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Recurrent Hernia … 12 years later
Seem to have had a blowout. Had laparoscopic surgery to repair an inguinal hernia (bilateral) about 12 years ago. Original issue was on the left, the right was fixed proactively. Now the right side is messed up…home improvement project side effect. Met three surgeons, all good. One wants to repair open, the other two robotic. One of the two robotic surgeons mentioned taking a peek first and possibly go open depending upon what he sees. I’ve had enough time to Dr. Google myself into true fear.
At this point it is a tossup between the open and the robotic procedure. My original mesh wasn’t on a recall list. And my family doctor thinks it could be a “new” hernia in a different location given how long it’s been since the original repair. She is not a robotic fan either and encourages the open procedure.
I have questions but I’m not sure what to ask. Really just want to feel normal again. I guess for starters, any consensus on open vs robotic?
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7 Replies
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1. The standard approach for a recurrence after laparoscopic inguinal hernia repair with mesh is the open approach.
2. There should be little to no discussion about mesh removal as a primary plan of care if you have no actual primary mesh-related problem (such as mesh infection or mesh-related pain).
Less is more.
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quote VegasHernia:Have put the robosurgery on hold. Wasn’t sure the rules in discussing specific doctors. Heading to SoCal for a business trip and plan to have a consult with a “hernia doc”. Unfortunately my insurance is out-of-network for my first choice. There is another one in OC that’s in-network, will follow up with them over the next few days.If you’re heading to Southern California anyway, you might want to see Dr Shirin Towfigh in Beverly Hills or Dr David Chen at UCLA, both are well regarded.
Good luck and keep us updated on your case and progress.
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Have put the robosurgery on hold. Wasn’t sure the rules in discussing specific doctors. Heading to SoCal for a business trip and plan to have a consult with a “hernia doc”. Unfortunately my insurance is out-of-network for my first choice. There is another one in OC that’s in-network, will follow up with them over the next few days.
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Totally agree with everyone ..every revision surgery care more risk than original…i would go to one of very top doctors we recommend remove mesh ..fix everything old way..and never touch it again…my humble opinion only.
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While robot assisted surgery is an important evolutionary step in surgery, in case of hernia surgery it adds no significant value. As Good Intentions noted, it just makes the operation easier for the surgeon, ti adds accuracy and precision to the work.
I would say that in general robot assisted surgery (RAS) has an advantage over traditional video laparoscopy (VL). But laparoscopy along with robot assisted surgery is inferior to open surgery (OS) in case of hernia surgery.
RAS > VL < OS
How to know when to remove a mesh? I think you will know the answer to that question if you start having complications from the mesh implant. This can result from foreign body reject, inflammation and mesh shrinkage and adhesion to soft tissues. These complications will also depend on a number of factors, among the most important I think is at what layer of the abdominal wall the mesh is inserted.
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The one thing that was consistent among all three surgeons was their saying “you have a hernia and I can fix it”. They know I have mesh but it raised no visible flags. Then I research it and the first dozen google hits all point to mesh lawsuits. Then you find forums with people looking for mesh removal doctors. How does one know when to remove mesh? During surgery to fix it? Have I just read too much and need to let the docs do their thing? These are probably what I’m looking to ask.
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I would avoid thinking about “robotic” surgery as anything more than adding accuracy and precision to a repair method. The same materials are used and the same thought processes on where to place the mesh. Robotics just makes it easier and safer and allows more precise work to be attempted.
Worry about the materials and methods first. A 6×6″ piece of mesh will affect you in the same way whether it’s placed via robotic methods or typical laparoscopy tools.
In other words, “robotic” has no significant meaning for what you are trying to research. The touting of robotic surgical methods might actually be another attempt to blame mesh failures on the skill of the surgeon rather than inherent flaws in the mesh material.
Good luck.
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