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Mesh location verification.
I had a rh direct inguinal mesh repair done in January 2023, recovery went well for the first 3 weeks and then things have been getting worse ever since.
I can feel 3 of the meshes edges and the measurements are the same as the mesh that was implanted. It was the Medtronic Dextile 1510ar.
One of the meshes edges is approximately 1cm away from the site of the original hernia. The other edge is approximately 13cm away from the original hernia site. I can feel intermittent bulging on the lower 1cm edge and pulling on the 13 cm edge. On three occasions I have felt the serrated edge of what I believe is the mesh beneath the skin. I could feel this through my finger.
I’ve had a CT scan without a valsalva manoeuvre, it apparently showed nothing. I’ve had an ultrasound scan that found a 2nd hernia on intermittent valsalva manoevers. Once this has been found the examination was concluded. It was done only in the laying down position. They only kept 8 screenshots and not the dynamic image.
I then had a diagnostic laprascopy performed. The mesh appeared to be correctly placed with it’s anatomical landmarks, showed no adhesions and otherwise appeared to be in good shape. But the examination could not locate the original hernia site.
The 2nd hernia finding was found to be a lipoma in the inguinal canal which was resected.
The images that have been kept of this are completely illegible.
The resection of the lipoma didn’t change the symptoms so I believe the original problem still exists. I don’t believe the mesh is adequately covering the hernia and I believe the mesh is also pulling tight as it can’t stretch at the same rate as the tissue it’s attached to.
Im 39 and quite physically active. I believe the hernia was partially caused by a cycling accident many years ago where the end of my handlebars impacted the same location. It then became a problem after a violent sickness bug. I don’t think there’s any age related determination.
The first surgeons notes are very minimal and we have no recorded size or location for the hernia other than my recollection. I believe it’s situated slightly lower than most inguinal hernias.
I’d like to know if a way exists where we could simply image the site of the hernia and measure from that to the edge of the mesh.
Thanks in advance
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1 Reply
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Hernias are typically “located” by the material that pushes through the weakness in the abdominal wall. During mesh implantation that material is either dissected or pushed back to where it came from. After mesh implantation the whole area shrinks, removing any signs of the previous hernia.
But, direct hernias are defined as weaknesses in the posterior wall of the inguinal canal. So if that’s what you had then that’s where a surgeon would look. The posterior wall will still be the posterior wall.
An exploratory lap procedure would have been a TAPP procedure. Often the mesh can be seen through the peritoneum, but if you had a TEP implantation the peritoneum was never breached so there will be no signs of where it was placed. During my mesh removal the peritoneum looked perfect, everything was smooth and normal.
When you say that you can feel the edges of the mesh with your finger do you mean that your finger feels it or that pressure with your finger allows you to feel it inside?
Anyway, overall, if you have mesh problems you’ll need to find a surgeon that has removed mesh and had success. They are the only ones that have real world experience in mesh problems and solutions, and will be confident enough to break through the perfect looking peritoneum to remove the mesh or find out out what is wrong with it. Because from inside the peritoneum there will be no signs of problems.
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