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Mesh Failed–What Now???
Greetings friends 🙂
I’ve been sifting through the Herniatalk.com archives for over a month to discover the most prudent options for addressing my mesh failure situation. I want to thank each and every one of you—patients and docs alike—who have so generously shared your problems, knowledge, compassion and insights. Special thanks also to the forum creators for providing this valuable humanitarian service!
Since many of you have negotiated this confusing maze of choices before, I’d be very grateful to hear your thoughts and guidance.
History
Currently, a 77 YO male, 175#, 6’0”, ; Coronary Artery Disease, stent in LAD, off blood thinners; health & fitness-focused—exercise includes body weight & strap workouts, biking (outdoor & stationary), elliptical machine, swimming, hiking, gardening, yoga
Pre-Op: Presented April 2016 with bilateral inguinal hernias. Right (protrusion half a hen’s egg), greater than left (large quail egg). Rt side present for a couple years prior.
Surgical Report Notes: 5/3/2016.
- Bilateral hernia repair by lap TEPP approach
- Preperitoneal space insufflated
- Right inguinal area dissected to expose indirect hernia sac which reduced without difficulty
- Left inguinal area dissected free to identify a direct hernia space medial to the epigastric vessels
- Large left Bard 3dMax mesh placed in left preperitoneal space, secured to anterior abdominal wall and pubic tubercule using SecureStrap tacking; care taken to ensure vascular triangle and lateral walls nerves not ensnared by mesh or tacking
- Large right Bard 3dMax mesh placed in right preperitoneal space, secured to anterior abdominal wall and pubic tubercule using SecureStrap tacking; care taken to ensure vascular triangle and lateral walls nerves not ensnared by mesh or tacking
- Mesh placement made to ensure overlying hernia defects by at least 3 cm..
- Closure
Post-Op:
- 5/23/2016 post-op check, normal healing
- 12/12/2016: Office visit with surgeon following detection of reducible, recurrent, left direct hernia, approx. area: 1 cm wide by 3 cm along inguinal axis. He inferred this was a new hernia at a different site to which I strongly disagreed—it was at exactly the same space as the prior one. Said he could fix it but I opted for watchful waiting using truss. Very disappointed.
- 8/17/2017: Was able to maintain fitness activities with truss. Increasing frequency of occasional inguinal area discomfort at a 1-2 pain level and discovery of widespread mesh issues led me to call surgeon for info. Said he used large Bard 3dMax meshes; Asked why my interest, I mentioned finding about mesh failure, migration, etc. Asked him how a defective mesh might be operationally removed since it becomes embedded in tissue. He said they rarely remove a mesh just for those reasons. Said they usually buttress the existing mesh with a patch. Asked if repair is done laparoscopically or by open surgery. He said that decision depends on a full assessment. Continued to manage hernia with truss.
- 12/1/2018: Felt significantly increased discomfort and pressure from hernia following spin class with lots of standing sets. Self-inspection show hernia bulge area had expanded to approx. 3 cm laterally and 10 cm longitudinally, with 1.5 cm elevation. Discomfort at 2-3 with bulging feeling much more frequent, gurgling detected at times. Still reducible lying prone or with truss. Ceased squats and avoid forward bends as much as possible—bulging makes me much more conservative.
- Now: Requested/received surgical report. My wife is scheduled to undergo bilateral knee surgery in late March so I am postponing any remedial hernia surgery until mid-summer. Actively seeking advice on how to proceed in the interim.
So, if you were walking in my shoes right now, what sequence of steps would you recommend to restore full function? Fortunately, I am able to travel anywhere domestically for consults and surgery.
Also would appreciate comments on…
- Living with it as long as possible vs. actively seeking repair surgery?
- Necessity of mesh removal?
- Patching mesh on mesh?
- Anyone aware of issues with Ethicon’s SecureStrap absorbable tacking system–mine must have come loose?
- Intrigued by simplicity of the Desarda procedure vs. Shouldice but note Dr. Tomas, for one, only removes mesh that is placed from an OPEN surgical hernia repair technique—is this due to liability risk? Are there others who remove lap mesh and do Desarda?
Thanks again!
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5 Replies
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[USER=”2029″]Good intentions[/USER] Thanks much for the guidance–which I’ll pursue!
Bard’s Mesh Technique Guide indicates mesh installation can be made with or without mechanical fixation but the TEP approach is shown without. Apparently a surgical option.
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[USER=”935″]drtowfigh[/USER] Thanks for getting back! Can you please tell me what patient info and diagnostic imagery are most helpful for a consult of a mesh-failure recurrent hernia? I already have the surgery report.
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[USER=”2042″]Jnomesh[/USER]
[USER=”2754″]PowerSeed[/USER] -
quote PowerSeed:Also would appreciate comments on…
- Living with it as long as possible vs. actively seeking repair surgery?
- Necessity of mesh removal?
- Patching mesh on mesh?
- Anyone aware of issues with Ethicon’s SecureStrap absorbable tacking system–mine must have come loose?
- Intrigued by simplicity of the Desarda procedure vs. Shouldice but note Dr. Tomas, for one, only removes mesh that is placed from an OPEN surgical hernia repair technique—is this due to liability risk? Are there others who remove lap mesh and do Desarda?
Thanks again!
Bard’s 3D Max product is supposed to be designed to eliminate the need for fixation. Finding a different surgeon certainly seems reasonable.
I would find a surgeon who has experience in fixing mesh failures. The expertise used for laparoscopic mesh implantation is probably quite a bit different than an open repair of a mesh failure.
Jnomesh is deeply involved in the problems with 3D Max. You might check out the Facebook pages he has linked in previous posts. There are probably others who’ve had a failure and had it repaired and might have real experience with surgeons who have that expertise. Experience is supposedly the number one attribute to look for when choosing a surgeon. Find one who has experience in fixing mesh failures.
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Thanks for participating in HerniaTalk.
Sounds like you have a hernia recurrence after laparoscopic inguinal hernia repair with mesh, with no other complications. That is, no direct mesh-related pain or reaction.
The next best step, if you’re symptomatic, is an open mesh repair.
Open Tissue repair after failed mesh repair is not considered standard as it’s expected to have a higher recurrence rate.
Mesh removal is not necessary.
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