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  • Looking for Advice

    Posted by Herminius on February 15, 2023 at 8:32 am

    Hi guys, bottom line up front: I would appreciate some advice on whether or not to go ahead with mesh removal.

    Background:
    -I had a laparoscopic inguinal hernia repair in September 2022 For a very small indirect hernia. The surgeon implanted 10×15 cm Covidien Progrip mesh. I experienced an unusual amount of pain after the surgery. After 3 weeks of gradual healing I lifted my daughter and immediately felt sick and like something was wrong. My surgeon put me on a regimen of medicine (Gabapentin among others) and also tried an injection to numb the nerves in the area. Nothing got rid of the pain which I’ve had constantly since then. Mostly a burning, stabbing, pulling, aching general area sensation corresponding to the location of the mesh.
    I’ve also experienced autoimmune/arthritis issues (pain and swelling in the joints of my fingers) regularly since surgery, which is something I only experienced once previously.
    I’ve visited Dr. Krpata at the Cleveland Clinic, who offered to remove the mesh but with a matter of fact warning that the consequences of the surgery could leave me worse off.
    I’ve visited Dr. Conze in Munich who gave me ultraound guided injections to determine if numbing the nerves would help the pain. It helped some, but not significantly. He said mesh removal is an option (not by him as he won’t operate laparoscopically) but should only be a last resort.
    Im 32. Prior to surgery I was extremely active. My ideal scenario would be to return to full fitness. However, I am also the primary caregiver for 3 children. I don’t want to disable myself past the point of being able to care for them.
    Currently I can walk, jog, lift groceries, etc. In other words live a normal, mostly sedentary lifestyle. But I experience pain throughout the day, leaving me exhausted by day’s end, and higher levels of exercise or sports are off the table.
    Is getting the mesh removed a worthwhile bet in my case?
    Thanks for your advice.

    Herminius replied 1 year, 4 months ago 4 Members · 4 Replies
  • 4 Replies
  • Herminius

    Member
    February 15, 2023 at 11:59 am

    Thank you so much for your helpful and detailed answers. I will definitely take what you all said into account.

  • Good intentions

    Member
    February 15, 2023 at 9:35 am

    Progrip has an absorbable/degradable polymer component that might explain your autoimmune issues. It takes a while for the polymer to fully degrade, I posted a link below.

    Spend some time and read the posts on the forum. As a person who was very active you probably understnad what your body is telling you. Mesh removal is mainstream now, a standard area of expertise that many surgeons are learning and touting. Robotic surgery methods are being developed to make mesh removal easier and safer. It’s just the new reality.

    If you do decide to have the mesh removed be very careful in who you choose to do it. Two names that seem to get good results are Dr. Belyansky and Dr. Peter Billing.

    One thing that I found when I was trying to live with mesh was that sometimes being more active actually made the pain better. I attributed it to getting fluids to move through the new poorly vascularized tissue around the mesh. If you’ve been holding back thinking that rest is best you might try to get some workouts or runs in and see what happens.

    Good luck and sorry that that you’ve been caught up in the mesh mess.

    Here is the link to the Progrip product, which is owned by Medtronic now. Polylactic acid (PLA) is the material that the little knobs are made from. It is unclear how long it takes for all of the PLA to disappear. 40% of the mesh is PLA.

    https://www.medtronic.com/covidien/en-gb/products/hernia-repair/progrip-laparoscopic-self-fixating-mesh.html

    Here is a link that actually mentions PLA.

    https://www.medtronic.com/covidien/en-gb/products/hernia-repair/progrip-self-gripping-polyester-mesh-prophylactic-suture-line-reinforcement.html#

    “ProGrip™ Technology in Abdominal Hernia Surgery
    Provides immediate tension-free fixation on the entire surface of the mesh – and offers surgical efficiencies and patient benefits.2,3
    It does this by combining monofilament polyester with a resorbable polylactic acid (PLA) microgrip technology. So surgeons get immediate fixation that is strong, durable and comfortable.3,4,5”

  • ajm222

    Member
    February 15, 2023 at 9:06 am

    You sound like a lot of us here – you’re not totally disabled but the results of the surgery have left you less than before, which is always very discouraging. Plus you potentially have some autoimmune issues. The former honestly was ultimately enough for me to get removal, along with a number of other folks here who are generally happy they did. I did not want to spend the rest of my life suffering daily even in a fairly mild way if I didn’t have to. It is exhausting. I was still running several miles, a few days a week. But it didn’t feel pleasant or ‘normal’. And I had a lot of strange sensations that were very disconcerting in certain positions. I had decided the mesh was the cause of my issues and I wanted it out. But I was terrified of removal, and it took me a lot of appts and time to finally do it. Once it was out, I still actually had issues, but I wasn’t worse, and I was also very happy the mesh was gone. After a long time healing I finally got to a place where the tightness and discomfort were much improved and are often totally gone. So I am still happy I had the mesh removed even if I’m not 100%. I am 2 years out from surgery. Took me 3 full years to make the decision on removal. I also had progrip mesh. I actually appear to have a recurrence of some kind and have a surgery scheduled Monday for a tissue repair that I am hoping tightens things up and improves them further even if it means another setback and lengthy recovery. Another forum member also had progrip mesh removed after about 6 months after reading about my experience. He then got a tissue repair later, and now he’s basically back to normal. He was also able to do things normally, but he said it just sucked because there was always that pain and discomfort.

    In your case it hasn’t even been 6 months. There is a chance things will improve. I know when I was relaxed and not as stressed, the discomfort lessened a lot. I think I have a lot of tension in my pelvis and the mesh just didn’t agree with me. But I did have times when I felt much better that I attribute to my core being very relaxed. I also think there is a tendency to read about autoimmune issues and start to blame everything on the mesh when maybe it’s something else or nothing. That said, after this amount of time the likelihood that your issues will totally fade away are probably growing slimmer. It may be worth it to give yourself another 6 months and see what changes occur and then make a decision. But I do think removal should be on the table. I think the percentage of people worse off is pretty small. Even if you’re not immediately appreciably better, psychologically you will feel some satisfaction. And later you can still get an open tissue repair if needed (though usually there is enough scarring at first to not immediately need anything else done). If your original hernia was small and uncomplicated and indirect, and you choose a very reputable removal surgeon to remove the mesh lap or robotically, you will likely be fine.

    There are I think other options in which a surgeon can go in and see if there’s something wrong with the mesh. I did have a friend where this was the case, and he claims to be fine now. He has no idea what the second surgeon did to fix him, and he struggled even with walking for a good month after that surgery because of a nerve issue, but claims he’s healed. But of course on this forum you will find a lot of folks like me that are more of the mindset that maybe it’s best to just get it out if you’re having complications more than a few months after surgery, and get a traditional tissue repair if needed later and be done with the mesh. It’s a very tough choice though.

    • This reply was modified 1 year, 4 months ago by  ajm222.
  • drtowfigh

    Moderator
    February 15, 2023 at 8:37 am

    Mesh removal should be taken seriously. Most patients do really well, but the operation has to be worth doing in case you fall in the 15% of patients who are not cured or may even be worse off.

    Mesh implant illness needs a full work up before committing to mesh removal. I have a full protocol that I follow.

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