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Mesh versus sutures? incisional hernia repair
Hello Dr Shirin,Firstly Thank you for your wonderful videos and common sense approach. I am not a medical student or doctor. Following a right hemicolectomy 12 years ago and during a routine colonoscopy three years ago I experienced an incisional hernia at the top of the vertical abdomen scar. This is the size of a “large” golf ball. In the UK we do not have hernia clinics. I have Lynch Syndrome ( hereditary bowel cancer) and am under the supervision of the amazing https://www.christie.nhs.uk/ hospital for routine surveillance.
My local doctor suggested the repair to be carried out at a major hospital in Manchester carried out by an eminent liver transplant surgeon who alleges he has carried out over 100 repairs. The discussion became, ” should it be carried out by him or by the colorectal surgeon at The Christie. This is part of the letter from the eminent surgeon as a result I postponed the operation after watching your video on suture repair.” We discussed the process of surgical repair as well as the use of mesh. I explained some of the potential complications associated with the surgery including risks of recurrence, damage to underlying structures including bowel & viscera as well as the requirement for a stoma. I also counselled the patient with regards to the small but important risk of death. We also discussed the potential use of tissue advancement techniques (component separation), pre-operative Botox use and the potential benefit and impact of this.
On balance, we agreed to proceed with hernia repair and I will arrange this for the near future under my care. The patient is aware of what they should do should they have any episodes of incarceration whilst awaiting surgery.
Open inguinal hernia consent:
I have discussed the various options (conservative, open and laparoscopic) with the patient who is keen to be considered for an open surgical repair of the hernia if at all possible. I have cautioned them with regards to some of the potential risks and complications including recurrence (quoted as 1%), pain and paraesthesia (quoted as 1 in 300), damage to underlying structures, mesh complications (including pain and infection), anaesthetic risks and ischaemic orchitis.Some concerns I have , ” component separation “, a simple term which seems dramatic.
I am considering paying for a private operation in Beverly Hills
Kind regards
Alan Collinge -
1 Reply
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100 repairs does not tell much. 100 repairs using a variety of methods could mean just a few tissue repairs or just a few mesh repairs. The words from the eminent surgeon are standard boilerplate warnings that all surgeons use for all surgical procedures.
Have you seen the original surgery records? It might be that you have already had a mesh implantation. Prophylactic implantations are a thing, although not so much 12 years ago. But if you did have mesh implanted that adds a complication. You’ll want somebody very experienced.
Ventral hernias are apparently some of the most difficult to repair. Good luck.
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