Mesh works for…

[ajm222]

David – my original hernia was indirect. I think it wasn’t particularly large, though I did have a noticeable bulge that I can push back in at times. My BMI is right at the border of normal and overwieight but only because I am especially dense and have a fair amount of muscle. The BMI stuff doesn’t really apply well to me. I look very thin.

[Mike M]

Keep in mind all the leading tissue doctors we mentioned (Dr. Kang, Dr. Grischkan, Dr. Sbayi, and Dr. Yunis) are “ok” or will “accept” BMI up to and including the low 30%.

Obviously the lower you can get your BMI the better but it can still be a very strong and viable permanent option from all the mentioned specialists+ surgeons if you are “overweight” or above “normal” BMI as long as you still fall within their required guidelines.

Unfortunately there are a lot of “overweight” patients in the United States and those patients shouldn’t be discouraged from avoiding a pure tissue repair (if so desired).

Personally I would be concerned with a repair being strong enough over the long haul if the guidelines were too strict regarding BMI because anyone could gain additional weight as they age down the road unexpectedly.

[David M]

Ajm, was your hernia direct or indirect, how big was it and what is your BMI?

I want to consider strongly tissue repair and I have a low BMI, am thin, which might favor tissue, but the hernia seems to be direct and seems fairly large,I’m guessing, about the size of a tennis ball. Large directs were discussed by Dr Towfigh and one of her guests and they said they would go with lap in such a case So, these are conflicting suggestions, I think. I am trying to get a feel for whether this size of hernia is disqualified from tissue repair.

Was just wondering about yours since it was post operatively suggested that you should have done tissue.
Thanks

[Watchful]

Going by the requirements of the Shouldice Hospital, you don’t need to be under a particular age, or have an athletic build. You just need to have a normal BMI (not overweight).

[ajm222]

i’ve talked to some reputable surgeons since the mesh surgery including Belyansky, my removal surgeon, and they all suggested that at my age at the time of surgery (41) and with my athletic and thin body type, i probably should have always been steered toward open tissue repair. most of them think mesh is fine, but in hindsight open tissue repair should have worked perfectly well for me.

[ajm222]

I do still have issues and they are similar to before the mesh was removed, but they are better. less of the tightness. i am glad so far that i had it removed. i have not yet (after a year and a half) ‘gotten back to normal.’ but i am better in some important ways. i am very active. i am hoping in a few years there will be more improvement that i see. psychologically it was also good to get it out.

i will add that recovery from any surgery takes a decent amount of time, and folks just a few days or weeks out from mesh surgery really aren’t going to know how they will fair ultimately for quite some time. though i had moderate discomfort and pain from the beginning that just never fully subsided, and then eventually the tightness and discomfort got worse and i started having some other issues. i was never in severe pain or discomfort.

[William Bryant]

Thanks Mike,

Can you update us on your repair when you have time, although I can tell you afe full of beans so I’m thinking it’s A, OK !

Yes Dr Kang repaired the cyclists hernia who had heart problem. Also COPD patient and someone over 100 years I think.

My issues are

High blood pressure (on ace inhibitor)
Mild or moderate copd (not on anything, no inhalers or oxygen)
Slight enlarged prostate but not on anything, could go on tablets if need be.

I’m not over 65
I’m about 5’6 and weigh about 11 stone.

[Mike M]

These were my personal guidelines / cutoffs when I was considering Mesh:

#1. Age – 65 or older.

#2. BMI – 40% or higher

#3. Underlying health condition – (Connective tissue disorder, Marfans, collagen production issue, etc.)

None of those applied to me.

However if any of them do apply to you there are still open tissue options to at least consider:

#1. Age 65 and older – has not been a major factor with the Kang repair or Shouldice with countless success stories in that age range.

#2. BMI – Lose weight or get down to the upper limit (Dr. Sbayi, Dr. Grischkan all maintain the low 30% range BMI as the limit.) if non-mesh is your goal. Shouldice Hospital guidelines are even lower but as MarkT said they will also assess people individually on a case by case basis.

#3. Underlying conditions – Not sure on this one. However I know Dr. Kang has worked on some very challenge cases on patients with advance illnesses.

[William Bryant]

Also my partner knows 3 people who had mesh….

1 perfect no issues
1 so so, manages on pain relief
1 terrible

Thats not brilliant odds. Granted small sample.

[William Bryant]

Have you still got pain after mesh was removed ajm? Is it less so though?

Thanks for reply. I don’t think I’ll be swayed into having mesh. It would be easier hospital and location wise. But as is often pointed out it’s to have a nesh repair after a tissue one (if need be)than vice versa.

That mesh works for some is pretty clear from a post on inguinal hernia support group UK where one person is weeks out from a mesh repair and just completed royal navy training lifting bergens (whatever they are but sound heavy).

Inguinal hernia UK group is a bit opposite of these sort of forums, a lot of mesh success with occasional disaster.

That said, by sheer fluke, there is a post from a us citizen saying they will only consider shouldice and with Dr Sbayi at stony brook. They say he has only had one recurrence!!!

[ajm222]

hey guys –

yeah, so I did reach out to a bunch of people and got mixed messages. Next door neighbor had three hernia surgeries and is totally fine. Only issue he had was the first open repair he got while in the army failed and he had it replaced with mesh, and then he got another mesh on the other side later. Had the usual stuff he said over a period of a year or more (occasional pulling or tugging sensations here and there) but nothing bad. Totally fine now. he did find the open surgery easier. lap was just really uncomfortable for him. same for me.

another guy had double mesh surgery and is totally fine. he also didn’t love the feeling he had a few days or a week after robotic surgery. but he recovered fine.

a third guy had mesh put in while in the army and always had some issues and then went in for a revision a few years later. that resulted in a month of almost being unable to go anywhere and he basically was housebound. nerve related issues. but those resolved and he claims to be fine now. i think they left the mesh in and maybe put more in and made some adjustments or something. he doesn’t even know. he didn’t ask. just said he was uncomfortable and went back into surgery as doctor recommended and he says he’s all better now.

last guy, older, had mesh many years ago and says it’s always been a tad off but doesn’t impact him too much. occasional discomfort but minor, and sometimes when bladder gets full he’s a little uncomfortable.

and then i have a friend who said her ex-boyfriend had mesh surgery and was always complaining about it. that’s second hand info for me.

none of these folks really recommended anything one way or another – they were just sharing their experiences. but i did find that when probed for more information occasionally you’d get that thing where they said everything was fine but then when pushed a little harder, they’d say something like ‘well, yeah, once in a while such and such is sore, or i have this minor discomfort, etc etc’. But most ultimately wound up satisfied to the extent I never heard them complain about it and they never did anything further about any issues mentioned. and when you reach a certain age i think there are always some aches and pains you can’t really determine the source of, so a lot of minor issues become white noise.

so i do think it probably works fine for the vast majority. i was definitely not in that category. but to this day i’ve still never understood why – if it was truly a mesh issue or if i have some extreme pain sensitivity or psychological issue. it’s all very confusing. but ultimately i did need mine removed because i wasn’t able to overcome the discomfort i was dealing with.

logically, i have no idea why implants work at all and don’t result in constant problems for everyone. you’re sticking some artificial material inside a body that doesn’t want anything foreign there, and will at some level always mount a response. and healthy tissue and nerves and stuff grows in and around the material. and we’re told not to drink out of certain types of plastic bottles to avoid microscopic exposure to the stuff, but then the gold standard for a hernia is to jam a large mesh piece of it into a body cavity that experiences tons of flex and constant movement and is surrounded by lots of important structures. and somehow this thing is supposed to stay in the right spot after surgery for long enough to result in a nice clean patch repair. meanwhile the implant itself shrinks and has no ability to be particularly flexible over time. it’s just wild.

so was the mesh an issue for me? or did i make it into an issue with worry? would i have been fine if i avoided this forum and done zero research before surgery and just trusted the doctor that it was no big deal? or am i gaslighting myself thinking that? no clue. pain and discomfort very complex. people with totally messed up spines are out there walking around with no pain at all, and people with perfect spines and effectively disabled, and no one truly understands why. there are people with total body pain and fibromyalgia and we don’t understand that either because on exam everything seems fine. there are days i have very little pain and other days where i have a decent amount. i can make the pain almost appear (or disappear) out of nowhere at times if i think about it, and then other times when i am relaxed it will be there. stress seems to make it worse, but not always. exercise sometimes makes it worse, sometimes better.

it’s a mystery.

[William Bryant]

Ah thanks Good Intentions.

I’ll search it out thanks.

[Good intentions]

If you go to ajm22’s profile you can go back to his first posts and see the progression of his journey. He started where you are now. He talked to many many people and had several friends/acquaintances who had had mesh repairs. They told him that he might as well get it done, although some of them seemed not quite happy with the results, if I recall right. I got the impression of people resigned to their fate, suggesting that there was no better way available.

He had the mesh implantation, then some years later had it removed. You’ll have to read the old posts to get the full story. If they are still available.

[William Bryant]

Sorry Good Intentions, what did ajm’s friends tell him? That mesh works ok?

At the moment Ive said yes mesh can work fine… But it can play up years later..

I do have that right?

I did say before the operation to them that when mesh works it works well. But when it goes wromg…….

[Good intentions]

It’s human nature to want other people to come along with you when you take a risk. ajm22’s friends told him the same thing.

[William Bryant]

Keyhole I believe.

It’s put a bit of pressure on me as Ive been told I’d be stupid not to let NHS do it…. But the horror stories are exactly that.

Would you ever consider mesh?

I just think it’s a massive risk. Yes if it works, it works perfectly but if it doesn’t…

[Watchful]

Yes, it’s possible for pain to develop later with mesh.

Did your friends have open surgery or laparoscopic?