Scartissue After laproscoptic Tep repair

[ajm222]

quote Julian:

Ajm222…just from my experience and from what I have read…I would avoid an open removal if you can…if your current mesh is in laparoscopically then have it removed the same way..just my opinion

yeah, for sure. i was just curious what dr. brown thought of open versus robotic removal recovery.

[Unknown Member]

Ajm222…just from my experience and from what I have read…I would avoid an open removal if you can…if your current mesh is in laparoscopically then have it removed the same way..just my opinion

[ajm222]

quote DrBrown:

[USER=”2051″]ajm222[/USER]
Dear AJM.
In your situation I often use trigger point injections. For example, if the mesh is injected with a local anesthetic and you feel great for a few hours, that would be strong evidence that removing the mesh will help you. If injecting the mesh does not help then I would perform a nerve block.
Regards.
Bill Brown MD

Another somewhat related question for Dr. Brown. I know you typically do an open repair, while Dr. Belyansky (at least in my case) would do a robotic repair (partially because that’s also how mine was put in). Do you think open removal has a longer recovery time than robotic removal?

[DrBrown]

[USER=”2051″]ajm222[/USER]
Dear AJM.
In your situation I often use trigger point injections. For example, if the mesh is injected with a local anesthetic and you feel great for a few hours, that would be strong evidence that removing the mesh will help you. If injecting the mesh does not help then I would perform a nerve block.
Regards.
Bill Brown MD

[ajm222]

quote DrBrown:

[USER=”2051″]ajm222[/USER]
Dear AJM.
I agree with your decision to give your body more time. The operation will only get rid of about 80% of your pain. And it will take you a long time to fully recover.
Regards.
Bill Brown MD

Awesome, thanks again. The pain is mild, and honestly an 80% improvement would be great because it would make it even less than it is now and might almost eliminate it. But I understand what you’re saying about recovery. The bigger issue is the strange fullness, pulling, pressure type feelings that originate in my flank and near my hip, like something stuck in my lower abdomen. Always odd because it doesn’t seem to be exactly where the mesh is – it’s higher up. But must be related, though. Just don’t know if it’s the mesh or scar tissue or adhesions or some combination of all. Or even something else. And I don’t expect that to go away without removal given how long it has lasted. But I suppose anything is possible. I did have an odd week in the middle of summer where’d I’d swear I was almost back to normal. Might wait until December or January and re-evaluate what I can and can’t live with. Just knowing I have options has helped me through this latest rough patch.

[DrBrown]

[USER=”2051″]ajm222[/USER]
Dear AJM.
I agree with your decision to give your body more time. The operation will only get rid of about 80% of your pain. And it will take you a long time to fully recover.
Regards.
Bill Brown MD

[ajm222]

Ok so I had a much longer reply that was unapproved so will keep it short. But yeah, it’s a tough call. On the one hand, Dr. B almost made it sound routine at this point to do removal. And he as well as Dr. Towfigh and Dr. Proctor all said there was minimal risk in the right hands and people are rarely any worse off. And something Jnomesh said to me also stays in my mind – that for a long time things were mostly ok for him before they got really bad all of a sudden. And he wonders if the complications he’s had since removal might have been less if he’d done something sooner, before things got bad. I’ve read a few other stories like that – things after surgery never really got back to normal but they were livable. But then things went south. And at that point the damage caused by the mesh was worse than it otherwise would have been. So I sometimes wonder if it’s a sign that I’ve had struggles since the beginning, and perhaps removal is inevitable and better sooner than later. All that having been said, on the other hand, things really aren’t terrible, and they’ve actually been better since Dr B. agreed to the removal. I think my hopelessness and anxiety before had amplified the pain and discomfort substantially.

In my case Dr. B said no rush – just let him know if and when I’m ready. So I can give it as much time as I need. May give it another couple months and see if anything changes for the better or if I change my mind about what I can and can’t live with. As long as he doesn’t move or change hospitals where my insurance isn’t accepted 🙂

[ajm222]

Testing testing

[Good intentions]

Hello ajm22. I’ve thought about your situation over the last couple of weeks and realized that you might not get as much relief from a mesh removal, compared to, for instance, me and jnomesh. We both had significant and severe effects from the mesh, making it obvious that it needed to come out. In my case, I was on a slow and steady decline so, at the least, I hoped to stop that. In your case, since you seem to be in a steady state of fairly mild discomfort, the risk might be more than the potential benefit.

I think that many of the problems with mesh come, also, from the dissection process itself. Creating the space for the mesh. If you told somebody that you were going to open up a large cavity in the abdomen between the peritoneum and fascia or within layers of muscle, that alone would be a significant trauma, probably causing lasting effects.

I think that goal of getting the mesh in, seeing it as a miracle fix for the hernia, clouds the common hernia repair surgeon’s judgement. The large dissection zone alone is a major trauma.

Something to consider. I think that you might be in limbo until things get better or worse. Good luck.

[ajm222]

quote DrBrown:

[USER=”3027″]Julian[/USER]
Removing the mesh is a big decision.
Work with your surgeon to have everything check before you consider removal.
You reported that you had many of this problems before surgery. So removal of the mesh may not help.
Bill Brown MD

Hi Dr. Brown –

I know you can’t say for sure as it’s partially subjective, but for someone who has mostly mild discomfort and issues almost a couple of years after a hernia repair, do you think it would be worth it to have the mesh removed, if it has been determined the issues are most likely related to the mesh? Just thinking in terms of risks/benefits. I know sometimes things improve over longer time horizons, but I also know they can get worse if things.

Thanks

[Unknown Member]

But the first couple of weeks I was getting better ..things weren’t tight and then things just tightened up…my hips back pelvic floor got tight…like just didint make sense really..alot of my problems right now come from my back hips and pelvic floor….when I massage my groin or pull it to the sides it helps open up …something is throwing off my pelvic posture and its effecting my hips back..butt..pelvic floor which is making things even more numb and tight ….I know body best and I know my current state isnt permanent but theres something that’s not letting my pelvic muscles relax and just sit correctly…could it be this laproscoptic mesh…idk…

[DrBrown]

[USER=”3027″]Julian[/USER]
Removing the mesh is a big decision.
Work with your surgeon to have everything check before you consider removal.
You reported that you had many of this problems before surgery. So removal of the mesh may not help.
Bill Brown MD

[Unknown Member]

…honestly what are my options for removing this one that’s in Tep…a recent MRI ” shows the mesh is flat ” so not sure if that would make it easier to remove this one…but I’m suffering everyday….like I seriously need help

[Good intentions]

Not duplicate now – The new tissue is one of the main purposes of the mesh. It will not go away while the mesh is there. More tissue might actually be created over time as foreign body irritation continues. In my case, wherever there was mesh the tissue got very stiff and tight. My lower abdomen became taut and flat and thick, not in a good way.

It seems very contraindicated for a surgeon to place another large piece of mesh after a mesh removal. Most surgeons who do mesh removal don’t do anything, no repair attempts. until the body has adjusted over time without mesh. I would find a new surgeon and get a new opinion. I think that the surgeon who did the removal then placed mesh via TEP probably screwed you up even more. The first mesh repair probably moved because your body was rejecting the mesh. Putting more mesh in after mesh removal seems somewhat ignorant of the known problems with mesh and how the body can react to it..

Many surgeons have strong opinions about the way that they do things and think that the “skill of the surgeon”, their skill, is the key to success. They don’t understand the false story, spun by the device makers, behind mesh repair. Yours might have let his passion for laparoscopy get in the way of logic.