Phasix mesh, neurectomy, non mesh repair

[LostNPain]

Thank you everyone for your responses. It has given me a lot to think about.
The doctor that offered the Phasix mesh has little experience with using that particular mesh. This doctor is very well known in the hernia surgery community and held in high regard.
I don’t really have any more options to go elsewhere. While I’m pleased that the mesh removal would be TAPP and robotic assisted, I’m disappointed that we aren’t going to investigate the cause of my pain before cutting the mesh out. Especially since the outcome is a gamble.

[Chaunce1234]

quote LostNPain:

I have been presented with options and am unsure which direction to go. It seems like each path is undesirable and I feel stuck.

Just out of curiosity, did a surgeon offer this trio procedure (mesh removal, phasix placement, neurectomy) to you? If so, have they performed the exact same procedure on other patients? What were the outcomes?

Phasix and other absorbable mesh could have potential but are unproven as of now, as clinical trail data awaits. Recurrence is always a concern, but I’d personally be much more interested in chronic pain outcomes and data points.

As for neurectomy, my personal opinion is that it is a gamble simply because nerves are unpredictable. You will find some patient stories regarding neurectomy here on these forums and elsewhere on similar forums, read through them if you’re considering it. Dr David Chen at UCLA Hernia Center has a fair amount of clinical experience and research on this topic and that data may be a good resource.

Best of luck and keep us updated on your case.

[Momof4]

I recently asked a physician about Phasix as I saw it mentioned on another platform. I was told that it is a fully absorbable synthetic mesh that absorbs in 18 months vs 8-10 months for most biologic absorbable meshes. It causes a high inflammatory response early on, moreso than other synthetics. It has been out for 2.5 years so the 2 year data should be coming out soon. It will be interesting to see the recurrence rate vs that of biologics. There may still be a high recurrence as with biologics, but just pushed back due to the longer time before absorption. Not sure if activity level plays a large part in deciding to use this mesh. I was told it is not good for someone with connective tissue problems. There will still be recurrences, they will just happen later!

Good Intentions, thanks for input on this forum. Sounds like you have done lots of research which is very helpful to those who have just been diagnosed and are trying to make the best, most informed decision. I wish there was a way for you to tell me the best mesh to repair my multiple recurrences after mesh removal, considering that it was removed due to reaction and I have a collagen problem. It’s a tough decision! I am certainly thankful for Dr. Towfigh’s expertise in mesh selection. Thanks again!

[Good intentions]

quote LostNPain:

Also, those who have had their meshes removed because of pain-did you find instant relief? Did you have a reoccurrence? Is your level of physical activity diminished due to caution of recurrence?

Is reoccurrence more common after mesh removal if a new mesh is not implanted? Especially with very active people ?

More questions…
For those who have had triple neurectomy, how are you feeling now? Are you happy that you had the procedure ?

I have been presented with options and am unsure which direction to go. It seems like each path is undesirable and I feel stuck.

Mesh removal is a pretty intensive operation, so you end up feeling, physically, somewhat like you did when you had the implantation. So, the relief for me was more mental, in that I was finally rid of the abomination in my abdomen. I had new hope that I might get some or all of my past abilities back. I also had certain problems, related to being a man, that did show immediate benefits, within days. Just removing the inflammation had that effect.

I did not have any recurrence and have not had any signs of one, in 4 1/2 months since. I doubt that I’ll try to set any personal bests for lifting heavy weights, but I have been doing heavy yard work, and just replaced a stove and a dishwasher, by myself. I’m not worried about recurrence. I’m back to just doing things, as I think of them. Not planning my life around the problem.

I also did not have any nerves cut. I don’t understand why that would be done. If it’s determined that the mesh is causing a broad-based inflammation there is no specific nerve that can be cut for that, as I understand things. I’m not a medical doctor but cutting the nerves seems like “insurance” for the surgeon, so that you won’t feel pain anymore. But it also means that you won’t feel pleasure, or just sensation, fomr what those nerves were connected to either. It seems like an extreme measure for a moderate, but persistent problem. I think that many surgeons don’t understand that it’s the persistence of the problem that is the real issue. Not the level. It never goes away. It’s always there and it is always going to get you. Cutting nerves just creates a new type of problem.

Sorry, I wrote another novella. I’m happy that I had my mesh removed. It was a hard decision to make though. I’m glad that I did not have any nerves cut.

I can offer though that TAPP seems to be the best method available today, to remove mesh. Dr. Petersen’s method of splitting people down the middle is just not necessary anymore. I would find a surgeon who uses TAPP and does not cut nerves. And has years of experience. They are out there, you just have to find them.

[Good intentions]

Here is a link to one version of Phasix. It is a fully resorbable mesh. It disappears completely, over a long period of time. Very different from the petroleum-based polymer fiber meshes. Bard says that it is designed for soft tissue repair like hernias, but they say the same thing for the polypropylene meshes.

Frankly, it looks like an experiment. All of the data is preclinical. But the FDA will probably approve its use as substantially equivalent to some past product. And Bard will start selling it. Then everyone will wait and hope.

https://www.crbard.com/davol/product-listing/sp/phasix-st-mesh/

From one perspective, it’s a sign that they are acknowledging problems with the existing products. On the cynical side though, it might just be the start of another ten to 15 year cycle of failure. They are playing both sides, telling people that the synthetic meshes are the “gold standard” but planning to replace the gold standard, all at the same time.

Sorry I can’t be more positive. The same people are behind all of these products.