Laproscopic Mesh Repair

[Alephy]

Hi Katherine,

I read you. There are very many different meshes, and sure enough the wrong one used for the wrong procedure is likely to break havoc….I am wondering now if the meshes people have been talking about for hernia repair that get reabsorbed, do indeed leave behind something (I was under the impression that they were designed to disappear entirely), although indeed there are some that get reabsorbed only partially ie they have a small content of a permanent part (polipropilene?)…incidentally one reason I would want to avoid a permanent foreign body is that I have Urticaria, and I would rather not run the risk of an adverse reaction of the body (it is not pleasant when it happens) ie between a smaller permanent content and a full sized mesh I would still opt for the first one…

[Katherine]

Hi Alephy,

Reabsorbable mesh. I have a nightmare story for you. During my spinal surgery, the surgeon had to do a sacral laminectomy on me. He also drilled holes in my sacrum to access the spinal nerve root cysts. I have very little posterior sacrum left. Instead of using an inert material (like titanium) that would protect what was left, he used a reabsorbable mesh – not to be used in the spine (manufacturer’s instructions). He used it off label, and quite negligently I might add. Before surgery, I had other symptoms due to the cysts, but no back pain. Now I have terrible sacral pain and the development of adhesive arachnoiditis due to the mesh. Although the mesh dissolves, some particles still remain. I am one of the unlucky ones that has had a continual inflammatory reaction to it. And it cannot be removed – just particles are left in dense scar tissue. Several neurosurgeons have warned against this use to the doctor that did my surgery, but he continues to use it. A forum I go to has patient after patient with terrible postoperative results due to this mesh. I will never, ever had this again – in any form of surgery. Because once it does start dissolving, it cannot be removed. So buyer beware. I think some doctors have started using this reabsorbable mesh for hernia repair, but I don’t think there are enough post surgical studies to see what types of complications there are yet.

[Katherine]

Hi Good intentions, thanks for the information on the laproscopic repair using the “eye shaped” lighter weight mesh. I did not know that this was most likely to have folding complications. I would certainly rather have a pure tissue repair – but what I’d like most is to find a fantastic doctor that does a pure tissue repair, but could honestly evaluate me and let me know what is best for me! Finding a needle in a haystack where I am! I guess I could go back to that pure tissue doctor that I had written about earlier (the one with the not so great attitude) and ask more questions about his type of Bassini repair. I keep spending all these copays to see all these doctors and that adds up. I could be using these copays to go see a really good hernia surgeon (thinking about either Yunis or Brown). But again, travel restrictions due to medical issues. Also, given my physical situation, I’m not likely to be lifting heavy things or pumping iron in the gym! So less chance of the tissue repair failing I believe. As always, I appreciate your insight!

[Alephy]

Hi Katherine,

I live in Europe, and I also have a constraining health insurance so options are limited…

ps:
If I myself decided to go for a mesh repair, I would definitely go for one that gets absorbed completely ie it disappears as it causes less inflammation (according to the studies) and in case of problems does not remain in the body anyway (hopefully a less severe problem than peeling off a permanent mesh off your body); and I have not yet found any study indicating that the long term rate of recurrences is (much) higher….

[Good intentions]

To be clear, my point about mesh being developed for situations like yours, should really say it’s meant for the situation that you might end up in because of your condition. Mesh is meant for use AFTER the pure tissue attempt fails.

[Good intentions]

I had written a long post that said essentially the same things that alephy said. The surgeon that you talked to sounded like a very common run-of-the-mill laparoscopic mesh repair surgeon. Everything you wrote is what the training of the day is. The “eye” shaped mesh sounds like a 3D product, which seems to be more prone to folding, from anecdotal evidence. “Thin” probably means lightweight mesh, an idea that was introduced to the market through the 510(k) process, but several studies have shown does not have the benefits that it was proposed to have. It’s the same or even worse than the older stiffer mesh. Small entry points (incisions) and quick “healing” are the selling points of laparoscopy, but lap also lets the surgeon insert a much larger piece of mesh than an open implantation. In short, the surgeon did not say anything special, therefore the one in six probability still applies. He’s the same as the other ones.

Your situation still fits the “pure tissue first then mesh if there’s a recurrence” approach that I think should be the standard for all hernia repairs. I would bet that from a patients’ welfare standpoint that the logic supports that approach. There would be less chronic pain and discomfort in the hernia repair population, fewer patients waiting to get a hernia repair (because of the lower pain rate), less pain management necessary, and even a healthier population of surgeons, because they would know they are doing what’s best for the patient instead of best for business. Their patients would be happier and forums like this would go back to what they were intended to be, full of confidence inspiring success stories.

If your tissue is weak and the sutures pull free, or a new hernia forms, then you can still get mesh. That is why mesh was developed, for cases like yours. It has spread like it has due to efforts from the medical device makers. It is a money-maker, much more revenue generated from today’s large mesh implants than selling a few feet of suture material per repair.

Since you have learned so much I think that your odds of having a successful tissue repair are higher than most. Many people, I think, can’t resist the urge to “test” their repair and do things that they know they shouldn’t be doing. You have already learned that your body has weaknesses and have learned to live with them. You’ll probably do the same after a tissue repair and get good results, would be my bet. But, if not, mesh is always ready and there are thousands of surgeons waiting to put it in.

• This reply was modified 3 years, 11 months ago by  Good intentions.

[Katherine]

Hi Alephy, thanks for your response. My symptoms are some slight soreness at times (other times I feel nothing). It seems to get larger during the day, when I wake up after sleeping, it’s doesn’t stick out nearly as much. If I bend down to the floor with my knees, I feel it popping in and out. It is more sore towards the pubic bone area than any other area. It also prevents me from doing things like core exercises because then it becomes larger and more sore. But day to day activities, it doesn’t interfere with. So, I would say they are pretty mild. My situation is rather unique. I had a very rare spinal nerve condition that caused me pain, but I wasn’t on any meds for the pain, but I just couldn’t sit! It would cause terrible neuropathic pain and sitting is 1/3 of our lives. So to overcome this disability, I had surgery. Well, the surgery failed. Now not only am I in worse pain, I’m on a ton of meds to control it. So… I guess I am feeling the same way about the hernia surgery. Will I look back and say I should have lived with the relatively minor pain I had before surgery if I end up with chronic pain or a failed repair or potential removal of mesh? I totally have surgery PTSD. I haven’t let anything invasive at all happen to my body since surgery because of it. So a large part of me says just leave it alone although it does bother me some. But I honestly think I’d kill myself if I had to deal with more chronic pain in my body that I already have. Most of the doctors I have seen have said that although they consider my hernia a “medium” size, if it doesn’t bother me, I can leave it alone. The risk of strangulation is very small. My back condition is most likely caused by some type of connective tissue disorder, so it is possible that my tissue is too weak for a tissue repair – but one doctor said he could do a tissue repair after looking at it. But most are just doing the mesh now. None of them would tell me their complication rate; however, after I asked one doctor about “watchful waiting” he said that is fine since “I can always make you worse”. So at least he was honest. I agree with all your comments in your last paragraph. But how do you find such good doctors? I have seen so many. I think if I had seen the one that I really felt comfortable with, I would have already done it. But I haven’t find that doctor yet (note: I haven’t considered out of state in this commentary due to the difficulty of doing so and insurance reasons). I think until we find that true comfort level, we just wait. Of course, it all depends on your personal situation. If you are young, healthy, no other issues but the hernia and you want to exercise, you may want to get it repaired. Because it does interfere with exercising for me. Where do you live? There are a few doctors that I have seen who have hernias as a large majority of their practice (one I saw said he does at least 1-2 per week, he uses mesh). And if not hernias, he practices mostly on abdominal type issues (lap band surgeries for weight reduction, gallbladder, other types of hernias, etc.) It’s so hard!

[Alephy]

Hi Katherine,

What are your symptoms if I may ask? You did not seek treatment back in 2018, did it get better afterwards?

My experience is that most doctors will tell you that: 1) the hernia is too big for a pure tissue repair or the tissue is too weak 2) that is better to operate sooner rather than later as watchful waiting is not recommended anymore 3) that it will only get worse and that 4) exercising makes it worse…one even said that waiting to fix the hernia on my right side will cause an hernia on the left one too.. and of course they will more or less all say that 5) the % of their patients with complications is very small (because they are obviously very good surgeons) although one doctor who works in a hospital did mention to me a 15% complications rate…

I have read many posts on this forum in the past 12 months, and I am no wiser than you are, but I can tell you what would guide my choice of a surgeon: He/she must be ok with answering ALL the questions, even after the visit (if at all, I know I will be able to ask questions if there is a problem afterwards), the surgeon should have followed up on his/her patients for a long period of time (otherwise any statistics of success/complications is meaningless), and when asked they should tell you a ballpark number of complications that is reasonable…whoever tells you they never saw complications is selling you a lie…same goes with those who tell you that the mesh is inert etc etc…my 2 cents