New here and desperate.

[Watchful]

William,

It’s a well-known technique used in severe intractable cases of pain. It’s more commonly used in bad spine issues.

[William Bryant]

That’s good of you Dr Towfigh. Edward’s situation is a terrible one and everyone here has been struggling to help..a 2nd opinion would be helpful I’m sure.

Im still not sure if the spinal procedure is used by others. It seems like it may be better than just snipping all the nerves which is my impression of neurectomy or is any similar attempt usually made to locate the one or ones concerned?

I’ve not heard it before.

[drtowfigh]

Details from the first surgery and how it was performed is key. Eg, was it a keyhole technique?

Mesh allergies/reactions don’t present with local pain.

I’m concerned you’ve had so many back to back operations. I’m curious what the thought process was behind each one. And what was the technique. Each operation has its own risks and thus may be causing you to be further injured if not performed by a specialist.

Post your first operative report here if you’d like. Alternatively, I offer Online Consultations to help figure these puzzles out and provide advice on next steps. You can contact my office directly.

[Watchful]

Right, it sounds like something bad or wrong occurred during the first surgery.

Decisions after that are extremely difficult. Do you let the same surgeon reoperate to try to fix it? They are the ones who “botched” your first surgery, so why trust them with a revision which can be even more challenging? On the other hand, they may know best what’s going on in there because they did the original surgery. Extremely tough situation. My inclination would be to avoid using the same surgeon who may be in over their heads on revisional surgery since that’s not something they normally do. Also, it would be hard for me too maintain trust. There could be special circumstances where I would still go with the same surgeon.

[Good intentions]

I read through your story again and, to be frank, it looks like your first surgery was not as “neat” as it should have been. You said “lesions” but I think that you meant adhesions. That is one of the big worries of all laparoscopy surgeons, adhesion of the intestines to the abdominal wall via a damaged peritoneum.

You didn’t say whether your surgeon used the TEP procedure or TAPP. The big advantage of TEP, apparently, is that the peritoneum is never opened, so the abdominal wall, the fascia, and the intestines never come in to contact with each other. The adhesion problem is dramatically reduced. But, a good TAPP surgeon is aware of these problems and will take extra care to close the peritoneum tightly after placing the mesh. In other words you really should not have any adhesions or colon problems. It’s not “normal” for mesh implantation. Scar tissue problems are not common for a simple mesh implantation.

The adhesions are probably why your surgeon used an open procedure to remove the mesh. Because the adhesions were blocking his entry points, or because he was worried about causing future incisional hernias at those points. The adhesion path seems to be one of those vicious cycles where attempts to remove the adhesions can cause more adhesions.

These are just thoughts from all of the reading I’ve done, I have no professional training in the area. As you probably realize all of these surgeries are really not healthy for you. Besides the multiple areas that have to heal you have all of the anesthesia to worry about.

To the points about getting a second opinion be aware that if the other experts were all from the same business group, or partnership, they have a vested interest in not finding fault with their partners’ work. It’s just one of those realities of business. You’re in a tough spot and you’ve already started down the “try something new” path. Be careful, and objective about what is going on. Your situation is more complex than most of the horror stories in this forum. Your surgeon might be trying very hard and honestly but he might be in over his head.

Good luck. Here are some articles that might help your thinking.

https://www.science.org/doi/abs/10.1126/science.abg5416

https://scholar.google.com/scholar?as_ylo=2019&q=surgery+adhesions&hl=en&as_sdt=0,48

[Good intentions]

There seems to be something happening in the Bard 3D Max world. The volume of reports in the FDA MAUDE database has jumped dramatically since 2019.

Put 3D in the Brand Name box and leave the other boxes blank. The attorneys seem to be getting ready to identify 3D Max products as a problem. I searched for other products like SoftMesh that was used on me and nothing comes up. It’s a poor database but it might mean something. Maybe Bard (BD now) made a change in the product and it was a mistake. Make sure to change the date range, it starts with just a one month span.

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm

[William Bryant]

Thanks for the clarification ref the spinal procedure. That at least does sound a better way than just cutting.

I’ve never heard of people on this forum having it done so think that’s a plus for you and your surgical people. Unless I’ve missed it on this forum.

Has anyone else heard of it. I don’t think it’s standard but i think it should be to locate nerve responsible.

[sensei_305]

Sorry Edward, I had the same mesh you did and mine was removed bilaterially as well by two different surgeons. I am scheduled to Fly back to Seattle in November – Thanksgiving week to get tissue repair done since I have a recurrence. Good luck man, hope you get better soon.

[David M]

I agree with everyone else, Edward, that in spite of your trust in your surgeon, you should get another opinion from a hernia specialist.

I say that, though I’m just going for my initial appointment next month. I had set up an appointment back in February, but the ice storm occured and I couldn’t drive the moderate distance to the appointment with the roads on that day. I think they were in the process of canceling the appointments when I called. Shortly thereafter I was plagued with a cough, which is just now getting back to normal.

The surgeon is the closest to me that specializes in hernias and he says he does Shouldice, so I figure it is a place to start. I’ll let you know if I respect the guy. I don’t think he has ever been mentioned on the forum. He’s in the DFW area.

[Good intentions]

Hello again Edward and welcome to the Forum.

Even though you trust your surgeon it would still be wise to get a copy of your medical records, for sharing and for long-term history. There is still a wide array of different opinions on how to best perform a mesh implantation. For example, prophylactic neurectomy is often performed. In other words the three main nerves in the groin area are cut, on the premise that this can avoid future pain, and the premise that they serve sensory functions only. There might be something in the procedure he performed that is a clue to someone with expertise, like Dr. Towfigh.

3D Max is a polypropylene mesh that that is very common in lap mesh repair. Nothing really notable there as far as immediate biological response, like an allergic reaction. But, who knows for sure.

How soon after the implantation did you feel the testicular pain and the left side pain? Obviously it was soon but was it immediate? What type of pain was the left side? Very localized and specific or diffuse?

Also odd that the surgeon performed open removal after laparoscopic implantation. Most lap surgeons would have removed it by the same method.

Finally, the involvement of the colon still seems odd. In both TAPP and TEP the body is placed in a position that lets the intestines drop away from the abdominal wall, where they are safe and out of the way.

These are just observations and questions. All surgeons sound confident in their work. I don’t think that a person can be a surgeon without a high level of self-confidence.

Anyway, the surgery notes might have some clues. A good surgeon will not be offended if a patient with problems wants to take a look at them. They are available to all patients just by asking. Most places can send them by internet or on a DVD.

[Watchful]

It’s a tough situation, but I’m with William on this. I would consult with one or more of the top experts for their take on this if possible. I would have already done it earlier before jumping into reoperations with the same surgeon, but what is done is done at this point.

[William Bryant]

I dont really know what to suggest Edward. I know you say you have trust in your surgeon but I’m wondering if a second opinion, a fresh take, may be an idea.

I’ve not heard of pelvic stimulation for pain control – how does it work or intend to work?

Youve had it rough so wish you luck.

[Watchful]

You don’t really sound like Chuck, and your story is quite different. It’s just that in recent times all the “newcomers” turned out to be Chuck.

[Good intentions]

Thanks for clarifying. There’s a reason I don’t do complex things early in the morning. I felt compelled this time though.

So, rewording with more correct dates – bilateral implantation of the same 3D Max that Chuck had, late spring of last year, “revision”, whatever that means, 2 and 4 months later, (about one year ago), spinal stimulator 7 months later (no mention of what was happening in those 7 months), emergency surgery on the colon one month ago (although the colon is not involved at all in a mesh implantation), and the “exact same symptoms” remain, but those were not described.

Edward, if you are a real person, I apologize for making your post more complex. There is a forum member who has been creating new personas in order to make up stories, basically trolling the members of the forum. He had a bad mesh implantation experience and has been worried about the after-effects.

So, if you are real feel free to add to your story in a way that will make your legitimacy apparent. Sorry, but these alternate personas seem to be a new internet thing.

[Watchful]

GI – It must be month/year, not month/day.

Yeah, I really wish Chuck stopped popping up with new identities here. I don’t know if this person is Chuck too.

[Good intentions]

The story has many similarities with “Chuck Taylor”‘s story. The writing style is similar also.

You went from 4/22 to 6/22 to 3/23 and then apparently had emergency surgery on 6/23 the day after revision surgery, then the last event was 8/22. The spinal stimulator trial was a month before the mesh implantation. Is a “spinal stimulator” a method of treating hernia pain? By the dates there was a spinal stimulator, mesh implantation, “revision” (unclear what that means) 2 months and 4 months later, emergency surgery the day after the first revision, and a MRSA infection. This all must have happened over a year ago since it’s only July. Very confusing story.

Could you retell your story in chronological order? It doesn’t really make sense. What were your initial symptoms and how did you end up getting spinal stimulator treatment? Good luck.

[Watchful]

Devastating. I don’t have any ideas to offer sadly. Did they ever tell you what went wrong with the first surgery, and what they were trying to fix in the right and left open revision surgeries? Did you go to very experienced surgeons? Sounds like a huge amount of incompetence.

[Good intentions]

Oops, I posted the link below, then saw that it was your thread.

https://herniatalk.com/forums/topic/surgeon-recommendation-in-oregon-or-washington-that-repairs-without-mesh/#post-32226

• This reply was modified 9 months ago by  Good intentions.

Surgeon recommendation in Oregon or Washington that repairs without mesh?

[SN]

Which surgeon in the Seattle area would you recommend for a tissue repair?

[Edward]

Oh boy, you too. Talk about opening Pandora’s Box. I have clocked over 125 Dr appointments in 15 months – and counting. I am tired. I really do wish you the best. Please do update us.

[Edward]

Hi William, One thing I noted about the whole process; it was almost like being pressured into buying a new car. For example, I had to choose the type of stimulator to be surgically implanted – I “chose” one not only based on its performance record but also on the customer assistance I received from the techs who would be tweaking the settings and contacting me daily. I’ll stop short of saying I felt pressured into choosing this model, but it is definitely a money-making scheme, like everything else. What isnt?

[Edward]

I appreciate you taking the time to review my posts. Yes, the initial procedure was a “keyhole” surgery. After the discomfort from the gas dissipated, the pain in my groin was clearly evident, particularly on the right side. Okay, so I must admit that the “revisions” my surgeon performed were his second and third, ever. His first was a case referred to him. I suppose I am partially to blame for, shall I say, blind trust. I simply wanted the pain to be gone. Silly me. Quite honestly, my wife and I are willing to sell our home to be able to travel anywhere to find a physician to assist me. This forum has been very helpful. I do not feel so alone in this. I will reach out for a consultation. Ed

[Edward]

Exactly. That was my physician’s thought process. Why cut the nerves permanently when he can “control” the pain with nerve stimulation? Then, if necessary he can remove the stimulator, or even adjust the impulses based on my pain. Made sense to me.

[Edward]

Thank you for the thoughtful response. At this juncture, I have seen specialists both in, and out of my initial surgeons’ network. Because the mesh was removed, the hernias remain, and as you noted, scar tissue is becoming an issue as well. On one hand, I do not desire to be caught up in that cycle of surgery after surgery to repair scar tissue. On the other hand, I cannot live with this chronic pain. I’ll review the articles you forwarded. Thanks. Ed

[Edward]

Thanks for the info. Always learning.

[Edward]

Best of luck with that, really. I am pretty limited by my insurance though. for example, I have been on a waiting list for a colonoscopy for some time now – I am scheduled for my initial GI consultation in October. When I was admitted to the hospital this last time in June, they were going to do a colonoscopy but the abdominal surgery was too involved so I got bumped back. Just to be clear, I have two issues, the colon is just a byproduct of scar tissue caused by the hernia surgeries.

[Edward]

I have been to three hernia specialists, rheumatology, urology, and a peripheral nerve surgeon, all are scratching their heads. Oh, I am under the care of two pain specialists as well. I just feel like I am an enigma, and I have been called that by my doctors.

[Edward]

The spinal stimulator is placed specifically where the nerves (in the spine) control pain in any specific targeted area of the body; wherever they place the “leads” in the spine. For example, “Ilioinguinal neuralgia is a frequent cause of pain in the lower abdomen and the upper thigh and is commonly caused by entrapment or injury of the nerve after lower abdominal surgeries. The ilioinguinal nerve is responsible for motor innervation of the transverse abdominis and internal oblique muscles”, per the National Institutes of Health (.gov). The same goes for the other nerves commonly entrapped after hernia surgery. Rather than guessing and possibly surgically cut the wrong nerve(s) responsible for my pelvic and abdominal pain, they use a stimulator to control pain in the entire area (e.g., all the nerves). The stimulator can later be removed (albeit surgically) with ones nerves intact.

[Edward]

Bad timing I guess. No, I am not Chuck.

[Edward]

Hi, Thanks for replying. After the initial surgery, I had an extraordinary amount of right-side pain. Immediately, the surgeon thought he may have compromised a nerve so he removed the right side mesh. The same thing left side. Then, with continued pain, we thought I may be allergic to the mesh or the staples or tacks.

[Edward]

Revision means removal. My initial surgery was 04/29/2022. Then right side removal 06/22/2022. Then left side removal 08/25/2022. Then, for months, a lot of Dr. appts. and pain medication without much progress. Then spinal stimulator trial (for pelvic and abdominal pain, which they blamed on nerve overstimulation) 03/28/2023 removed 04/03/2023. Then abdominal surgery for scar tissue (related to hernia surgeries) 06/19/2023.

[Edward]

I am not this Chuck person. Sorry he is ruining this for everyone. How can I validate my identity? I really am attempting to glean information.

[Edward]

Hi, I am not sure who Chuck is but if his ordeal is like mine, I am amazed! Yes, my timeline was described as month and year; it has been 15 months since the beginning of my ordeal. All this began with a trip to my GP, who discovered my hernias, that was in February of 2022. My revision surgeries were due to the extreme pain, but also because there was a thought that I may be allergic to the mesh, or even, as we discussed later, the staples and tacks (we’re grasping at straws now looking for any explanation). My surgeon’s name is Stanley Deturris, he has performed all four abdominal and pelvic procedures. My stimulator was done by a pain specialist, Dr. Lipnick (I reside just outside Gainesville, Fl.). Yes, I know the colon procedure has nothing to do with hernias, however, it has a lot to do with scar tissue – from the previous three surgeries. Incidentally, I fully trust, and respect, my surgeon believe it or not. I just think my body is reacting bizarrely to these surgeries or something. I just do not know. All I do know is I am a real person, Edward Ruben, I am at my wit’s end, and I am hoping to gain and add to the discussion forums. Thanks.