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Watchful waiting and pure tissue repair
I wanted to ask, I have read in the forum that the longer one waits to have an hernia repair, the bigger the hernia and therefore the more problems there might be with a pure tissue repair: is this correct?
Should one then seek a tissue only surgery asap?
Thanks again!
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19 Replies
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Only you can decide the right course of action, and the right time Alephy.
I wish you the best of luck with the option you choose, for your repair.
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Also at the moment I have minimal pain i.e. I can walk/train etc. The discomfort is occasional but not stopping any activity yet (it is also true that I am 50 and I am not certainly running for the Olympics:)
This is to say that I would not bargain this with a worse off situation just out of doing it quickly…. -
Well certainly better Shouldice than mesh. But I would like to try and find a surgeon who does the tailored approach that Dr. Brown discussed on the forum few times i.e. someone that can adapt to the hernia type etc. Say I happen to have an indirect one instead of a direct one, perhaps Shouldice would not be the right option or at least few less invasive ones might be on the table too. But even on the tissue only repair side of things, doctors often offer one procedure only (is this due to the fact that tissue only repair is not taught any more? probably)….
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Hi Alephy,
I think your plan to see surgeons who perform shouldice hernia repair surgery is the safest option, but the longer you wait the bigger the hernia and the more problematic the repair becomes.
All the best Alephy.
Di
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@dianew indeed I will not! I wish I could have all this behind one day but in the meantime it will be watchful waiting…I’d love to go back to my previous routine without which it is like not being me, which is depressing…but I have urticaria and so I cannot run any risks….all the doctors kept saying it’s not a problem but even if allergy tests were negative there would be no guarantee…
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You’re not wrong Alephy!
Alan, if you’re not a proponent of mesh or native tissue repairs, then why are you weighing in on this discussion? The data is available if you truly want to know what it is. I’ve done my research, I’ve joined multiple mesh injured support groups from around the world to ascertain if I have a bomb in my body otherwise known as mesh, have read horrific stories from hundreds of people on these forums, have read the data provided on various websites by doctors actual doctors performing mesh removal, as well as data on the efficacy of native tissue repair versus mesh repair. Our you want data to support either side of the discussion go find it yourself, it’s available if your prepared to do the work!
Alephy, unfortunately it’s not just chronic pain from the mesh, but nerve pain which is excruciating! And that’s just the tip of the iceberg. The list of symptoms is extensive and frightening, particularly when you’re ticking off the symptoms experienced.
I realise finances always dictates what we have access to Alephy, particularly health choices as modern medicine is so expensive, and I understand you can’t find surgeons in your country that are experienced in native tissue repairs, but please don’t get mesh implanted in your body. You end up playing Russian roulette with your health because you won’t know if the quality of the mesh is substandard and will cause massive infections that can’t be shut down. And if you heave any allergies in your family your risk of reacting adversely to the mesh immediately increases exponentially. Go get tested first for petrochemical allergy/sensitivity, see if you react to it. If so, run away from mesh, don’t touch it.
As for longevity of mesh, look at anything made from petrochemicals like polyurethane and you’ll see it breaks down over time. Add your bodies immune response in trying to break down the mesh because it’s a foreign body and the life of the non-removable mesh decreases accordingly. Add infections on top of that … and I how you’re starting to get the picture.
I will have to move to another state in my country to see a surgeon who will attempt to remove my mesh and perform a native tissue repair. Because the nerves from our spine congregate around the belly button, cutting into that area to remove my mesh will be extremely risky for creating more nerve pain, and I will have to get a personal bank loan to pay the costs. But that is the only choice I have. I understand that the financial aspect is important Alephy and you will be forced to go to another country and party the medical costs yourself, but the cost of mesh is too high.
Sorry for my ranting, but mesh brings with it an horrific cost, including death, and the surgeons who use it in all but the rarest occasions where there is no other choice are unconscionable and must be held accountable for the longing suffering mesh brings!
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You’re not wrong Alephy!
Alan, if you’re not a proponent of mesh or native tissue repairs, then why are you weighing in on this discussion? The data is available if you truly want to know what it is. I’ve done my research, I’ve joined multiple mesh injured support groups from around the world to ascertain if I have a bomb in my body otherwise known as mesh, have read horrific stories from hundreds of people on these forums, have read the data provided on various websites by doctors actual doctors performing mesh removal, as well as data on the efficacy of native tissue repair versus mesh repair. Our you want data to support either side of the discussion go find it yourself, it’s available if your prepared to do the work!
Alephy, unfortunately it’s not just chronic pain from the mesh, but nerve pain which is excruciating! And that’s just the tip of the iceberg. The list of symptoms is extensive and frightening, particularly when you’re ticking off the symptoms experienced.
I realise finances always dictates what we have access to Alephy, particularly health choices as modern medicine is so expensive, and I understand you can’t find surgeons in your country that are experienced in native tissue repairs, but please don’t get mesh implanted in your body. You end up playing Russian roulette with your health because you won’t know if the quality of the mesh is substandard and will cause massive infections that can’t be shut down. And if you heave any allergies in your family your risk of reacting adversely to the mesh immediately increases exponentially. Go get tested first for petrochemical allergy/sensitivity, see if you react to it. If so, run away from mesh, don’t touch it.
As for longevity of mesh, look at anything made from petrochemicals like polyurethane and you’ll see it breaks down over time. Add your bodies immune response in trying to break down the mesh because it’s a foreign body and the life of the non-removable mesh decreases accordingly. Add infections on top of that … and I how you’re starting to get the picture.
I will have to move to another state in my country to see a surgeon who will attempt to remove my mesh and perform a native tissue repair. Because the nerves from our spine congregate around the belly button, cutting into that area to remove my mesh will be extremely risky for creating more nerve pain, and I will have to get a personal bank loan to pay the costs. But that is the only choice I have. I understand that the financial aspect is important Alephy and you will be forced to go to another country and party the medical costs yourself, but the cost of mesh is too high.
Sorry for my ranting, but mesh brings with it an horrific cost, including death, and the surgeons who use it in all but the rarest occasions where there is no other choice are unconscionable and must be held accountable for the longing suffering mesh brings!
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Hi Alan,
Well this is exactly the point against mesh i.e. where is the data? I mean, long term data showing pros and cons of the meshes (the very many that are circulating…)? I think many also made a point that chronic pain is mostly a mesh phenomenon (papers have been mentioned in the forum many times)…
As for the tissue repairs they have been around for a long time: all of a sudden someone came up with crazy figures for the recurrences (still do not understand where these numbers come from) and then mesh had to be somehow….People correct me if I am getting wrong somehow…
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Diane,
A quick additional note. I am not a proponent of mesh nor of tissue repair. Like many, just trying to find the reliable health care data.
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Diane,
I understand and am sympathetic to those points. But, you’re only partially addressing my points with such well-known issues with the use of mesh.
Since, tissue repair would seem to be the superior repair in most cases, where is the current, objective, verifiable data to support the assertions?
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Hi Alan,
Have you seen or heard of the Johnson and Johnson class action lawsuit that occurred in Australia rece,ntly,where the complainants won? If not,you should read a copy of their transcripts to get a very long list of reasons why mesh shouldn’t be used. Reading the reports from their medical specialists should give you more data about the dangers of implanting mesh into human bodies.
You could also do a Google search on worldwide stories & medical reports about the extensive and long term health problems people experience after having mesh placed inside their bodies.
The surgeon may have skills, but they can’t guarantee the quality of the mesh being used, or that the mesh won’t accidentally be nicked at the edges during implantation which will begin the early breakdown of the mesh, or stop the mesh breaking down over time, or bunching up inside the body, or moving around the body. When polyurethane breaks down it releases a tidalwave of toxins into the body, and because the mesh can’t be removed without causing so much more damage, both tissue and nerve, once it’s been implanted you’ve got it for life in most cases. Or you can pay out around $50K to find the few surgeons located around the world who are able to remove the mesh, but never without more injury!
Using your own “native” tissue means you won’t have any immuno problems like “foreign body immune response” because foreign material hasn’t been used, it’s your own tissue. And you shouldn’t have any problems with “biofilms” which come about where mesh meets flesh.
There is so much information out there, if your mind is open enough to read it and believe it. I have read the data, and I’m experiencing the side effects of mesh first hand, like thousands of others around this planet, so please Alan read the massive amount of data that’s available out there yourself. Don’t push mesh as it’s a life of misery for so many people!
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Where is the data that demonstrates that pure tissue repair should always be preferred to utilizing a skilled surgeon using mesh?
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@pszotek Thanks a lot for your reply! You mentioned that at times you reinforce the tissue repair with a biological scaffold when the patient’s tissue is too weak: is this like a bio mesh that is reabsorbed or something else altogether?
It is the first time that I hear of such a reinforcement…Thanks a lot again!
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Hi all thanks a lot for your comments! The problem is in Switzerland the health insurances cover up to a point so I cannot get surgery out of the country. All the surgeons I spoke to insisted on mesh (they may mention pure tissue repair but they don’t do it). One or two doctors 1h by train from where I live do Shouldice but have not seen them yet. No surgeon offered several options or a tailored approach or rather the tailored bit is how they would go in but then it is mesh. One agreed on shouldice with the condition that she could decide to opt out at surgery to mesh if she felt the tissue was not strong enough. So the watchful waiting bit comes from having not many options…I had an umbilical hernia 17 years ago and was done without mesh as small (didn’t know how lucky I have been) and even though it is back but still very small it never gave me any problems or pain: this is to say I am not entirely unprepared about hernia surgery….had i had the tailored option offered by some doctors here I would have done it 4 months ago already…once the Corona virus mayhem is over I will reassess the options for travelling. It seems in Europe only Germany offers tissue repairs with still a focus on one or two methods. What about France and Italy?
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Hi Alephy,
I had an umbilical hernia which I nursed for about 2 years before seeing a doctor about it. I unfortunately went to a public hospital that performed hernia repairs using only mesh. The doctors prefer to use mesh as they can perform 3 hernia repairs in the same time it takes to do one hernia repair, so they make more money using mesh.
Although 8 years later the hernia remains repaired, the mesh has caused ongoing health problems including foreign body immune response. The mesh is not your own tissue, and therefore can and does cause ongoing problems from increasing incidents of biofilm infections, long term use of antibiotics, migration of the mesh to surrounding areas inside your body leading to perforation of internal organs , attachment to or severing of nerves and/or other vital parts like your urethra, bladder, etc which is dependent on where the mesh has been placed, as well as breaking through your skin where the mesh becomes exposed outside your body!
Over time the material breaks down inside your body which releases toxic chemicals which poisons your body, as well as allowing free-moving particles throughout your body.
Don’t wait till the hernia is so big that you have no other choice than to have mesh used to repair your hernia, always use your own tissue to repair your hernia as your minimising the amount of foreign material placed inside your body. Even internal stitches used in any surgery can cause your body to overreact due to foreign body immune response.
Go get it repaired.
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So I’ll weigh in based on my own experiences.
I did the “watchful waiting” (or procrastinated) for about 10 years after getting a hernia when I was running marathons. My reasons were due to having 3 newborn/young sons in that time frame, a hectic travel schedule, and couldn’t figure out how to work in the downtime around repair surgery. MY PCP all along kept saying, just do it- he was right!
At first I couldn’t justify surgery as it didn’t really bother me, except once in a blue moon. Over time of course it got larger and the discomfort became worse and more frequent. It finally got to the point where I’d had enough and it was impacting my quality of life. I had a buddy who had a mesh repair with complications, I was frankly sacred
Through my most recent relocation, I had moved to the Bay area and by chance I found Dr William Brown. At my consult, I was able to ask all the questions any informed buyer could and we determined a tissue repair was the way for me to go.
Did it hurt, yep for about two weeks. But that 2 weeks was a cake walk compared to the daily discomfort of letting it go. Now 6 months post-op, I had no idea how much pain I was actually in for the last decade.My advice is don’t wait. The older you get the longer the recovery and the larger it will be. Its OK to scared, even terrified. Shop for the most experienced hernia MD you can find, ask all the questions, and feel as comfortable with it as you can be.
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Alephy,
The answer for your question is different depending on where you are now but here is some general knowledge that we have:
1) Tissue repairs are dependent on the tissue you are repairing for durability. In many of the cases I do tissue quality for repair is proportional or at least related to the size of the hernia but not always. As hernias get bigger the tissue quality surrounding them often diminishes and the feasibility of long term success with a tissue repair may decrease. So in this sense the sooner you get it repaired the more likely you will have a successful tissue repair. In the instance where the tissue is weak or even there is no good tissue we often use a reinforced biologic material to help augment and support the tissue after performing the tissue repair. That being said we are also able to offer the robotic approach using the reinforced biologic with excellent results. When discussing these options with my patients I spend a lot of time going through the pros and cons of all types of repairs from mesh to no mesh open raptors to robotic repairs. There are benefits to each approach.
Here is why you get them fixed in my opinion:
1) Getting bigger.
Sooner it’s fixed the more likely to ge the repair you desire as when they get too big there is just not enough tissue without reinforcement.2) Pain/Increasing Discomfort.
3) Risk of bowel entrapment.
I do virtual consultations and would be happy to discuss your options with you. What I would say in relation to you question about who to see is that make sure your surgeon does all the operations and will offer you a choice. If you are not offered a choice of repair that you feel meets your value then move on and seek another opinion.
Thanks for your post!
Dr. Szotek
Office: 317-868-1305
Email: [email protected]
http://www.indianahernia.comIf you want to set up virtual visit to discuss options let me know.
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I will be 60 years old in a few months and I have had my hernia for 10 years
It has become the size of a baseball now. It does hurt once in a while but not often.
I have cancelled the surgery twice because of fear. As long as it doesnt hurt , I will not have it repaired . I dont trust the repair options available , I dont want mesh . I realize it is going to be a large repair.
My sex life is still pretty good and I wont risk losing that until the pain is constant. I used to wear a hernia belt but I quit wearing it 5 years ago
I have read to many horror stories and my 23 year old son had his repaired
He began having problems with pain and discomfort
My sex life is too important to risk -
Out of curiosity, Dr. Szotek, when doing pure tissue repairs, which repair techniques do you specialize in?
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