News Feed Discussions Questions re: inguinal hernia repair

  • Questions re: inguinal hernia repair

    Posted by DavidJ on February 6, 2018 at 11:19 am

    I am trying to decide between an open mesh and no mesh (Shouldice) repair for my inguinal hernia. I have a couple of Qs for medics/others which will help me decide:

    With an open mesh repair what if anything prevents adhesions to bowel/peritoneal tissue? Is this a significant risk?

    With an open mesh repair is mesh migration/shrinkage a significant risk?

    If there is a recurrence, is it easier to repair a primary shouldice repair or a primary open mesh repair? My thought was that an open mesh repair of a failed shouldice repair might be easier than another open mesh repair of a failed open mesh repair.

    Thank you.

    Beenthere replied 6 years ago 4 Members · 9 Replies
  • 9 Replies
  • Beenthere

    Member
    February 26, 2018 at 7:27 pm

    Good intentions

    I hate to write and I am not very good but I think we come from the same side of the debate. When this first started I requested no mesh, my surgeon quote an expert said it had to be done with mesh. I relented since at the time I was a complete novice of having a surgery. I think my post about no mesh and mesh with to possibility of recurrence in no longer on the site or very old. At my age in my 50’s if I was told the truth about mesh I would take my chances with no mesh and recurrence over mesh and the pain and other side effects post surgery. I found out after my surgery and even asking the surgeon and staff multiple times what about side effects or complication from this surgery. I was told less than an 8% total, only to find out this facility in fact had a 25 to 30 percent post surgical pain after one year. If I would have been told this I could of held off on this semi elective surgery.

    When the problems started the facility thought it could be an allergic reaction to the surgical clips or the mesh. They tested me with the clips but both the manufacture and the facility that performed the hernia surgery would not provide a sample of the mesh so I could be tested. I even offered to buy a sample.

    What I meant if I had a choice mesh or no mesh with a top specialist in this field I would go no mesh and take my chance on a recurrence. But if I had a surgeon like mine who had no clue on what he was doing (he used mesh) without mesh or a true specialist using mesh I would go with mesh.

    I saw Dr for my sports hernia today but I found it interesting he stated for a sports hernia he is going back to an open surgery!!!!

    My thoughts doing an open no mesh surgery takes more time and skill to right(patients prospective)than slapping in mesh!

  • DavidJ

    Member
    February 26, 2018 at 12:20 pm

    Thank you. Some more things to think about.

  • Good intentions

    Member
    February 26, 2018 at 2:40 am
    quote Beenthere:

    The knowledge, skill and experience have more to do with the outcome than mesh or no mesh.

    Beenthere, I know that you’ve been through a lot, I’ve read your posts. But this, what you wrote above, is the standard meme being propagated by the medical device makers. I think that many doctors and surgeons actually believe this to be true also. No surgeon wants to think that what they are doing can cause harm. So, it’s easier to believe that it was the fault of an unskilled surgeon, a beginner maybe, not the mesh material itself, that is causing people harm

    I think that this is one reason that surgeons are so resistant when their patients come back with problems. It’s just not supposed to be, especially if they are very skilled. They did everything “right”. But some or all of the mesh materials are not “right”. So it won’t matter how skilled the surgeon is, it’s the material that is the problem.

    My surgeon was top-notch and actually part of a group that trained and certified fellow surgeons in the latest laparoscopic techniques. It didn’t matter, it was the Bard Soft Mesh itself that caused the problem, via constant inflammation. He did everything by the book.

    The industry has a huge investment in the process and the materials. So much so that it’s almost incomprehensible to them that it’s not working the way they thought it was going to. Or, worse, it is known to some, but the business is too good to change anything, Like gun sales. Until a better material is developed, the surgeons will continue forward with what they were trained to do, hoping that stories like mine are total outliers. There will be a constant stream of injured patients, populating forums like this one. And probably many more people who just aren’t harmed enough to seek help, or post on forums like this, but aren’t in the shape that they were promised. Diminished, but still functional. The harm isn’t on/off, black or white, it’s a continuous spectrum.

    It’s a terrible situation, with doctors and patients both, and other medical professionals, constantly seeing these mesh inflammation problems. Imagine being in the healing profession and knowing that there’s something wrong with what you’re doing, but having no one to turn to to help figure it out. Only a few people are stepping up to address the reality of what they see, but progress is very slow.

    So, please don’t pass on the false memes out there, that a patient just has to find the right surgeon, and that all mesh materials are essentially the same. It’s just not true.

  • Beenthere

    Member
    February 25, 2018 at 11:21 pm

    Take your time unless it becomes an emergency. Do your homework and ask a lot of questions. My expert turned out to have not performed a hernia surgery for over 18 months. I you can afford the time and money, travel to one of the names that keep coming up on this website. The knowledge, skill and experience have more to do with the outcome than mesh or no mesh.

    I will post this again read this before surgery. https://www.amazon.com/Unaccountable-Hospitals-Transparency-Revolutionize-Health/dp/1608198383/ref=sr_1_1?s=books&ie=UTF8&qid=1519600171&sr=1-1

    Good luck

  • Good intentions

    Member
    February 25, 2018 at 6:31 pm

    I had posted a long post, recommending that you consider what you plan to do after the surgery, with other details. Hopefully, it is allowed, I added a link to Ethicon’s web site and it got flagged as possible spam.

    Mesh has more problems with active people. If you plan to be physically active, take extra care in what you choose.

  • Good intentions

    Member
    February 25, 2018 at 6:21 pm

    I would consider strongly what you plan to do, physically, after the repair. Apparently, many professional athletes do not get mesh repairs, most likely because they have problems with performing their professions afterward. And there is a thought expressed often that low body fat people don’t do as well with mesh as normal or higher body fat people. But, low body fat people are also, generally, active people. I am a very physically active person and most of my mesh problems were due to physical activity.

    When you add up all of the anecdotes and study results it looks like physical activity and mesh do not work well together. If you lead a sedentary life and plan to keep doing so you might be fine with mesh. But if you have plans to run, or hike , bike, or lose some weight via physical activity, you might regret having mesh implanted.

    Also, if you can do it, distinguish between “mesh” as some big broad thing that’s all the same, and the different types of mesh, the amount of mesh, the type of surgery used to implant the mesh, and the surgeon’s results from past surgeries. It might be difficult to do because the medical device makers are “recommending” through their paid consultant surgeons that large areas of the abdomen be covered with mesh, to avoid future problems. They are propagating a myth that the doctors can put as much mesh as they like inside because it’s FDA approved and has no adverse effects. Some doctors know that this is not true and will tailor their approach to your future plans. But many doctors are just following the instruction sheet from the device makers. Find a physician who is truly a physician. You’ll have to ask hard questions, and try not to get lulled in to a false sense of security. Today’s medical system is supposed to be based on informed consent, with much responsibility passed on to the patients. But there’s not enough information available to be fully informed.

    Here is a link, below, in which Dr. Kercher of Ethicon describes covering the side of the abdomen that was asymptomatic. Just put it in, it won’t hurt anything to have more. (I had wrongly posted that this video had been removed. It’s still there. About 2:00 is where he describes adding extra mesh.)

    Get hard details from the surgeon that you choose. They should know how well their procedure works, by keeping track of their past patients. They’re not all the same.

    http://www.ethiconinstitute.com/node/885/asset

  • DavidJ

    Member
    February 25, 2018 at 2:56 pm

    Thank you for taking the time to respond Dr Towfigh. I appreciate it. I am still trying to decide between having a shouldice or lichtenstein repair and I can see there are pros, cons and risks to each of these methods. I am a man in my mid 50s. I am very slightly over weight. I have a smallish direct inguinal hernia on my RHS. I am find it very hard to make this choice. I know there isn’t a right answer. My gut says shouldice mainly to avoid having a mesh implant. I can see the intellectual case for lichtenstein. I suppose I should make the choice I am most comfortable with after taking advice from my sugeon and comit to that choice.

  • DavidJ

    Member
    February 25, 2018 at 2:45 pm

    Thank you for taking the time to respond Dr Towfigh. I appreciate it. I am still having difficulty deciding between a shouldice or lichtenstein repair as I can see that there are pros, cons and risks to each repair method. I am a 57 M with a primary direct inguinal hernia on RHS. My gut feeling is shouldice mainly to try and avoid mesh complications, but on an intellectual level I can see that lichtenstein seems to generally have a lower recurrence rate. Decisions, decisions. I suppose all I can do is make the best decision I can and try to be comfortable with it.

  • drtowfigh

    Moderator
    February 18, 2018 at 4:02 am

    With open mesh: adhesions to bowel of peritoneum is not an issue. Mesh migration is also not an issue except for the Plug mesh technique. Shrinkage is an issue with every mesh, but not a risk if the mesh is implanted with that knowledge in mind (i.e., not tightly sewn in).
    A recurrence from an open repair is best repaired laparoscopically. It doesn’t usually matter if it’s a Shouldice or a mesh repair unless for whatever reason you cannot undergo a laparoscopic repair.

Log in to reply.