Pros and Cons of Open vs Lapro

[ajm222]

This is very helpful info. Confusing though as to why I have tightness and discomfort and pulling after a robotic mesh repair. Seems like that would be very unusual. Not much pain and soreness, though some. But mostly just foreign body stuff. Very frustrating and it’s making me very hesitant to get removal despite knowing it definitely must be the mesh.

[drtowfigh]

My take:

OPEN WITH MESH
Pros:
– can be done under local anesthesia with sedation. Ie, no general anesthesia.
– allows for plication of tissue in case of direct hernia.
– allows for reconstruction of giant inguinal hernias with complete pelvic floor blowout
– cosmetically hidden scar in hairline
Cons:
– mesh interacts with spermatic cord and can cause testicular pain and affect sexual function
– mesh can interact with nerves.
– mesh at risk for infection (low risk)
– mesh-based chronic pain, tightness, shrinkage
– larger scar than laparoscopic
– longer recovery than laparoscopic
– higher recurrence than laparoscopic if done by specialist.

OPEN REPAIR WITHOUT MESH
Pros:
Pros:
– can be done under local anesthesia with sedation. Ie, no general anesthesia.
– no mesh-related complications
– cosmetically hidden scar in hairline
Cons:
– highest recurrence rate of all options (Data claiming lower recurrence rate is based on cherry picked low risk patients)
– chronic pain risk due to tightness, tear, nerve injury/entrapment. This is important. Chronic pain is a real problem with tissue repair as well.
– larger scar than laparoscopic
– longer recovery than laparoscopic or open with mesh

LAPAROSCOPIC REPAIR WITH MESH
Pros:
– small scars
– short recovery
– lowest recurrence rates of all options
– lower risk of mesh-related complications than open repair with mesh
– less nerves at risk of injury as compared to open repairs
Cons:
– requires general anesthesia
– visible scars, cosmetically
– mesh-related complications, including adherence to spermatic cord, folding
– direct hernias and giant hernias are mostly patched and not plicated or sewn (robotic approach allows for sewing).

[Casimir]

@jnomesh Thanks for the feedback and info 🙂

[Jnomesh]

I think this is a great idea.
Especially about the most of doctors that specialize in no mesh repairs (besides the 3 or 4 that routinely pop up and are widely known) and the best of the best surgeons for mesh removal and post mesh complications.
There are a few other FB mesh forums that also have comprehensive lists of surgeons who do mesh removal and non mesh repairs. For a while I was helping contribute to one of them as I cane across People who had successfull removals and non mesh repairs. The name KD the forum is Hernia mesh hurts too. It may be a good resource for you to cross reference and or possibly find new names of surgeons etc.

[Casimir]

@drbrown Thank you.
And @drtowfigh.

I am working on making a private group FB page for people searching for consolidated information, not so much a discussion group (as consolidated information does not exist as far as I can tell in an effective manner) as they start on the healing path from a hernia. This is due to my own experience which was seriously misguided and flawed at large financial and emotional cost, even as I tried to do what I thought was best, where something like this would have made a big difference in my life, and now to help others that are in the same situation that can be helped — and there are so many — scared and feeling helpless.

The group is here:
https://www.facebook.com/groups/643409982866461/

I have these topics so far:
Inguinal – Checklist
Inguinal – Open Pros / Cons
Inguinal – Lapro Pros / Cons
Inguinal – Mesh Procedured
Inguinal – Non Mesh Procedues
Non Mesh Doctors
Revision Resources (drs who specialize in post 1st surgery issues)
Infographics

I’m missing the other hernia types. But I’ll get to them.

I think this would really without exaggeration have the potential to save many many peoples quality of life by helping them make better, more informed decisions and to find corresponding help.

If any doctors would be interested in helping with this, or being listed in the doctors section just let me know.

I think interviews with doctors would be good to have as well. I think there is a really large and important opportunity to help, and address a real void.

[DrBrown]

@cshelter
The lap repair requires the use of mesh which can be a source of chronic pain.
The open pure tissue repairs allow the surgeon to visualize all the important structures such as nerves and blood vessels. It is the operation that I advise for all my patients.
Regards.
Bill Brown MD

[Casimir]

@good-intentions Thanks. I’ll check out that video.

I saw where @drtowfigh mentioned there are benefits and risks more inherent to each without going into them. I was hoping for an unbiased condensed response. I hear from some no-mesh Drs that say you can get up and back in action in a matter of a week or two. And I hear where some people with mesh have pain for up to a year.

I guess I was thinking more like “open can cut nerves more readily, but gives a clearer view of the anatomy”… and “lapro doesn’t risk particular nerve damage as much, but”… a general list like that.

I don’t know what the risks are there, maybe it’s harder to navigate the anatomy and there is more risk to a particular part of the anatomy via lapro, and you need general anesthesia.

I am trying to put together a resource on FB where answers to common questions can be easily found, the questions that keep getting asked over, and over, and over… there are support groups, but a lot is the (suffering) blind leading the (suffering) blind.

Along with a list of Drs that do particular techniques, and in what part of the US they are in.

There are the questions I see being asked over and over and over on forums. For instance I myself didn’t know there were so many great non-mesh docs around. BUT MY GOD IN HEAVED — I WISH I DID! Whey is it so hard to learn this? And I am an internet marketer. And I looked. Something is wrong.

I didn’t know what the differences were or advantages of the different techniques — most of what you find is very clinically spoken and written for academia, draws unclear conclusions unto the technique itself, not in a comparison manner, and not allowing a prospective patient to have any influence in their path forward based on being informed with the big picture.

I feel very strongly that there is a need for that, that an opportunity exists for a solid resource, from 1) what to find out and ask about regarding YOUR hernia, to 2) what generally are options for various situations so someone can understand options in general and 3) a list of drs if they want to be listed with what they specialize in, so the path form start to finish could be assisted if surgery is desired.

I’d like to have interviews with doctors posted. Basically, a resource for this ailment which is so mysterious and can cause so much despair, and where so many feel so lost.

I’m trying to do make positive from my own terrible experience that might help others avoid it happening to them, basically.

[Good intentions]

I have not watched this video yet but it has your question in the title.

https://www.youtube.com/watch?v=XqygsAX8puQ

You did not distinguish between mesh or non-mesh. Somewhere out there is series of four tutorial videos describing the four main ways to implant mesh. In the last video the surgeon says it doesn’t really matter which way is chosen as long as the surgeon feels comfortable with it. As long as the mesh gets in, any of them is good enough. All that matters is getting the mesh in. I had created a Topic about it but the Search function is not finding it.

Search the SAGES library on youtube and you’ll find a lot. Here’s another.

https://www.youtube.com/watch?v=KmmeD2pt3Ck