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Parietene Mesh removal vs pain management.
I am being referred to pain management and am willing to do anything to reverse my pains.(sharp flank and abdominal pains running up to ribcage as well as spermatic cord pulling pains ontop of pubic bone).though i am ultimately wondering if mesh removal within 2-3 months of implantation is early enough to get it out in one piece? It is a parietene onlay mesh implanted via open surgery. Currently 2 months out. My biggest fear is pain management not fixing my pain And waiting too long to have it removed in a safe manner. Then again it seems like there is a chance of further damaging my body regardless of how long the mesh has been growing into my muscle tissue. So many questions..so few answers..any wisdom or professional opinions are appreciated greatly. Thanks again
Josh -
11 Replies
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It looks like you’re taking the right approach, collecting information from the experts. Fascinating though that there are so many different opinions.
I found that over time I developed a fairly accurate idea of what was happening with my mesh problem. It was a broad-based inflamed feeling, wherever the mesh was, with a specific area that felt wrong. And that’s what was found, a folded area with nerve entrapment in the specific area and edematous tissue, tissue swollen with excess fluid, wherever the mesh was. As you learn more about how the mesh was placed and what was intended and what could have gone wrong you’ll probably understand what the root cause of your problem is.
I would still follow up on the odd parts of your notes. You might find that they are incorrect, or that they are correct and the wrong mesh was used. Parietene is not indicated for inguinal hernias. That might be a more significant reason to have the mesh removed, if he used the wrong material it might be prone to worse problems in the long-term. “Transparent” polypropylene is not the same as normal semi-crystalline polypropylene, and the anti-adhesion properties might give unknown results. You might be part of an experiment.
I hope that you find a simple solution but it’s best to be prepared for the worst.
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Friends issue was excruciating groin and testicle pain.though his mesh was placed laparoscopically so that probably would make the apple to oranges difference when I think about it..I took his advice with a grain of salt but in a hopeful way. I agree that it seems there is some sort of nerve involvement in the 10 of 10 ten pain..its right where my nerves could be entrapped. I spoke to dr brian jacob on the phone the other day and explained my situation. Told him I woke up from surgery and the pain was excruciating and radiated all the way up to my ribs in two lateral fashions. He said that seemed abnormal and if it were up to him he would remove the mesh and bring me back to normal anatomy. I spoke to dr brown whome recommended nerve and mesh injections, and if those failed to bring relief then consider mesh removal..Dr towfigh kindly reiterated that there was no rush to remove the mesh, but the pain has me driven to seemingly irrational thoughts. My own surgeon offered pain management and if that didnt work that he would go back in and cut my ilioinguinal. I somehow need to boil all this info down and make an executive decision..
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What was your friend’s original problem? You might be comparing apples to oranges.
Listen carefully to what the professionals tell you. Your description, “barely touching it produces 10/10 pain”, suggests that you have direct contact with a nerve. I am just a guy on the internet but I see just one factor, not a vague “multi-factorial” problem.
There is still much that is odd about your story. Odd mesh, odd procedure. Get a second opinion from a respected hernia expert. It’s too soon to be taking advice from friends with non-specific problems.
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Had a friend advise steroid injections into the genitofemoral and ilioinguinal nerves via the back instead of the normal groin shots. No clue how it makes a difference but he said its brought him relief for over two years now…anybody heard of such a method?
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Thanks everyone for your advice and wisdom. I went to my first pain management appointment and they believe my pain is multifactoral..there is no sensitivity to touch when It comes to my sharp side- upper abdomen pains, they are simply brought on by physical activity. I believe my testi pain has something to do with the intensely agonizing pulling pain over my pubic tubricle whenever my mate sags..( only hurts when sagging a clue?) And recently I’ve developed an excruciatingly tender area a half inch to the right of my incision. This pain is mostly present when laying down. barely touching it produces 10/10 pain. Moving my leg and baring down also set it off…I’ve pain mapped my entire abdomen, have researched to the point of insanity and still come up dry. It’s so hard not to feel hopeless at this point,..the Bills are piling up and I really need to get back to work but I can barely leave my bed…gotta love the reality of damn near becoming homeless due to a routine surgery….
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Take your time to figure out exactly why you have pain and therefore what is the best next step. There is no rush to remove mesh.
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Dear Joshio.
The mesh is difficult to remove and the pain will often decrease with time. I would advise you to work with the pain doctor. If that does not work then consider having the mesh removed.
Regards.
Bill Brown MD -
Joshio, your method actually looks like a “modified” Lichtenstein method, by the descriptions in the video below. You can find people touting the benefits of mesh but still experimenting. Lichtenstein’s method is perfected but needs more perfecting. The usual comments about tension and avoiding nerves, even though tension is created during the healing process, pulling on the nerves. The use of Parietene is still odd.
Do some research on the nerves that are described and you’ll probably find the one that affects your pain. The mesh is probably rubbing on the nerve or a suture has pulled free. You have a difficult problem ahead of you. Pain management will treat the symptoms but leave the cause. And there are very recent studies confirming that NSAID’s are even worse for people than has been disclosed in the past. Long-term use of pharmaceuticals is not really a solution.
Good luck.
3:00, 5:30, and 8:45 are interesting points.
https://www.youtube.com/watch?v=YG_9bv2A-UM
NSAID’s
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724772
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Localcivilian I have no clue..perhaps you could better judge through reading my op report (I do not mind sharing my report if it helps determine answers) I am nowhere near as competent when it comes to figuring this stuff out. All I know is what I feel at this point regardless of my hours and hours of research…I’m pretty sure what I feel is abnormal as I can’t find anybody else complaining of sharp stitch like pains running all the way up to the rib cage on flank and up to my floating rib in front..especially considering incision is less than 2 in.. and is wayyy down next to my shaft and bottom of inguinal ligament. I agree things seem rather unusual all around good intentions..why would they use a type of mesh that literally prevents unwanted tissue attachment..isnt that the point?? As always thank you all for your input and opinions.
Joshio
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Do you know for sure if he implanted the mesh in IPOM (in contact with bowel) fashion? That’s pretty unusual for an inguinal hernia repair.
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You have a strange situation Joshio. Parietene is not, apparently, designed for inguinal hernia repair. It’s a composite mesh, designed to reduce adhesions. And your surgery notes say some things that seem unusual, although I am not a surgeon so might be wrong. It seems like he did quite a bit of suturing. Overall, it looks like you’ve had an unusual material used in an unusual way.
If I read the notes right, you had an indirect hernia. The surgeon basically reformed your internal ring, using mesh, but used a lot more mesh than seems necessary. All the way to the pubic tubercle. Your report reads oddly so getting a second opinion from another hernia expert still seems advisable. Surgeons can do whatever they feel is appropriate. It looks like yours had some unique ideas.
Although his method might be the latest and greatest, for open with mesh. It’s hard to tell. Good luck.
[USER=”935″]drtowfigh[/USER]
[USER=”2580″]DrBrown[/USER]
https://www.medtronic.com/covidien/en-us/products/hernia-repair/parietene-ds-composite-mesh.html
“Parietene™ DS composite mesh is part of our commitment to offering solutions that can help you advance patient care.
It’s made from a transparent macroporous polypropylene that’s easy to work with because it’s not too soft or too rigid.1,2
Plus, on one side, we’ve given it an absorbable synthetic film to help minimize unwanted tissue attachment.3,†
The result is a balanced mesh that’s been designed with you — and your patients — in mind.
“
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