Mesh Removal? – or something else?

Hernia Discussion Forums Hernia Discussion Mesh Removal? – or something else?

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    • #32904
      Nightmare
      Participant

      My story starts 1,5 years ago when I had a surgery – Incisional Hernia (previously was an appendectomy) that was recurrent after a free tissue repair.
      I did not had any pain , I was running ultramarathons with a whole around 2-3 cm long did not any problems whatsoever, just my thoughts that over the time the damage/whole will increase if I will not address it.

      I’ve decided to tackle it, I went probably to the most specialized doctor in our country (Romania) , I’ve told him how active I’m ,what I’m doing like running ultra and being a very active person and I would like to be the same after the surgery, he told me that the only way to do it is with mesh laparoscopically , but he never presented me the downsides or what will do even though I was insistent about the fact that if I will not be able to be as active as I was , I prefer to skip it for the moment.
      He even told me that after 12 weeks max. I will be able to resume my running’s without any limits..

      He ended up doing an hybrid operation laparoscopically & open to place a retro-muscular mesh (lightweight mesh- Coviden ,if I recall), he told me that this is safer as the mesh will never get in contact with your organs..
      why he converted to open ? (don’t know exactly, he said due to my adhesions from previous surgeries).

      Doctor decided also to do a TAR without noticing me prior because why not , and most probably my core is instable or weak on the right side because of that.

      After 1,5 years I can say that I have the following problems:

      1. Constant back pain – my back muscles the opposite side is overcompensating for the incorrect alignment of the abdomen. ( around rhomboid / trapezius muscles )
      2. the mesh was placed to tight , I feel constant tightness or something that is pulling my right rectus side and probably I already started to observe an overstretch of my linea alba.
      3. I see that the abdominal pressure is not equal on the side of the mesh with the normal side as the oblique where the mesh is does not expand the same and probably this destabilize my entire core and from there might result the problems from point 1 and 3.
      4. When I urinate the pressure is not as it was before the surgery even though i feel my bladder is full.
      5. lymphatic node inflamed near the oblique/leg zone from the surgery till now.

      After this time I’ve never ran more than 2-3 km , I’ve been through probably the most difficult journey of my life from doing what I’ve loved the most to being miserable..

      I tend to believe that I’m in this situation due to how the mesh was installed ,technique or other details that to be honest does not matter at this point , at least for me…

      But I’m looking for answers , to find out the cause of all my problems above:
      If is not due to the surgery/mesh then what is it? What I can do about it?
      Yes, I don’t have a whole anymore , or at least as far as I know , but I have far more problems that I had before this surgery…
      If is the mesh , what we can do about it? What will be the downsides or possible risks?

      I also foresee allot of problems that might appear in the near future because the mesh is to tight constantly stretching / pulling my rectus , abdominal pressure flow that is higher on the healthy side compare with the mesh side etc.

      I’m sorry for the eyes of the reader , but unfortunately i don’t know how to make it shorter.
      I would realy like to know if someone has any recomandations, tips, advices … will be highly apreaciated.

      • This topic was modified 3 months ago by Nightmare.
    • #32908
      Good intentions
      Participant

      Tightness and loss of flexibility is common around mesh implantations. And, apparently, incisional hernias are difficult to repair. The recurrence rate is higher than for inguinal hernias.

      If you can get your medical records, and if necessary, translate them to English, it migth be worthwhile to contact Dr. Meyers at the Vincera Institute. He is well-known for working on runners, among other athletes. He offers a free consultation, but is expensive, as I understand things. But he might have some ideas.

      https://vincerainstitute.com/

      https://vincerainstitute.com/practice/physicians/

    • #32909
      Good intentions
      Participant
    • #32910
      Nightmare
      Participant

      @good-intentions, first of all thank you for your thoughts and ideas.

      Well thightness and lack of flexibility might be a common problem for mesh , but in my case as it is on my right flank it took away the ability of the tissue to expand.. i’m not a doctor or PT , but i know my body very well and somehow that changes how the internal pressure flows in the abdomen.

      I wrote to doctor Koch , but it seems that via the clinic email address is not that easy to reach as i did not got any response.
      Do i have any other viable options around Europe?

    • #32911
      Good intentions
      Participant
    • #32913
      drtowfigh
      Keymaster

      Couple of comments:

      – Dr Victor Radu is the most talented surgeon I know in Romania. Not sure who your surgeon was.
      – Lateral hernias are a different situation than midline hernias. The muscles are weaker. Hernia repair outcomes are worse. I’m curious how your repair was secured. Eg, we have moved away from pinning sutures into the bone. A TAR was likely performed because the defect was too wide to close without a TAR. Do you know how wide the defect was?
      – Lateral/flank repairs will feel tighter than the opposite side. Fortunately you had lightweight mesh and it was placed retromuscular. That’s the best option.

      I’d review the operative report to see the technical issue that may be contributing to pain. Perhaps some sutures can be removed. Mesh removal will be difficult and likely result in worse outcomes. Physical therapy and even neurotoxin injections may help.

      The surgeons mentioned focus best on groin and I doubt they would be able to help you.

    • #32914
      Jack2021
      Participant

      If you don’t have any luck with Dr Towfigh’s suggestion of Dr Radu, you can access Dr Koch, Dr Wiese and Dr Muschaweck through Biohernia – https://biohernia.com/.

      You could call/send them the details you posted above and see if Biohernia are able to check if any of those three surgeons may be able to help, or recommend other surgeons alternatively.

      Two other German hernia specialists you could also try:

      – Dr Joachim Conze, who runs the Munich Hernia Centre – https://www.hernien.de/

      – Dr Ralph Lorenz at https://www.3chirurgen.de/

      Good luck!

    • #32924
      Nightmare
      Participant

      @drtowfigh, thank you for taking time to reply and offer some suggestions.

      I will reply below to some of your comments:

      – Dr Radu was the person who performed the surgery. 🙂

      – As far as I understood the mesh was not secured, just the space was created but it was also inserted starting below right side of the rectus muscle till my hip or at least ‘as much as he could laterally’ this is how he expressed after the surgery. (15cm long by 9 cm wide). Also he said that I can still develop an inguinal hernia as probably the mesh is not covering that canal. Maybe these details matters for your opinion.

      – also I understood that I have some permanent sutures in my muscles, i can feel them also by touching the scar through the skin etc.

      – on my pre-surgery CT my defect was 0,5 cm wide by 2-2,5cm long. During the surgery i understood that the defect was larger but maybe also due the abdominal gas that they inserted when the did the measure etc…

      – the main problem that I have is with my back, I always feel that my torso is twisted to the right flank, and my opposite side of the ribs / rhomboid / trapezius muscles /erector muscles whatever is overcompensate or being forced to work in incorrect posture.
      I also have the feeling that my rectus muscles is pulled or stretched to the right flank and you can see also when I breath how my linea alba is bended in a C-shape.

      I felt this way and saw it immediately after the surgery, but the back pain became worse and worse.

      When it comes of the PT, I’ve tried almost anything, i have the work ethic and the patience when it comes to recovery, sports etc …I’m stretching my back daily ,trying to make it stronger at least to improve a bit my situation ,but nothing seems to work at least till now.
      My concern is that somehow I might see that I start to develop an overstretch of the linea alba.
      P.S. – I’m not overweight, never been ,so no extra abdominal pressure.

      From running ultramarathons with that whole in my right flank to this…never anticipated to be honest.

      I don’t know what to do, or if I can do anything, but I’m miserable and my back hurts even if I seat all day on a couch doing nothing.

      • This reply was modified 2 months, 4 weeks ago by Nightmare.
    • #32931
      Good intentions
      Participant

      Here is a video discussion that Dr. Towfigh had with Dr. Muschaweck. Her focus is on the groin, both sportsman hernias (athletic pubalgia) and inguinal hernias. But her specialty is athletes. If she does not have a solution she probably knows somebody in Europe who does.

      If you’ve already seen the top surgeon in Romania and you have problems then you will need to broaden your search and try to learn on your own. One problem in having a well-known surgeon is that they have a reputation to worry about, and, often, like many smart people, they might have problems accepting that what they did did not give good results. This forum and internet sites around the world have stories of top surgeons avoiding their former patients when they have problems. It’s just the way things are. My surgeon was chair of surgery at a large clinic and was even recommended on this forum. He did his best to get me to move along to someone else, or to just to accept my fate of a degraded life. Luckily I found a surgeon who was able to help me, after a long and tedious search.

      Good luck and don’t give up hope. The big names might not be the ones who can help you.

    • #32965
      Nightmare
      Participant

      @good-intentions , thanks again for trying to share of your experience and wisdom.

      even if I have a new user on this forum, believe me, I’ve read almost all topics in here , I saw what other people are struggling with …tried maybe to learn something.

      The video I already saw it right away after the live session.
      It might be that Dr. Muschaweck. cannot help my particular case as she is more oriented to groin hernias, and mesh problems in groin erea etc

      Immediately after the surgery I almost had a consultation with Dr Muschaweck, but it went down as I could not travel that time to Germany, and afterwards tried everything that cross my mind to improve my side effects from the surgery.

      The top surgeon in Romania, with whom I that had a very detailed chat upfront my surgery were I explained what I do and likely would like to do afterwards, and somehow he kinda told me a story that I will be ready for going back at the same level in max 6 weeks, as this is pretty routine …

      Immediately after the surgery, I told him that I have the feeling that my torso & rectus muscles feels like the are twisted or dragged in the right flank, told me something like : “even DaVinci sculpture weren’t symmetric” – and I can swear to God that this is what he gave as a reply.. 🙂

      He also said that these feelings that my torso is twisted is just in my had and that I’m emotional..
      I said ok I will give it 6 months – 1 year ,1,5 years , but what if that feeling will never fade away and the problems that I have will still be there, what then?

      He told me directly like this ” the mesh will get out only when you will be in the ground” ..

      So that was my last appointment ,never been/talked to him since then..

      I went to other 5 doctors in Romania, they all gave their opinions about my situation and all 5 saw what I’ve complaining, but only 2 of them said that would be a great idea to explore what is happening with the mesh and to consider to remove it as something over there is “to tight”.

      The others said that mesh/mesh explanations are not something that they don’t do, one of them was pretty honest and said he is afraid that somehow will make it worse.

      Right now trying to find somebody that would like to understand exactly what is causing my back problems and if is the mesh can we do something about it?
      If yes, what are the risk of doing more damage that currently I have…

      Anyway , I really don’t get it, how a doctor will deny immediately a patient when he says that he is feeling that something is hurting or not ok.
      I mean I guess he has the medical expertise of 15-40 years whatever , but also us we lived in our bodies for more than +30-40 years, should be a joint efforts and based on both experiences…
      I mean , I’ve ran ultras , I know better that anybody what physical pain is and how u can manage it , also I know almost every piece of my body how acts , muscles engagements , laxity etc. I have a high level of body awareness and somebody saying that its all in my head…

      I had +3 years ago my ACL surgery , recovery is hell , and went from marathons to ultra without my ACL in my knee…So, I know what pain is, I know that sometimes recovery is like watching the grass grow…but my problem that I currently have I felt it from the first day after the surgery that is not something that will go away… but I said ok lets give it time to settle it, sometimes I started to doubt myself maybe indeed is in my head.

      I did every day since, and I mean it , every day PT and I cannot find the right path to improve it or contain at least my back problems.

      Anyway..its been and gonna be a hell of a journey

      • This reply was modified 2 months, 3 weeks ago by Nightmare.
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