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Mesh sandwich / sandwiched fascia
I have a question about dangers of TAPP repair of recurrent anterior plug and patch.
I have been on this forum before and to sum up the situation in just a few words – I am in my 30s and two years ago I had an open inguinal plug and patch that was unsymptomatic for over a year. Last fall, however, a small bump appeared in the area lateral to the internal ring, possibly where those Liechtenstein patch cut flaps are located, at the edges of the mesh close to the hipbone. Imaging was not conclusive to determine if this was a recurrent hernia, a regrown lipoma or a scarred/calcified plug pushing on the prolene patch.
But let’s suppose that it is a recurrence. So, what would be the best way to fix a plugged-and-patched inguinal recurrence?
The surgeons I have seen disagree. One has said that TAPP is the ideal way to fix this recurrence (if it is that – TAPP will tell) by taking out the plug and putting in the new mesh (no staples) over the defect.
Another surgeon had told me that this is very dangerous. It will lead to a condition, similar to PHS, where my transvers. fascia will be sandwiched between an anterior onlay and posterior outlay mesh patches. This will squeeze the life out of the fascia, squeeze on the nerves, leave me in greater pain for the rest of my life and would render me inoperable in that area in the future (for example, appendix or prostate lap surgery). Furthermore, unlike one layer meshes, this double layer mesh sandwich is virtually impossible to remove if it gets infected many years down the road. The only way to remove the mesh sandwich would be to remove the fascia that is sandwiched in between scarred meshes thus leaving me without fascia, just a hole in the abdomen.
Any thoughts on this? This mesh sandwich business seems very scary. How serious is a possibility that TAPP mesh sandwich will make matters worse? How credible is the assertion that the only safe way to treat a recurrence is through another open surgery and revision of the original mesh or adding an onlay mesh?
How often do surgeons repair failed plug-and-patch or failed Liechtestein inguinal hernia through TAPP and what are the success rates in terms of avoiding chronic pain and avoiding death to fascia cells in between?
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3 Replies
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Mesh sandwich / sandwiched fascia
Gardner,
It looks like things a going slowly for you. Again if you can get out of Wisconsin for help, go to one of the top hernia specialists. I was denied multiple times MRI to find out was wrong and again go to a surgeon that does this type of surgery all of the time not once in a blue moon.
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Mesh sandwich / sandwiched fascia
1st surgeon seems on the right track. Recurrence after open inguinal hernia is typically best performed via laparoscopic approach. If the hernia recurrence is from the plug repair, and the plug is in the way of a good laparoscopic repair, then it can be trimmed at the time of laparoscopy.
I have no idea what the second surgeon is describing. I do not agree with the concerns presented. We don’t see that in clinical practice. The best practice standard is to approach the hernia recurrence from an open repair via laparoscopic approach. That approach provides lower risk of hernia recurrence, less risk for chronic pain, best long term and short term outcome.
MRI is best imaging to evaluate recurrence after mesh has already been implanted. CT scan cannot clearly differentiate between mesh and muscle. If MRI is denied, which many insurances attempt, then your surgeon needs to seek peer to peer review to get approval. I had to do that with two patients today. Such a waste of my time but I had to do it to get my patients evaluated the best I can.
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Mesh sandwich / sandwiched fascia
I don’t have the answers for you but hope the dr can chime in. I just wanted to say I’m sorry you are going through this and hope that you will get the correct surgery to help resolve your issues. It seems very involved and I’m sure you are gathering all the information you need to make an informed decision regarding your health. Best of luck to you. Have you considered consulting with any of the top
Hernia doctors mentioned on this site before? You might have to travel but am sure it would be worth it.
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