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Mesh Removal
I had Bilateral inguinal hernia repair TEP with Ultrapro Flat Mesh (15CMX10CM Both sides) with securestrap absorbable tacks in August of 2014. I have had terrible groin pain on my right side ever since. If I have my laparoscopically placed mesh removed can it be done without significant damage to the Transversalis Fascia?
Since the hernia that was repaired was described to me by my original surgeon as “very small” can it then be stitched or will the possible destruction of the T. Fascia cause on gigantic hernia? Can this Laparoscopically installed mesh be removed through an Open – Lower Midline incisional proceedure as I am being told? I realize the Mesh can be removed Laparocopically and that only a highly experienced surgeon should perform mesh removal regardless of the method of removal.
I am basically concerned with the possible destruction of the T. Fascia or will the scar tissue that forms in it’s replacement along with the regeneration of the peritoneum ( which will be removed with the Mesh) hold the internal organs in after healing?Thanks Jim
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5 Replies
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Mesh Removal
jgens99218’s Avatar
Thank you Dr. Towfigh and Dr. Earle. These responses answer this difficult issue precisely. I am now able to make an informed decision
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Mesh Removal
Thank you Dr. Towfigh and Dr. Earle. These responses answer this difficult issue precisely. I am now able to make an informed decision.
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Mesh Removal
Laparoscopically placed mesh can be removed off the transversus abdominis. Some muscle will be injured as part of the removal, as the muscle has grown into the mesh. Surgeon technique and surgical technique can help reduce the injury. It is usually not a major problem. There is minimal muscle tissue that is removed with the mesh and it typically does not affect abdominal wall strength.
I recommend that laparoscopically-placed mesh be removed laparoscopically. To do so via an open laparotomy, in my opinion, is causing too much extra damage and instability to the abdominal wall, cutting through the abdomen full thickness to get to the mesh. The recovery is also much longer. That said, there are not that many surgeons who routinely perform mesh removal laparoscopically. Mesh removal itself has risks of vessel (external iliac artery/vein), bladder, spermatic cord, and nerve (genitofemoral or lateral femorocutaneous) injury regardless of technique.
I have switched to performing all of these with robotic assistance, and have found the results to be much better, with less injury.
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Mesh Removal
So is it safe to say that the Mesh can be removed without significant damage to the transversalis fascia?
Also what type of potential damage can happen in regards to the Nerves upon removal of mesh? Givin the TEP method are the nerves in direct contact with the mesh?
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Mesh Removal
You should be ok in terms of a recurrent hernia, but it’s unpredictable. I have taken Mesh out And follows patients for a couple years without recurrent hernia, however that doesn’t predict what will happen to you. It’s also possible your pain isn’t due to the mesh. You might want to consider a month of antiinflammatory treatment with s Merrill dosepak followed by 3 weeks of narposyn and myoflex cream. If that does the trick, you may avoid another operation. Hope this helps!
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