(Suspected) Chronic Mesh Infection after Inguinal Hernia Repair – Thoughts/Advice?
08/09/2018 at 7:08 pm #11417
I am in need of some help. I apologize for the long read but this is something that has been plaguing my life the last several years and I’ve had no one to talk to about it.
I am a 29 year old male in DFW, TX in otherwise good health and have been suffering from an inguinal hernia since I was about 22.
I remember wearing the same very tight belt around my waist at work, and eventually a quarter-size lump formed under where the belt buckle was. I remember the belt buckle used to kind of dig into my waist and would hurt. I suspected this was somehow related, as the lump was directly where the belt buckle was that was imprinting into my skin, although perhaps it’s coincidental. I quickly ditched the belt.
Every six months or so, almost like clock-work, the quarter-size lump would return with sharp pain. It would be debilitating for days-weeks, but would eventually subside. I put off going to the doctor for quite some time, until finally I had enough of dealing with this every six months (I think it flared up a few times until I finally went to the doctor).
I originally went to a local, walk-in clinic doctor who alleged that I had been there a year prior for the same reason and that he had given me instructions to take some kind of medication and that I did not have a hernia (I didn’t recall any of this; I suspect he was confusing me for someone else, my mother perhaps. As far as I can remember this was the first time I had consulted a doctor on the issue, and maybe only the second time I had ever been to that doctor, and I know it was not for a hernia), and he essentially scolded me for not following his advice, of which I don’t remember him giving in the first place. I never went back to him; he was rude and wouldn’t listen to me. I believe he said that if I didn’t play sports, then I shouldn’t have a hernia and he rushed me out of the office, prescribing some anti-inflammatories. I have never had an experience like that before from a doctor and I was appalled to say the least.
So here starts the real journey:
I eventually consulted with a local general surgeon who said yes, I do have a decent sized inguinal hernia, and we quickly scheduled a repair using Ethicon UltaPro mesh in early 2014.
Everything seemed fine until about 6 months later, when the exact same symptoms arose: quarter-size lump under skin, sharp pain on the site, etc.
I went back to the surgeon who prescribed some anti-biotics. I believe everything was fine for another six months.
The same symptoms arose, only this time an abscess formed with a large buildup of fluid. The surgeon wasn’t able to see me before the fluid discharged, and I’m not sure if he believed me or understood the severity of what I was going through. Needless to say, I was shocked when all of a sudden I felt and saw streams of blood oozing down my penis. I didn’t know that was to be expected and I nearly had a heart attack when I went to use the bathroom.
Each time after this, an abscess would form, each time getting larger and more painful.
I think there was only one time I was able to see the surgeon while I still had a large abscess before it had drained (I wanted him to see it, otherwise I felt like he didn’t believe me as he seemed to brush it off, at one point saying it might “just be a nerve thing”), and he prescribed some more anti-biotics. I had also met with a different walk-in clinic on one of the occasions where my surgeon was not able to schedule me for a visit, and they had given me anti-biotics and a steroid shot.
In 2016, after more symptoms, I went back to my surgeon who performed a debridement on the original surgical site in an attempt to remove the infection. His belief was that I was likely having a reaction to the glue that they used to suture the wound. They used nylon stitches on this procedure.
Of course, six-twelve months later my symptoms were back. I was able to see the surgeon within a day or two after the abscess had drained, so he was able to somewhat sterilize the abscess wound (that’s something I wasn’t able to do before since he was never able to schedule me within 2 or 3 weeks, and the abscess only lasts about 2 weeks before it drains). I was put on more anti-biotics, a lot of anti-biotics, with the hopes that it would knock out once and for all whatever infection there may be. He said if I showed any more symptoms, we may need to replace the mesh with a biological mesh.
Which brings us to today, about a year later, my symptoms are starting to come back. At this point I just don’t know what to do. Do I go back to the same surgeon and just hope for the best with a biological mesh? I’d like to think I am smarter than that and don’t want to repeat history. My instinct is telling me to get this f**king mesh out of my body and don’t put anything else in it, biological or not. I am so scared and have been having suicidal thoughts as obviously that would be much easier to perform with no complications, although I only want to do that as a last resort once all hope is lost.
I am only on the third day of having symptoms, and the abscess is just starting to form. I know I am running out of time before it grows larger and drains. My surgeon, as usual, can’t see me for 2-3 weeks. I am so sick and tired of dealing with this and I feel like I’m alone and no one will listen to me or take me seriously. I don’t want to go on like this for the rest of my life. When the abscess forms, the symptoms are worse than the original hernia was. I can’t stand, sit, lay down, cough, laugh, wear pants at the waist, etc. without severe pain and worrying about popping the abscess (at least before the infection, I didn’t have to do all of this without fear of popping an abscess).
Does anybody know if this sounds like my body is rejecting the mesh? I have searched online plenty of times in the past years but I can’t find any pictures or descriptions that sound exactly like mine.
I know that ultimately I need to consult a doctor, but I want to see if anyone else has had similar experiences or know of anyone who has. In the meantime, I am trying to find experienced doctors in mesh removal or mesh complications, but the few local hospitals I have contacted all say “well the doctor has experience in putting mesh in as well as abdominal reconstruction, so they should be able to remove it.” I haven’t heard anything confident so far, so I am scared and looking for feedback. I don’t necessarily want to waste my time or a surgeon’s time by consulting with them on something I don’t think they have a lot of experience with.
I’m attaching a picture of the last time the abscess formed in 2017 and when it drained (warning: graphic) to see if anyone recognizes if this is a sign of mesh infection.
Can anyone help me and let me know if they think this is a case of an infected mesh or my body rejecting the mesh, and if so, any advice? I am unable to consult with my surgeon for another few weeks, so any feedback is appreciated.
Thanks in advance,
08/09/2018 at 7:52 pm #16634
Hello muzik. This sounds like a terrible experience. I can appreciate gong back to the original surgeon, since they should know what might have gone wrong, and they also need to know that their work has gone wrong, but from the details of your story it seems like you should find a new surgeon. Implanting the mesh and understanding the problems with mesh are not necessarily connected.
There are simple, quick, blood tests that can be performed to determine if infection is present. Unfortunately, as I understand things, infected mesh is very very difficult to clear up, or “salvage” as they say. Regardless, your mesh does not seem to be “incorporated” in to the surrounding tissue as it is supposed to do. I’d say that you do need an expert in both infected fields and in mesh removal. Dr. Towfigh has that expertise and probably knows of others who do also.
Can you give your general location? Somebody can recommend a surgeon with the knowledge that you need.
Also, if you haven’t done so yet, you should get a copy of your medical records. There are several versions of “Ultrapro” some with a polymer that degrades and is absorbed and others without, plus different physical forms like the plug. They probably have different types of problems.
Good luck. Post your location soon so that people will see it.
08/09/2018 at 9:03 pm #16635quote Good intentions:
I agree, I would prefer to see my original surgeon for the same reasons, but at this point I feel I need to “shop around” as even he admitted that the procedure would be a difficult one (to replace the mesh with biomesh; he advised against removal completely). I’m sure the procedure is difficult for any surgeon, but still not something that instills confidence.quote Good intentions:
Of course, I should have mentioned I am in DFW, TX.quote Good intentions:
Good point. I did get my records last year. Mine was an Ethicon UH8M, which is not currently listed on their website. I see an UHSM, which I assume must be similar. It is the kind that has the plug and the degrading polymer (Poliglecaprone-25: gylcolide, e-caprolactone), for anyone curious.
08/09/2018 at 9:43 pm #16636
I had similar depression when my mesh implant wasn’t working. But now, ~9 months after having it removed, I feel like I’ll be back to at least 80-90% of where I was before the hernia. So there is hope, if you find the right surgeon.
If you had a simple direct hernia, which is what that system is used for, then I don’t think that there is a need for a biologic mesh. Your current surgeon seems to be thinking in extreme measures. Even the UHSM system is on the extreme end of hernia repair, used for large hernias in people who will be stressing the area after repair, I believe. It’s a lot of “repair” for a small simple hernia. I don’t see the absorbable polymer in the description though. Maybe you got the “Comfort Plug” which does use the PLA.
Dr. Towfigh just removed a plug system that was causing pain. And she has published on infected fields. So, hopefully she’ll have a recommendation for a local surgeon. Dr. Peter Billing removed my mesh, he is in Shoreline WA.
Here is Dr. Towfigh’s recent tweet about the plug removal –
And here is the Ethicon product page –
08/09/2018 at 9:46 pm #16637
I wrote a long reply but got “green-screened” as unapproved. I am doing very well after mesh removal, so don’t give up hope. Your surgeon seems to be thinking in extreme measures, which may not be necessary.
I also sent a message to Dr. Towfigh so hopefully she will have some comments.
Here is Dr. Towfigh’s recent tweet about plug removal. Good luck.
08/09/2018 at 11:29 pm #16638quote Good intentions:
Thanks for the reply. Did you see a specialist or were you able to go to a local surgeon to do the surgery? Did they seem confident in their abilities? How long has it been since you’ve had your removal?
08/10/2018 at 1:56 am #16639
I’ve just been doing more research and I’ve just discovered after all of this time that these may be recurring keloids or hypertrophic scars. I have never heard of either before, but I’m reading about them and looking at pictures and it seems exactly like what I have been dealing with.
So perhaps the mesh is not to blame and this is just an issue with the skin at the surgical site. I’m still left with many questions as far as remedies, but I feel slightly more at ease knowing perhaps that the mesh may not be the cause of the abscesses. I did have a debridement done a couple of years ago, but the abscesses still come back, so not sure what will need to be done to fix it. I guess time will tell…
If anyone still has any input, I would appreciate it. I will share more as time goes on.
08/10/2018 at 4:43 am #16640drtowfighKeymaster
[USER=”2672″]muzik[/USER] Thanks for your post
sounds like you have a mesh infection. There is no reason to have recurrent infections in the same place unless there is a foreign body that has seeded with bacteria and so the infection keeps recurring.
The UHS mesh is a good one. It’s considered lightweight, even ultra lightweight. Thy tend to be more resistant to infection than heavier weight mesh products.
If the mesh is infected, it must be removed in its entirety.
Unfortunately, I don’t know of anyone nearby to TX who can handle this problem.
I am happy to help you if you’d like to travel to CA. These are pretty straightforward operations. I don’t recommend biologic or anything else put in. I recommend a staged procedure: get rid of all foreign body and have the area scar in and be infection free. Then we can discuss hernia repair at a future date if you still have a hernia. The intense inflammation and scar from infection often seals the area and hernia recurrence is less likely.
08/10/2018 at 2:40 pm #16643quote drtowfigh:
Hi Dr Towfigh, thank you for your reply. I will schedule a consultation with you shortly.
08/10/2018 at 5:48 pm #16647quote muzik:
I traveled out of my insurance network to see Dr. Peter Billing of Eviva in Shoreline WA. He is known for removing mesh but does many other things besides hernia work. I’ve been impressed with his practice from the beginning. It’s been about 9 months since I had two 6×6 pieces of Bard Soft Mesh removed. Of course, they weren’t 6 x 6 anymore they were very shrunken and stiff. My problem was not infection but just constant irritation due to the nature of the mesh.
Dr. Billing also did not repair any hernias while he was removing the mesh. So far I’ve not had any signs of recurrence, but the recovery process is long and slow. I had the mesh implants for three years so the surrounding tissue had thickened and distorted and it’s taking time to reform to its new environment. It’s all been forward and promising since removal though. I don’t regret it.
08/12/2018 at 4:47 am #16658JnomeshParticipant
Yes mesh can be safely removed but only by a experienced surgeon such as the two mentioned and there is also dr. Igor Belyanski in MD. I have heard it mentioned that infected mesh is often easier to remove since often the mesh hasn’t fully incorporated into the surrounding tissue.
08/12/2018 at 5:05 am #16659JnomeshParticipant
I should also point out this is one of the problems with using mesh of any kind Bc once issues arise there seems to be little to no help from the original implanting surgeon. Whether it be from infection , nerve entrapment, meshoma, autoimmune issues, foreign body reaction, inflammation-the big and to me inexcusable problem besides the pain one goes through is that there is very little help from the medical community. How irresponsible when one considers also that this is supposed to be a permanent device. I come across these horror stories all the time, patients in pain after mesh implantation being passed off from one doctor to another, test after test only to eventually be prescribed some sort of pain medication.
I mean the fact that this gentleman had to go online and do the research himself and thankfully come across this forum and thankfully hear back from dr. Towfigh they yes it appears to be mesh infection really highlights that something is wrong out there when things go wrong with mesh implantion.
we have thousands of surgeon implanting mesh for hernia surgeons and what seem to be far to few who are trained on mesh complications.
And this poor guy has the pictures tonshow there is obviously something very wrong and he was still gaslighted by his surgeon.
if mesh is going to be continued to be used things need to change. Surgeons first need to be trained on non mesh repairs at the very least equal to mesh repairs. They also need to be trained on mesh removal-and if they can’t do it then they can’t implant it. There also needs to be a mandatory registry that tracks mesh conpilications. You think this guys mesh issues got reported? Good luck. It’s obvious to me there would be tons of complaints documented if this were implemented Bc this is a perfect example of how it doesn’t get reported-the surgeon doesn’t give the proper diagnosis for whatever the reason, the patient gives up and moved on.
Dont get me wrong there are competent and reputable hernia surgeons out there but far far to few-when mesh goes wrong.
cant think of anything worse then the pain people go through with mesh issues except for being in pain and not being property treated for ones pain.
Thank you dr. Towfigh for your support-your level of care should be the standard not the exception.
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