Mesh Month

[MeshMangledMerritt]

Next month you’ll be posting my pics here doc B! I can’t wait to be free of this cursed mesh.

[DrBrown]

[USER=”2051″]ajm222[/USER]

I remove mesh through an open incision, but the robotic is also an excellent choice.
After the surgery, you should be able to return to work in two weeks.
There is a good chance that Dr Belyanksy will not need to add mesh.
Best wishes.
Bill Brown MD

[ajm222]

quote DrBrown:

To celebrate Mesh Month I have uploaded the photos of the mesh removed this month.
Regards.
Bill Brown MD

Hi Dr. Brown,

I am considering removal as my robotically inserted progrip mesh has been giving me mild pain and discomfort (sometimes moderate) for well over a year and I am now at 1 year and 8 months. In your experience, how long does it take to recover from removal on average? I can’t likely take off much more than 2 weeks before needing to go back to the office and wondering if that’s ridiculous. I hear some people say they felt the removal surgery was easier than the initial surgery, while others have taken months and months to get back to normal. This not being a routine thing, I guess it makes sense that every case is different.

I only have one side that needs to be removed, and Dr. Belyanksy says that he will not use more mesh when he removes it robotically, and that I likely have enough scar tissue to hold things without needing any more repairs (though I know he will sometimes do some kind of tissue repair to strengthen the area if it appears weak). I know he has quuoted others as having a 10% chance of recurrence with just the natural scar tissue, and that it should hold well for quite a while. Do you agree in your experience that enough scar tissue is often present to cover any hernia? Do you remove mesh robotically or only laparoscopically or via open method?

Thanks

[DrBrown]

[USER=”2899″]PeterC[/USER]
The Vas Defersns can usually be separated from the mesh without damage to the Vas deferens..
In most men the pain during sex goes away and the sperm counts remain normal.
Regards.
Bill Brown MD

[PeterC]

[USER=”2580″]DrBrown[/USER]

In case number 4 where the Vas Deferens was scarred to the mesh – what is the procedure/what happens to the patient’s vas deferens as you remove the mesh?

[DrBrown]

[USER=”2029″]Good intentions[/USER]
In Photo 1, the patient had had a laparoscopic hernia repair about 12 years ago. Lightweight prolene mesh was used. He started to have pain about 8 months after the operation. He tolerated the pain until he fell with a twisting motion late last year and the pain became debilitating. Rest, Steroid injections, and analgesics were not helpful. As you can see from the photo then flat mesh had scarred into a complicated three-dimensional mess. So far he is doing well.
In Photo 2, the patient had a laparoscopic hernia repair 4 years ago. He had noticed a bulge and pain with exercise starting about 6 months after surgery. Physical examination and ultrasound documented a recurrent hernia. At the time of surgery, the mesh did not completely cover the inguinal floor. I do not know if the mesh was placed incorrectly or if the mesh contracted with time.
In Photo 3, The patient had a Lichtenstein hernia repair and had pain almost immediately after surgery. He had allodynia in the distribution of the ilioinguinal nerve. Repeated nerve blocks provided only temporary relief. He did not improve even after waiting for 6 months. As you can see, the nerve was densely scarred to the mesh.
In Photo 4, The patient had pain during intercourse. Spermatic cord blocks provided temporary relief. Analgesics and time did not help. I suggested that he celibate, but he did not like that option. When the mesh was removed the vas deferns was scarred to the mesh.
In Photo 5. Anytime mesh is being removed, it is very common for the epigastric artery and vein to be scarred to the mesh. Several times I have accidentally damaged those vessels and had to deal with significant bleeding. Now, I identify the vessels early and I am prepared to ligate the vessels quickly if they are damaged. The scarring of the mesh to the epigastric vessels is probably not a source of pain but can make mesh removal difficult.
Regards.
Bill Brown MD

[drtowfigh]

Mesh removal is indicated for a variety of reasons. Usually, for those reasons, waiting does not result in improvement, as it’s a mechanical problem.

[Good intentions]

That is terrible Dr. Brown. Can you give more details on the type of mesh, the type of repair, and how long the patient suffered with it? Also, how soon after the first repair did they start to feel pain? How long did it take for those vessels to become trapped?

Many people wonder how long that they should wait before considering removal.

[USER=”2580″]DrBrown[/USER]