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Pain pattern and mesh removal
Hi,
I am new to this forum and I appreciate all the useful contribution on this site.
I live in Denmark and my hernia story is described in the following:Male,
Age: 37
Weight: 67kg
Height: 180cm
Trying to stay in shape via running.In 2014 I experienced mild pain dragging down towards my right testicle. No hernia was revealed during several CT and UL scans nor by physical examination. The surgeon thought it appropriate to do an exploratory laparoscopy. I agreed and was looking forward becoming pain free. Therefore, I underwent surgery December 2014.
The applied method was TAPP. The surgeon found 2 tiny hernias, a lateral and a femoal. Consequently a 10x15cm reinforced polypropylene mesh (Gal-mesh) by the Italian maker Gallini-medical was applied and fixated via Histoacryl, a n-butyl-2-cyanoacrylate glue.
The peritoneum was closed using V-lock 3-0.
By the time I woke up from surgery I was in a lot of pain. I was given more and more morphine to control the pain.
I was told by the surgeon that surgery went fine and the pain was normal.
I was discharged despite a lot of pain – could not stand up straight or lie down. The next day in lots of pain I contacted the hospital again. I was readmitted the following morning but quickly discharged with strong analgesics.
Today, I am still in pain unfortunately. I am not sure about this but, to me the pain is not similar to what most other patients with post-operative hernia pains typically experience. It is not burning or stabbing and it is not a sensation on the skin. Rather, it is a deep thumping pain, like somebody pushing their finger directly where the mesh is placed, not removing it again. It is provoked by stationary positions, primarily sitting and lying down. Physical activity however, is able to relieve the pain. Thus, rest recovery and restitution presents a challenge in my everyday life, as well as social engagements can become overwhelming tasks. I have been taking Gabapentin for a few years which may seem to help a little bit.
In October 2017 I underwent a small re-operation at a specialized hernia-unit to investigate if the mesh had created a fold at the point where the pain is localized. But this has unfortunately not helped the pain.I am still affiliated to this specialized unit, which is the leading institute in Denmark regarding post-operative hernia pain. Through the years, the surgeon has been aiming at a double/triple neurectomy but I am very doubtful about this. I have therefore postproned this procedure for quite a while. This mostly because in my opinion (but also the surgeon),I do not display the typical pain characteristics; stabbing, burning etc. + I think the 15% risk of worsening is a lot.
Then, change of plans. The latest visit to this unit the surgeon suddenly said that the mesh needed to come out. Years ago, I asked about getting the mesh out. But at that time it wasn’t possible and would only make it worse, the surgeon told me. So now I am confused. Several years of rejection against mesh removal, and now this. I am not sure what has triggered the surgeon. Apart from that, I trust this surgeon – I asked how many meshes he has taken out, he said about 25-30. I don’t know if that is a lot?Has any of you experienced the same type of pain pattern?
Do any of you have the same mesh implant?
What are your experience with mesh removal?
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20 Replies
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Dear Stonehood
The site of your pain could be the mesh or a nerve.
Ask your surgeon to inject the mesh with a local anesthetic and if you feel better I would then advise a steroid or PRP injection.
Then try a nerve block if injecting the mesh is not helpful.
Regards
Bill Brown MD
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That X alone doesn’t help me figure out the cause of your pain. My patients often undergo over an hour of detailed investigation, examination, imaging review, etc., before a plan of care can be determined.
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Dear [USER=”2580″]DrBrown[/USER] and @drtowfigh
I am very grateful for your response.
I indeed feel it is a big decision having the mesh removed – however, it is the direction things are going now.
What is your opinion about the location of the red cross in the picture?
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Dear Stonehood.
I believe that your best chance for pain relief is to have the mesh removed.
I know that is a big decision, but you need to get your life back.
Best wishes.
Bill Brown MD -
Laparoscopic repair with glue for fixation has very low likelihood of nerve injury except for genitofemoral nerve. So triple neurectomy is not a good idea.
I would seriously consider removal of the mesh and just see how that goes. -
[USER=”2580″]DrBrown[/USER]
Certainly, I hope it makes sence now.
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[USER=”2580″]DrBrown[/USER]
Certainly, here you go. I hope it makes more sense to you now. -
[USER=”2580″]DrBrown[/USER]
Certainly, here you go. I hope it makes more sense to you now.
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[USER=”2580″]DrBrown[/USER]
Certainly, here you go. I hope it makes more sense to you now.
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Dear Stonehood.
I do not understand the exact site of your pain. Would you feel comfortable posting a photo of yourself with marks on the skin that identify the sites of your pain.
Regards
Bill Brown MD -
Dear All,
I have had 3 local anesthetics. First and second with 2.5%Bupi 40 ml at trickerpoint(pain area, very painfull). Third with 2.5% macain ca. 20 ml. These did not help much. I could still feel the pain. When using dermatome Mapping it all ends up with O’’s. I do not experience any noticeable topical pain certainly no numbness. Will try to describe where the exact pain is; point max 1 cm below christa iliaca sup,- about 6 cm medial for this -– a feeling of a small bulge in the depth. -
Dear Stonehood.
Consider diagnostic injections. For example, if the mesh was injected with local anesthetic and you felt better, then that would be evidence that the mesh was the source of your pain. If that did not help, then inject the local nerves with local anesthetic. Repeat the process until you find what is the etiology of your pain.
Regards.
Bill Brown MD -
Imaging can show if the mesh is folded, if there is a recurrence, and other causes for pain. It helps with planning of the next best step.
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Here is a link to the Gallini Medical products site, I think. No mesh products shown.
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quote Stonehood:Hi,
I am new to this forum and I appreciate all the useful contribution on this site.
I live in Denmark and my hernia story is described in the following:Male,
Age: 37
Weight: 67kg
Height: 180cm
Trying to stay in shape via running.This mostly because in my opinion (but also the surgeon),I do not display the typical pain characteristics; stabbing, burning etc. + I think the 15% risk of worsening is a lot.
Then, change of plans. The latest visit to this unit the surgeon suddenly said that the mesh needed to come out. …..I am not sure what has triggered the surgeon. Apart from that, I trust this surgeon – I asked how many meshes he has taken out, he said about 25-30. I don’t know if that is a lot?
Don’t be afraid to ask the surgeon the hard questions. The fact that he changed his mind means that what he thought he was right about yesterday he does not feel is right today. He should be able to explain why. The world needs more surgeons to accept that fact that maybe they’ve been wrong or led astray. Holding on to the wrongness just delays the inevitable and harms more people along the way.
You probably have your own feeling of what needs to be done. We all know, generally, how nerves work and can tell when a specific part of our body is affected, or a more general area. In my case I could tell that everywhere that the mesh contacted my body was a problem, and that every day it was there was causing more damage.
One thing that you want to consider is if the surgeon plans to perform neurectomies during the mesh removal. Just because he recommends removal doesn’t mean he won’t still do neurectomies. There are surgeons out here who perform neurectomies during mesh implantation, as a preventive measure. It seems unethical and probably is but one posted so on a different forum.
You might consider the clinic in Germany. They do many mesh removals and have a focus on athletes. Many professional athletes travel there, apparently.
Get more details from your surgeon. Good luck.
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Interesting that you suggest imaging.
I have actually already had CT and MRI scans after my surgery. All of this was mandatory to my referral to the specialized unit with a medical approach. The images has mainly been used to eliminate other factors.
Now the focus has shifted from a medical approach to a surgical approach (mesh removal). Therefore, I am interested in what type of images you would suggest and specifically what to look for in those images. -
Pain is complex and there are many reasons for it after laparoscopic repair.
Mesh removal may be necessary but I would not do it u til there is an understanding of why you have the pain. Imaging is necessary. Triple neurectomy is not Indicated.
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In the operative report, the surgeon states a lateral hernia and a “presumed” small femoral hernia.
Regarding the mesh, I have never been able to track down an approval. I am also concerned about that – unfortunately it seems the regulations in Europe are less restrictive than in the US.
I’m actually also concerned about the glue used for the fixation. Specifically the toxic nature of the degradation products as well as the exothermic reaction during polymerization.
Well it started with some irritation dragging down the right groin towards the testicles. I had my testicles US scanned before the surgery, they were both fine. The pain I’m having now doesn’t compare to the pain before surgery. I’m am not experiencing testicle pain anymore.
I have seen an urologist after the surgery, everything checks OK.
I experienced the testicle issue for a few months prior to surgery – however the surgeon was fairly confident she would be able to relieve my pain, so I was all for it. If I had known what I know now I would NEVER have agreed to the surgery. The surgeon told me before surgery that if a hernia would appear she would implant a mesh. Here, it is common procedure. One size fits all, no tailored procedure, unfortunately. -
Taking out 25-30 meshes is enough to be experienced, but of course 250-300 would be much better for dealing with any possible complications during and after procedure (like airplane pilots, the more hours you have the better).
Hard to help here but I’d take mesh out. Also I doubt those hernias that escaped physical examination, CT and US be real. Those hernias seen by laparoscopy only might be false positives IMO.
Then I’d check if I really had a hernia. If so I’d prefer a non-mesh repair. Also many people here have groin hernias and they agree with me for sure that they are painless unless there’s a complication (generally requiring urgent surgery).
Sportsmen sometimes have groin pain related to anatomical structures involved in hernia that must be diagnosed by experienced people and special imaging studies.There’s never any visible hernia anyway IMO.
All this started with testicle pain. Did you have an examination by Urologist? Also I presume pain was severe and long-lasting enough for you to take exploratory laparoscopy. Is this correct? And after surgery you never felt testicle pain again?
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What a case. Maybe removing mesh would be best option.
I wouldn’t take any neurotomy especially just to see what happens.
Are you sure there was a femoral hernia? That’s quite unusual (yet dangerous) particularly in a man.
Can you check an approval for that mesh? I can’t find any. Is this normal for a medical device? Also their site http://www.gallinimedical.com doesn’t exist.
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