example, my surgeon had to sacrifice the inferior epigastric artery on one side because it was so entangled. He also had to leave a piece of mesh in, because of the risk of more damage. It’s an example of the high stakes involved in lap mesh hernia repair. If problems happen they are very very difficult to solve.

So, overall, it seems reasonable to estimate that open mesh removal is less risky than lap mesh removal. And, since Lichtenstein’s method does not involved a plug, there should be less entanglement with critical structures. That’s how it looks to me, but I’m just a person who reads a lot.

[Good intentions]

Dr. Towfigh apparently did one of her HerniaTalk Live sessions on mesh removal recently. It’s not on her Youtueb site though, maybe it will be there later.

@drtowfigh

HerniaTalk **LIVE** Q&A: Mesh Removal Myths & Facts 09/06/2022

https://www.youtube.com/results?search_query=towfigh+Mesh+Removal+Myths+%26+Facts

[aldpeev]

@good-intentions thanks for your replay and thoughts.

I know tho in open mesh removal nerves have to be cut as well to eliminate the risk of chronic pain.

There isn’t a lot of information about open mesh removal on the web and seems to be true for this forum as well.

Any other information about open mesh removal would be greatly apriciated!

[Good intentions]

Dr. Towfigh has updated her Youtube channel. I have not watched the video but it might have some value. I have to assume that the “myths” are from the perspective of the surgeon. It would be interesting to see the myths written out so patients could add their real-world experiences.

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