-
Researching surgeons – what questions to ask
-
I do like that this surgeon said he’s been using the same mesh for ages (at least a decade I believe). He gave me the name but I’ve forgotten and plan to ask him specifically what it was. And he also did say he’s happy to do the non-mesh repair if I choose. And he said one study suggested mesh versus non-mesh at three years had the exact same recurrence rate. No better or worse. They just don’t really know beyond that perhaps what the recurrence rate is. He did say it looked great, though, and he seemed confident in that method.
-
quote ajm222:But he says he only does that when patients are very determined not to have mesh because of what they have read on the internet.
I understand that people can have major problems with mesh, and that’s definitely a big concern. But it seems the vast majority are fine.
Just to add some clarity to past comments – I have “mesh”. I’m not just an internet rumor.
And, the point a few of us have been making is not the part about the majority but the part about how very bad things are if you’re one of the unlucky ones. It’s not the probability of a bad mesh experience. it’s the level of the damage that you’ll experience, and the difficulty you’ll have n getting it fixed if it happens. So, basically, it’s a gamble, where the odds of winning are high but if you lose, you lose a lot.
Also, one of my points was that what you’ll get today is not the same as what you would have got just one year ago. That’s why I said that if you can find someone who had a good experience, get exactly the same procedure. These professionals are assuming that because they had success before that they can make changes and will be successful again. They are venturing to unknown areas, with no data to support their actions. That’s where the danger is. They are being sold new materials and procedures and getting new recommendations, and trusting that the medical device suppliers know that they work.
When your doctor talks about getting the surgery and all of his past successes, just ask him if he’s doing exactly what he did before. If he says no, ask him how he knows the changes work. Ask him why he changed if the old method worked.
“Mesh” is more than one simple thing. There are numerous types and forms of mesh available for hernia repair, and they can all be shaped in to uncountable shapes and placed almost anywhere in the abdomen. The combinations are incredible. Maybe that’s why nobody wants to take on the challenge of determining where the bad results come from. It’s easier to categorize everything in to one simple box, the mesh box, and only talk about the good results, ignoring the bad ones. That is what’s happening when you talk to your surgeon. He is ignoring real problems. Because it’s easier. That alone should concern you, because if you have a problem, it won’t be real to him. And if talks about “mesh” as if it’s just one thing that should concern you also. He should be able to describe the different materials and methods, and why some of them give bad results. If he can’t he’s not keeping up.
Make sure that you get a proven set of materials and methods. An expert surgeon using the wrong combination is no better than a bad surgeon using the right one
Sorry to be so wordy. These conversations always tend to get pushed back to vague unsupported opinions, assumptions based on no data, not even a few good anecdotes. Nobody can say for sure what the best method is, at this point in the development of all of these new materials.
-
This is very interesting and good to know. The surgeon I initially consulted with does do the Desarda technique, presumably on both direct and indirect hernias. But he says he only does that when patients are very determined not to have mesh because of what they have read on the internet. Perhaps because my hernia(s) are indirect I should likely go ahead and get the mesh. I really don’t want to wait because I am now already more uncomfortable and just cannot distract my mind from the fact that I have this damage to my body that I am worried will quickly get worse and/or cause complications. Most people I have talked to have not had any issues with mesh and consider themselves back to normal and pain free several years after surgery with no recurrence. Some had a longer than expected recovery, and some light twinges and pulls of pain up to a year or two after the surgery. But all seemed to eventually see even that disappear.
I understand that people can have major problems with mesh, and that’s definitely a big concern. But it seems the vast majority are fine. There doesn’t seem to be any way to predict ones reaction. And clearly in the US it is very difficult to find surgeons who do tissue-only repair. And because of the way insurance in the US works, it’s not as easy as just finding someone on the other side of the country and traveling at ones own expense and paying much more money for an out-of-network doctor to do a consultation and then scheduling a procedure.
Dr Kang – do you have any concerns with mesh? Do you do mesh repairs, and if so how often do you see issues and people returning for removal and chronic pain more than a year or two later?
Thanks!
quote drkang:Hi,I understand why some people prefer to wait and see if they have an asymptomatic hernia. This may be due to fear of complication of mesh repair.
But strictly speaking, asymptomatic hernia cannot exist. Because hernia buldging itself is a symptom (actually a sign).
So it’s just the difference between having or not having pain.
However, the presence or absence of pain and progress of the hernia are not proportional. A large hernia may not have pain at all, and pain in the early hernia may also appear. And a painless hernia can also cause severe pain with sudden incarceration or strangulation at any moment. It’s an emergency.I think you can wait and see a little when it is a small hernia. But eventually it will grow bigger and require more extensive surgery. So, I think it is better to have surgery as early as possible when considering the hernia itself.
The only obstacle is the risk of mesh repair. But there are actually other options, though not easy to find. Shouldice or Desarda repair is the one that does not use a mesh. These repairs are used for both indirect and direct hernia. However, if you look for these surgical procedures on youtube, most of them show only direct inguinal hernia surgery.
Why not indirect?
This is because these operations, which are known as typical tissue repair, are actually suitable for direct inguinal hernia. Not only these but also other tissue repair methods, such as Bassini, McVay, Ferguson, etc., are the same. It means that indirect hernia, which accounts for 70% of the inguinal hernia, does not have the appropriate tissue repair procedure. I think the limit of existing tissue repair, such as high recurrence rate, is due to this fact.But in fact, there is an appropriate tissue repair procedure for the indirect inguinal hernia. It is just forgotten and ignored. That’s the Marcy operation.
I am a surgeon who strongly advocates tissue repair. And I am trying to make up for the shortcomings of tissue repair and to get better surgical results than mesh repair in all aspects. As part of that, I have devised and implemented different hernia repair procedures for both indirect and direct hernia. Somewhat similar to Marcy operation and Desarda repair, respectively.
I do not know if there is a doctor in the US doing Marcy operation. (Actually, Marcy is an American surgeon who was active in the early 20th century.)
Anyway, if you have an indirect inguinal hernia, I recommend you to seek a doctor who performs Marcy-like operation, and if you have a direct hernia, find a Desarda repair. I think Shouldice is unnecessarily invasive.In my experience, I do not think that the choice of surgery should be changed according to the size of the hernia. The patient’s body weight and activity also have no significant effect on outcome.
If you can meet a surgeon familiar with the above tissue repair, you will get the best surgical results without fear of mesh.Thank you!
-
Hi,
I understand why some people prefer to wait and see if they have an asymptomatic hernia. This may be due to fear of complication of mesh repair.
But strictly speaking, asymptomatic hernia cannot exist. Because hernia buldging itself is a symptom (actually a sign).
So it’s just the difference between having or not having pain.
However, the presence or absence of pain and progress of the hernia are not proportional. A large hernia may not have pain at all, and pain in the early hernia may also appear. And a painless hernia can also cause severe pain with sudden incarceration or strangulation at any moment. It’s an emergency.I think you can wait and see a little when it is a small hernia. But eventually it will grow bigger and require more extensive surgery. So, I think it is better to have surgery as early as possible when considering the hernia itself.
The only obstacle is the risk of mesh repair. But there are actually other options, though not easy to find. Shouldice or Desarda repair is the one that does not use a mesh. These repairs are used for both indirect and direct hernia. However, if you look for these surgical procedures on youtube, most of them show only direct inguinal hernia surgery.
Why not indirect?
This is because these operations, which are known as typical tissue repair, are actually suitable for direct inguinal hernia. Not only these but also other tissue repair methods, such as Bassini, McVay, Ferguson, etc., are the same. It means that indirect hernia, which accounts for 70% of the inguinal hernia, does not have the appropriate tissue repair procedure. I think the limit of existing tissue repair, such as high recurrence rate, is due to this fact.But in fact, there is an appropriate tissue repair procedure for the indirect inguinal hernia. It is just forgotten and ignored. That’s the Marcy operation.
I am a surgeon who strongly advocates tissue repair. And I am trying to make up for the shortcomings of tissue repair and to get better surgical results than mesh repair in all aspects. As part of that, I have devised and implemented different hernia repair procedures for both indirect and direct hernia. Somewhat similar to Marcy operation and Desarda repair, respectively.
I do not know if there is a doctor in the US doing Marcy operation. (Actually, Marcy is an American surgeon who was active in the early 20th century.)
Anyway, if you have an indirect inguinal hernia, I recommend you to seek a doctor who performs Marcy-like operation, and if you have a direct hernia, find a Desarda repair. I think Shouldice is unnecessarily invasive.In my experience, I do not think that the choice of surgery should be changed according to the size of the hernia. The patient’s body weight and activity also have no significant effect on outcome.
If you can meet a surgeon familiar with the above tissue repair, you will get the best surgical results without fear of mesh.Thank you!
-
Very quickly I’ve gone from feeling like mine are asymptomatic to noting a significant amount of aching and soreness particularly in the testicle when standing even short periods of time. Not sure why it went that quickly but at this point I feel like I can’t get it done soon enough.
-
quote saro:Hi, Good Intentions: a question: your prosthesis is made of polypropylene?
Yes, it’s polypropylene. Bard Soft Mesh.
I just came across an article that shows, in a way, the environment we’re all dealing with. There are people with power and responsibility in these giant medical device organizations that just don’t care about the people they’re affecting. When things change rapidly, these kinds of things happen. Five years after they were sure it was bad, they kept on selling it. After they introduced it with no trial data. Ethicon is one of the big hernia mesh companies. The same people might still be there, pushing hernia repair mesh. How does anyone know?
http://www.ethicon.com/healthcare-professionals/products/hernia-repair-and-fixation
jnomesh makes a good point about fixing a small defect over a large one. But, still, if it’s not changing, it’s not really broken. There’s no need to “fix” it.
-
Thank for all the advice. And yes, that’’’s it – Desarda. I’’’ll try and find out how many he’’’s done. He quoted an interesting study suggesting at three years that method had same recurrence as mesh. No more, no less.
-
Dr. Belyanski is a top hernia surgeon in Annapolis Maryland.
Not to scare you but to inform you about mesh but if something should go wrong with mesh and it needs to come out it is a utter nightmare to remove. And very few surgeons do it. Dr. Belyanski removed my mesh-so if you decide on going with mesh I’d consider getting the surgery with him he is highly skilled and in your area-and even a bigger plus is he does and knows how to remove it-should something gonwromg in the future.
this is my biggest complaint about mesh-it’s not whether something will or won’t go wrong or whether it is good or bad-but if it does go wrong it is a utter disaster and an ordeal to get it removed and even if you do get it removed it’s not a slam dunk that you are better off. This stuff can do a lot of damage.
the D you are talking about is most likely the desarda pure tissue repair. Ask how many he does of these types of repairs.
Do your research and make the best decision you can on which way to go.
there is nothing wrong with waiting however if it is small it is much easier to get a pure tissue repair if it gets bigger over time and you want a pure tissue repair it may be harder. -
Hi, Good Intentions: a question: your prosthesis is made of polypropylene?
-
Thanks. This surgeon said it appears I have it on both sides (indirect inguinal) and suggested a laparoscopic robotic surgery with a mesh they’ve been using for well over 10 or 15 years. He had a colleague in this practice that apparently did it recently. He did say he does the open no mesh surgery method that starts with a D (can’t remember name) as well.
-
I can’t emphasize enough how important it is to get the details of what worked and the details of what your surgeon is planning. Make sure that they match. Things are changing very fast right now and things are being tried that have not been proven to work. There is a lot of experimenting going on, with no long-term follow-up.
Get on to youtube and search “sages conference hernia” or similar and watch some of the presentations. Many of the talks are about the new things being tried, and if you watch closely you’ll see that many of the presenters aren’t really confident that their methods work. Their patients go away and they never hear from them again.
It’s great that you have friends that have had the surgery. But you’ll probably have to press them to find out how they really feel. As I said in post #10, we don’t want to look weak so we tend to hide our problems. I know I did, and still do. Plus I spent a couple of years trying to believe that I hadn’t screwed up by having the surgery done. Convincing myself that things would get better eventually.
The “find a surgeon with many surgeries under his belt and you’ll be fine” advice that you see is almost a marketing tool, to make people feel comfortable about having it done. My surgeon had about 400 repairs behind him. He was very skilled. But he was still modifying his method. He told me that but I convinced myself that he was fine-tuning to perfection instead of asking him what was wrong with the way he had been doing things. Maybe he had had earlier problems. I still don’t know.
It’s very difficult to challenge an expert about what they are telling you. Some will get angry. But you’ll live with your choice for the rest of your life. Much longer than a few months of healing pain. If they can’t answer your questions then you know that they don’t know for sure that their methods actually work. Make sure that their method is tailored to you, and is not a one-size-fits-all method. It’s been posted here and I heard it from my surgeon, that active people with low body fat tend to have more problems with mesh. He told me this after I went back with problems, not before. Even though he knew that I was very physically active, and am obviously low body fat.
Good luck.
-
Very sorry to hear that. I had one friend who had open for one repair and laparoscopic for another. He said he has no issues now but did mention the open method was actually easier recovery, mainly because the lack of bloat that took a couple of weeks to go away. Another friend has had two surgeries. Said the first wasn’t bad but the second took him a month to leave the house and he had nerve damage in legs, which eventually resolved. He was out of work for two months. He said he’s now recovered. Another friend had three surgeries and he says no problems now but I haven’t really talked to him at length yet for details. And the last said he gets anoccasional twinge or discomfort I guess but feels mostly fine. I don’t know what he had done. But I believe all had mesh repairs.
It’s good to be informed but also scary. Went to a law firm website for worst case scenarios and scaremongering and saw stuff about teeth falling out and bowel obstructions and brain damage. But I also know this is one of the most common surgeries there is and has been done with and without mesh for a century. But that doesn’t really matter I suppose if you’re in the bucket of folks who have complications. I know my grandfather had hernia surgery as a middle aged man and never heard anything about complications later in life (he lived to be 91). But I have no idea what method was used for repair. Sigh. So much information out there and so hard on someone like myself who has trouble making decisions. Will see what surgeon(s) say. Thanks again for all your thoughtful responses.
-
quote ajm222:By the way, did you have a bad experience? Having trouble finding previous posts. Thanks.
I did and I’m seeking solutions. I had bilateral laparoscopic mesh implantation of Bard Soft Mesh, for a direct hernia. It hasn’t been anywhere near the impression that’s fostered by the industry. It’s the worst thing that’s happened to me besides the death of family members.
-
quote ajm222:Thanks! That’s great info. Most friends who’ve had the surgery always say ‘sooner rather than later’ but perhaps they simply weren’t aware of the possibility of ‘watch and wait’ or had very symptomatic hernias.
I thought that I had found the perfect person for advice when I had mine. A surgeon who had actually done hernia repairs, and had had a hernia himself, which he had repaired. But after I had the surgery I found that he had his done by the open repair method.
If you have friends that will honestly talk about how they are, including all side effects, you’ll be lucky. The thing about healthy active men (maybe women too) is that we are all raised to suck it up, throw some dirt on it, be tough. And we don’t like to admit that we made a mistake. So I think that many of the problems are being hidden by the patients themselves. And the pros who could extract the information, through an anonymous survey, or discussion, aren’t seeking out the truth.
If you find someone who had success, and has been okay for over a year, and they do similar activities to you, and have your same body type, consider having the exact same surgeon and procedure.
-
By the way, did you have a bad experience? Having trouble finding previous posts. Thanks.
-
But. If you do decide to go ahead and have it done, I would ask the surgeon if they have actually talked to patients who’ve had the materials and techniques the surgeon is currently using, after 6 months to a year, and heard the patient say that they were happy with the results. Not results from older methods and materials, because change is being made based on potential benefits not proven benefits. And every surgeon has a different method. So you can’t even compare materials and methods. I’ve only found a few people who will say that they’re happy with the results of their hernia repair. I think that there are probably many many people who aren’t but have just accepted their new diminished life. Because there’s nothing that they feel they can do about it.
There are pretty sizable communication barriers between patient and doctor these days. If I want to talk to mine, I have to call his answering service. They deliver a message. If he wants to he can call me back. Or he can ask me to come in for an appointment. That means waiting one to two weeks, then paying a copay, then getting 15-20 minutes of time.
In short, just ask for proof that what the surgeon is going to do to you actually will make you better. It’s a very reasonable question.
-
Thanks! That’s great info. Most friends who’ve had the surgery always say ‘sooner rather than later’ but perhaps they simply weren’t aware of the possibility of ‘watch and wait’ or had very symptomatic hernias. I imagine if I DO get surgery I should find someone that seems aware of all the things you’ve mentioned and have considered them. Must be some knowledgeable and experienced surgeons aware of these problems and care enough about their patients to discuss them. But I’ll be sure to bring this up. And perhaps try and steer clear of any cutting-edge, latest-and-greatest mesh products and ask for something tried and true if possible. Will find out tomorrow hopefully what’s going on and start considering what to do.
-
quote ajm222:The idea of watching and waiting panics me
Seems finding a great surgeon is critical and I want to do my homework and be prepared.
I don’t want things to progress any further (largely asymptomatic right now) but don’t want to get surgery on something that isn’t currently a huge problem if it means I risk more life-long pain or complications. But I also feel like this is a ticking time bomb
I felt similar to you when I found that I had a hernia. But mine was symptomatic and painful and was inhibiting my doing the things I liked to do. If I can be frank – a person would be a fool to get an asymptomatic hernia repaired, by any method, if it’s not getting worse and they are doing all of the things that they like to do.
It’s not a “bomb”. If it gets worse it will be fairly slowly. You’ll know that it;s getting worse. More stuff will push out and you’ll have a sizable bump and various other discomforts.
This is an interesting time for hernia repair. There’s been a very big push to get the new mesh products and techniques out to the masses (25% of the population is massive, marketwise). Everyone involved has been overlooking problems, and/or hoping that all of the change is only for the better. But, as you’ve seen, many of the professionals, from the device suppliers to the insurance companies, and many surgeons, are ignoring the signs that there are major problems. The cost, to the patient, physically, of a problematic hernia repair is huge, but the probability of it happening is smaller. They, the people I mentioned above, are paying for lower recurrence rates with the lives of the few that have problems.
Basically the odds of a successful repair (no recurrence) are better but the cost of complications is huge. It will completely change your entire life. That’s what you should be afraid of.
If I had just discovered a hernia and it was minor and asymptomatic I’d wait and see how things shake out. I don’t think that things can continue as they are, the law firms are lined up out there. When I was researching for mine, in 2014, just three years ago, I barely saw any law firms advertising for hernia mesh lawsuits. All I saw was transvaginal mesh law suits. Now the first search page for “hernia mesh” is almost all about hernia complication law suits. That’s in just three years. I’d wait.
-
wonderful that’s great to know thanks
-
the majority of mesh implants will be permanent, and hopefully will never need to be removed.
I didn’t mention mesh vs. non-mesh in my first reply because it is a much bigger issue as you can see from other posts. You will find the overwhelming majority of surgeons will use mesh these days, and it will be polypropylene or polyester which is a permanent implant.
Log in to reply.