Recurrent Inguinal Hernia?

[pmv]

[USER=”935″]drtowfigh[/USER] according to the operative report:

“The meshes were secured together in the midline using interrupted 2-0 Vicryl suture x2 at the midline. The peritoneal flap was then closed with 2-0 V-loc suture in a running fashion. Any holes or tears in the peritoneal flap were repaired with 2-0 Vicryl.”

Would I feel a seroma/hematoma, bilaterally, 1 year after the da Vinci robotic repair of my bilateral inguinal hernias (direct & indirect on right-side & direct on left-side)?

What I am experiencing, one year after the surgery, is a feeling of tightness, pulling, and cramping (but not pain, per se) bilaterally in my hypogastric/suprapubic area. These symptoms are persistent but ebb and flow. And don’t appear to be worsened by vigorous cardio exercise (stationary bike or elliptical for 60-90 minutes).

Is an MRI (with or without contrast) of my abdomen and pelvis worthwhile with or without valsalva movement on 3T scanner?

What else can I do to determine if there is a hernia reoccurrence and/or a problem with the ProGrip mesh (i.e., movement, shrinkage, etc.)?

Thank you, [USER=”935″]drtowfigh[/USER]

[drtowfigh]

[USER=”2894″]pmv[/USER] have you read your operative report? Did they mention how they handled your direct hernia? Did they patch it or did they imbricate or suture close the defect? Perhaps what you felt was a seroma/hematoma where your hernia defect was. You should not be able to see any deformity from the mesh itself as it’s Dee to the muscles.

[pmv]

If you don’t mind sharing. For initial surgery or recurrent surgery or mesh removal surgery: What hernia surgeons would you recommend? And who would you avoid?

[Good intentions]

The thread is very long, 55 pages, but has a lot of good information in it. ShoulderBrah had a good experience. I didn’t. You’ll see that people who had a good experience will recommend that everyone not wait, just do it, while those who had a bad experience will say avoid mesh at all costs.

It’s worthwhile to browse through the posts. There are quite a few Progrip stories in there, and some people are still commenting years after their repairs.

One thing that I’ve said in the past is that nobody can “power through” or force their way to a better life by trying harder when they have a mesh problem. More physical exertion, whether measured in effort or quantity, will not help. The prime directive of many body builders, athletes, working people, or just generally tough people, to “tough it out”, just does not work at all, with mesh problems.

[pmv]

Are you the weightlifter ShoulderBrah?

[Good intentions]

Thank you. Here’s another thread on a different site, that might be useful. I got blocked on my first attempt so this might end up being a double post.

https://forum.bodybuilding.com/showthread.php?t=133353003&page=1

[Good intentions]

Thank you. Here is another good site for information, more relevant, maybe, for you. Good luck.

https://forum.bodybuilding.com/showthread.php?t=133353003&page=1

[pmv]

I am sorry to hear about your awful experience.

I hope you are doing better physically and emotionally.

You are providing an important to service to many people by sharing your experience and knowledge. And, for that, you should be very proud.

Keep hope alive.

[Good intentions]

quote pmv:

If you don’t mind. What was your hernia repair experience? Good? Bad? Surgeon? Mesh or no mesh? And how are you doing now?

pmv

It was very bad. The worst experience of my life, aside from the death of family members. I’ve written quite a bit about it. I post on this site to let people know what’s going on and how easy it is to get drawn in to a bad situation.

https://www.herniatalk.com/search?searchJSON=%7B%22authorid%22%3A%5B%222029%22%5D%2C%22channel%22%3A%222%22%2C%22exclude_type%22%3A%5B%22vBForum_PrivateMessage%22%5D%2C%22starter_only%22%3A%221%22%7D

[pmv]

Good intentions,

That ProGrip “satisfaction” study is very interesting. And very limited.

I wasn’t a sedentary person when I had my surgery. I was a very active 61 year-old. Cardio & weightlifting workouts for 2-3 hrs/day, 6 days/week.

After reading the information you have shared, I suspect that the ProGrip mesh has, in some manner, interacted with my internal structures — nerves, muscle, tendons. And this interaction has caused “tension” (as you define the term more broadly).

At this point, I am going to get an MRI (with & without contrast; also using the valsalva protocol on a 3T scanner). Have to convince my insurer to authorize that imaging of my pelvis/abdomen.

In the meantime, I’ll just deal with the daily lower abdominal
discomfort best I can. But, Never Surrender.

Thanks, again!

pmv

[pmv]

Thank you, Good intentions.

You are very knowledgeable. And it is very thoughtful of you to share your knowledge and experience with me and others on herniatalk.

If you don’t mind. What was your hernia repair experience? Good? Bad? Surgeon? Mesh or no mesh? And how are you doing now?

pmv

[Good intentions]

Here is some verbiage from the single reference that Medtronic references in their marketing literature, regarding “satisfaction” with the use of Progrip mesh by the patient..

“The grips are biodegradable, and when the tissue grows into the mesh, the grips break down, leading to a reduction in the overall tension and chronic strain of the foreign body.”

“Most patients had a sedentary job or lifestyle or were retired or unemployed, and they performed little or no exertion on a daily basis. Hours of physical activity outside of work varied, with the most common activities being walking, golf, and other exercise.”

“Overall, the vast majority of patients were satisfied with the surgery, and all patients would recommend the procedure to family and friends.”

“However, longer-term randomized data are required to better assess the benefits of this approach compared with the other techniques available.”

But they never said how the patients were interviewed or what questions they were asked. It’s fascinating to dig in to the references and see how “light” they are. Not much to them.

https://www.liebertpub.com/doi/10.1089/lap.2015.0056

[Good intentions]

I can’t say much about what you might be experiencing or what to do about it. The mesh is usually not discernible by imaging for most “image readers”. Many people have gone through tedious MRI’s and examinations and been told that the mesh was perfect and there was nothing to be done only to find when they had removal that the mesh had moved and/or folded. It is not easily seen by imaging.

The reality though, in the end, is that it doesn’t matter where the mesh ended up. If you don’t have another hernia there is only pain management or mesh removal. Or just living with it. Discomfort from mesh repair is not uncommon. Read ajm222’s posts and you’ll see somebody who is kind of stuck in the middle, like you might be. Not bad enough to take action, but bad enough to be worried.

Wish I could give some advice for direct action that you could take. But the fact that you are fully functional and not in pain means that you are a “success” by mesh industry standards. Good luck.

@pmv

https://www.herniatalk.com/member/2051-ajm222

[Good intentions]

The term “tension-free” was created when Lichtenstein started using mesh to repair hernias, as I understand things. The definition was very narrow, focused on the sutures used for a non-mesh repair. I’ve attached a link that gives a good general definition of “tension”, below.

https://www.evergreenhealth.com/hernia-repair-types

The narrow focus of the term is about the sutures and the way that they pull on the tissue. But, the reality of a mesh repair is that a new kind of tension is produced. A broad tension from the scarring in of the mesh, which causes the mesh to pull tightly together as the new collagen shrinks. When I use the word “tension” I am using the broader, literal, definition of tension, not the term used to promote mesh repairs.

Another term that is used that sounds good but is actually not correct, in my opinion, for today’s hernia repair is “minimally invasive”. Again, if you use the word literally and look at what happens during a laparoscopic repair you can see that laparoscopic mesh implantation is not minimally invasive. Actually, literally, compared to a suture repair, I think that it could be called “maximally invasive:”. I don’t think that you will find a surgeon who can give a rational reason for calling laparoscopic mesh implantation “minimally invasive”. It’s just not.

I think that the term has been carried over from the original uses of laparoscopy for things like appendectomy or gall bladder removal. In those cases, where the surgeon has to create a large incision to get to the organ, laparoscopy probably actually is “minimally” invasive. A small incision allows the surgeon to remove the offending organ with minimal disruption of surrounding tissue. For mesh implantation a very large area needs to be dissected, splitting the peritoneum from the muscle wall, to create a space for the mesh. A suture-based hernia repair would only “invade” or disrupt the area local to the hernia. I’m not saying that one is better than the other just the use of the term is disingenuous. It’s not true.

If you browse through the device makers’ pages and product literature you’ll see that much of what you, and your surgeon, read is market and sales literature. It’s for selling the product.

[pmv]

Good intentions,

Regarding “tension.” Dr. Towfigh states that all mesh repairs for inguinals are “tension-free”?

Could you explain?

Thanks.

[pmv]

Thank you so much, Good intentions!

The surgery notes describes the mesh as follows:

Mesh ProGrip Flat Sheet 12cm × 12cm (LPG1612 BX/1-LOG235319).

Yes, you were right. Approximately, 48 square inches (hopefully lying flat) in my abdomen.

A few questions, if you don’t mind:

1. How does the mesh cause “tension”? What internal nerves, ligaments, muscles, etc. is it impacting?

2. Is there anything that can be done to reduce the “tension” (i.e., the lower abdominal discomfort)? Or is this something that I just have to learn to live with?

3. Are there any activities that I should avoid because they might increase the “tension”?

4. Is it normal for the “tension” to be more noticeable about one-year after the surgery, than it was earlier on, as in my situation?

5. Is it worthwhile having imaging performed to help determine if the lower abdominal discomfort I am experiencing is, in fact, a result of “tension” from the mesh or, perhaps, caused by a recurrence of a direct or indirect inguinal hernia, or an occult hernia?

6. Clinically and visually, is there any additional signs that would indicate that I have a hernia recurrence or a new hernia if, as in my situation, visually I notice raised skin (and a tiny bump) bilaterally over the path of the inguinal canal — kind of like a ridge line?

7. Any other thoughts on my situation?

Once again, thank you.

Have a great holiday season!

pmv

[Good intentions]

Bilateral laparoscopic mesh implantation, even robotic assisted, usually involves placing very large pieces of mesh, much larger than the defect they are meant to fix. Get your surgery notes and they should have the dimensions of the pieces that your surgeon started with. Do the math and compare to your abdomen and you might be surprised at how much area is covered, assuming that the mesh was laid flat around the abdomen. It won’t you make me feel physically better but you might feel more secure understanding where the tension comes from.

Also, Progrip uses absorbable material in its construction. It takes months for the material to dissolve and be absorbed. As it does the body will attach more firmly to the remaining synthetic fibers. That might be why things are still changing, many months after surgery.

Good luck. You are probably physically fine so your doctors will have trouble finding a reason to take any action.

https://www.medtronic.com/content/dam/covidien/library/us/en/product/hernia-repair/progrip-laparoscopic-self-fixating-mesh-overview-brochure.pdf