Optimal BMI for mesh removal..?
03/11/2017 at 9:26 pm #10974marcello71Member
I have noticed(from lap surgical mesh removal vids) that a large factor determining how stuck & scarred the mesh becomes(to vital blood vessels & nerves in the groin) is how much fat is insulating the area. This also determines how easy it is to remove mesh from those areas. A few surgeons have also said to me: “whether the lap placed inguinal mesh can be removed from the iliac vessels safely or not depends on if there’s a layer of fat there”. However most surgeons also say it’s best to be as healthy, fit & skinny for any surgery to have the best outcome.
So my question is, is it better or worse to have more fat or a higher BMI before lap placed inguinal mesh removal?
I mean does having a slightly lower BMI for overall health reasons really outweigh(no pun intended) the benefits of having more fat layering to insulate the mesh for easier extraction?
I’m sure it’s not black & white either way but pros & cons would be great to hear about regarding this…
03/12/2017 at 7:40 pm #14583drtowfighKeymaster
True and astute observation: if you have more fat under the area of the mesh placement, then removing it is somewhat easier over sensitive areas, such as nerves and vessels.
That said, we don’t typically place mesh with the primary intention of removing it. :p
Very very thin people have virtually no fat in these spaces. They have been shown to have more postoperative chronic pain, possibly due to the lack of fat to buffer some of the inflammation and stiffness from the foreign body. I usually tailor options for patients, including taking their BMI into account, when recommending options for them surgically.
Most people naturally have fat in these places, even if they are considered thin by U.S. standards. That amount of fat is adequate. Also, you cannot gain fat in the retroperitoneum. You either have it or your don’t and gaining weight will not preferentially increase the size of the fat cells in the region. If anything, gaining weight may jeopardize the outcome after mesh removal, by increasing surgical site infection risk and hernia recurrence risk.
Short answer: no, we do not recommend gaining fat prior to mesh removal.
03/16/2017 at 7:18 pm #14593marcello71Member
Thank you Dr Towfigh this is very helpful to know, I will be continueing to stay fit prior to removal now.
I also saw a presentation of Dr Novitsky explaining the value of taking L-Arginine prior to surgery, is this a good idea too?
Are there any other OTC supplements that are good to take pre-op to maximize the possibility of a better outcome?
How often do you find that the lap mesh over the iliac artery is too risky to remove as a result of the patient not having enough fat there to buffer it?
In other words, how often are you able to remove all 100% of a lap placed inguinal flat mesh?
03/22/2017 at 1:25 pm #14602drtowfighKeymaster
Dr. Novitsky has published about preoperative optimization. L-arginine supplementation has been shown to improve outcomes from abdominal surgery. Nutrition in general is important, focusing on a high protein diet, as proteins are the building blocks of healing. Vitamin C and Zinc supplementation are associated with improved healing. Not much research has definitively shown any other OTC supplement to help with healing.
For sure, removal of mesh off the external iliac vessels can be risky. I have removed all the mesh in all of my patients, with 4 exceptions. However, I see patients with mesh-related pain, not just meshoma-related pain, so 100% removal is more important in that subset of patients.
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