[ajm222]

It also could be related to type of hernia. Dr. Belyansky suggested he really hasn’t seen recurrence among those who had an indirect hernia originally and had their mesh removed by him. But those who had direct hernias sometimes get another hernia within just a few months. Something about the anatomy. I do know one person who had both direct and indirect on the same side and had removal and they have not gotten another hernia so far after 3 years. Several other people I’ve spoken to remain hernia free after 2-3 years. It could also be related to the type of removal – open versus lapro. And I think good intentions may have had a direct hernia (?) and had his mesh removed several years ago with no new hernia. Who knows if that will change.

[ajm222]

How bad are your symptoms? Can you wait? Plug and patch is definitely not the way to go. Certainly there are people with a plug who do just fine, but it’s no longer considered good practice by the experts. Shouldice would be ideal if you can hold off. I think the hernia has to be a certain size and the patient a certain weight (and probably a non-smoker, etc etc). But that’s what I would recommend if you can hold off. If not, I would try and at least get a second opinion if you are able (would be really disappointing is this isn’t allowed) and hope they don’t use that method. Just my opinion. Good luck.

[ajm222]

Also kind of curious about long-term complications not including recurrence. Like, could you get a removal and these up fine but then have some related complications years later from removal.

[ajm222]

thanks again @drbrown. i don’t really love the idea of someone sticking a needle through the mesh that’s under the layer of muscle since this was placed robotically, but perhaps that’s an option. it sounds like in some people the mesh doesn’t actually become hard, and in some people it does? if so, i would assume it’s just different inflammatory responses? becoming harder than expected would certainly explain why I feel like my right side is stiffer and why i have a mild foreign body sensation when raising my leg or bending over. and perhaps shrinkage is why i have the tightness and pulling sensation in my lower abdomen. all would seem reasons to remove the mesh considering these things will not change and possibly get worse. i was told that there is rarely a hernia present immediately after removal, and that there are rarely early recurrences either after removal if the original hernia was indirect (which is what mine was), and that i can get a pure tissue open repair down the road if anything does happen. would just have to hope no complications from the mess of removal, and to expect a fairly long recovery period.

[ajm222]

That works! Thanks!

[ajm222]

Thanks, @drbrown – i’ve been checked for nerve involvement and don’t seem to have that issue. we suspect it is probably the mesh. just not as severe a case as many here. that’s why it’s been so hard to make the decision to remove the mesh. would love to just get it out, but i also understand the risks.

[ajm222]

Thank you!

[ajm222]

That’s really interesting, though it’s probably safe to say that in 99% of the country we’re still in “peak mesh” times. These changes start slowly though and this is good news.

[ajm222]

Hey Ben –

Out of curiosity, did you have any other repair done, or did they just remove the mesh and there was enough scar tissue to hold things?

Thanks

[ajm222]

Perhaps in reality, the area behind the muscle wall after removal is so damaged that it impacts sensation and feeling and function on the other side. I could see that. But they suggested the tissue itself would be undisturbed. I was also interested to hear Dr. Towfigh suggest that very little actual tissue is removed during removal surgery – the amount was fairly negligible.

[ajm222]

Understood. But from a surgical perspective there’s a difference between the anterior and posterior surgical realms of course, and these two surgeons suggested in fact that surgery via open method after robotic mesh placement and removal would still be working with virgin tissue. I always forget which is anterior and which is posterior. So yes, the area behind the muscle wall and that general vicinity will be changed after mesh placement and removal, but the other side of the muscle should still itself be so-called virgin tissue.

[ajm222]

“But if you have mesh problems you can never go back to a pure tissue repair.”

I would add that in fact it’s my understanding it would be possible to get a pure tissue repair after mesh if the mesh was placed and removed robotically. Both Belyansky and Procter advised me that an open tissue repair would be feasible if mesh was placed and removed robotically because the tissue in the front would be undisturbed.

[ajm222]

Yeah, doing a bilateral removal would also have me very cautious about removal. Of course, Good Intentions can speak to that. I believe he had both done but in separate operations?

I really think the outcomes are dependent on a lot of factors, but factors we sort of understand to some degree now. In my case, I had robotic mesh, and the removal would be robotic, and it’s only on one side, and I have no real nerve involvement. And it would be performed by someone who does 3-4 removals a week and has a reputation for being an expert with the robot. No guarantees but I believe this greatly improves my chances at a positive outcome, compared to those with nerve issues and particularly those who need to have open removal.

Most of the folks with bad results seem to have started off pretty bad and also had open removals that were often done by surgeons that don’t often do removals. I think every case is very different and that makes it tough to predict.

I’ve certainly seen a number of very positive stories here, and I think there are many more we don’t see – people that don’t post on here or on FB group pages for the ‘mesh injured’.

Also, I know in my case the mesh issues haven’t gotten worse. They’ve actually gotten better. But the foreign body sensation is still there. And I worry about flares. And I worry about the several years of lots of discomfort. So it’s even harder to decide now. But I really want to see how things would be with the mesh removed. And I think my chances are good. But it’s still risky obviously. And I do worry much re-herniating. But Jnomesh and Good and others haven’t had that problem, amazingly.

[ajm222]

Yeah, it’s a tough position to be in. What did Yunis recommend? I think in my case I’ve gotten to a similar point in the last month or two where it’s still there but it’s not bothering my psychologically as much. And the main thing that was bugging me (weird discomfort in lower abdomen has finished a lot). But I’m also worried any day it’ll ‘flare’ – and anything that bothered me this much for three years and is still noticeable should still possibly be dealt with regardless. It’s a big surgery with lots of possible complications, but the top removal surgeons should minimize the risks substantially. I had tentatively scheduled surgery again for late Jan but it was cancelled because of Covid. Expect to hear something from them again early next month. Still considering it. I also worry about job loss of insurance changes and then being stuck.

[ajm222]

Ah, that’s right. Now I remember your situation. In my case, my problems started kind of from the beginning, in terms of the soreness. The worst of the foreign body sensation in my lower abdomen didn’t really start until a few months after surgery, though. But I have heard that is often the case – as the body kind of deals with the mesh and incorporating it and scarring around it, it can take a few months before it starts pulling on things or folding.

My case was also a bit unusual in that my pain and discomfort weren’t substantial. The soreness from the initial surgery was never great, but it just kind of lingered. I suppose one could argue that perhaps by overly focusing on the surgery, I may have healed but prevented my body and mind from letting go of the pain. But if it were just the pain and not the foreign body stuff and heaviness on my right side, I probably would be ok with the soreness. All together, I feel the mesh has just been a problem.

But I have to accept that I will always be in a weird place where it’s not so bad that the decision will ever be cut and dry. When things flare up, I do get close to 100% certainty, but that just never lasts more than a week or so, and I always wonder if it will be the last time or if I can control it to some extent. Very frustrating, but clearly you know what that’s like as well.

Anyway, thanks for your responses. Hope things continue to improve for you. I will certainly let you know if I ever end up going through with this surgery. Another one scheduled again for late January. With my luck I’ll finally decide to do it and it’ll be cancelled because of the pandemic 🙂

[ajm222]

Thank you for the comments, and same to you!

What did Dr. B end up suggesting?

I think in my case that while the soreness comes and goes, the foreign body sensations likely won’t go away even with therapies like shots or whatever. Maybe I’m wrong, but Dr. B also confirmed that they aren’t likely to be permanent or help that much. Perhaps it’s possible, though. I’m glad you had such relief for so long with the cortisone. I suspect my issues are higher level inflammation causing the soreness, and maybe the mesh folding or pulling on something to give the foreign body sensation. Imaging shows nothing and I have had it all (ultrasound, CT, MRI).

When I am less stressed and preoccupied with other things, It’s not too bad. Still there, but I’m closer to a 1 or 2 out of 10 in terms of pain and discomfort. Makes me wonder how much is caused by tension in the area and psychology. But then when I am stressed and it’s flaring, it’s more like a 5 or 6 out of 10. Maybe more.

Ugh.

[ajm222]

Forgot to mention that my surgical plan is to simply remove the mesh and do nothing else, hoping the scar tissue will hold things in. If it doesn’t, then I can get a tissue repair via the open method at some point down the road. I had my mesh inserted robotically, and it would be removed the same way, which means it’s highly unlikely any major nerves would need to be cut. Fortunately I also am not an athlete and I’m in my mid-40’s, so I just want to get back to living without pain or discomfort and be able to do light to moderate exercise without issue.

[ajm222]

Hey Peter –

Thanks for the advice! Yeah, that’s the other thing messing with my head – knowing that surgery isn’t guaranteed to improve things, and could potentially make them much worse. Or it could change my life for the better. Dr. Belyansky is my surgeon. I have confidence in him. But I know that even he would admit nothing is guaranteed when it comes to something like mesh removal. I am definitely approaching this with huge amounts of caution. On the one hand I can’t discount almost three years of regular on and off discomfort. On the other hand, at the moment it isn’t bothering me much. But I suspect if I call and tell them I’m not ready still, I will likely have a flare up. Always makes me wonder how much is in my head. And I wonder if slowly over time things will get better and better as I get older, and maybe eventually I’ll mostly feel ok and learn to live with whatever mild symptoms remain. Or if the mesh is a ticking time bomb.

Not a great position to be in. But I know you can sympathize. I hope you get your issues sorted out at least to the point that you can feel more normal.

Thanks

[ajm222]

Got it, that’s helpful. I had a mesh placed robotically and likely to have it removed the same way. The expectation (and hope) is that there is enough scar tissue and no hernia present, and it stays that way with no further repairs needed. Hope you get your nerve issues sorted out. Sounds like your recovery went pretty well otherwise, which personally gives me hope. The nerve stuff is always tricky. I myself don’t seem to have any nerve issues and hoping removal doesn’t introduce any.

[ajm222]

thank you. i think i initially was confused and thought your mesh was purely posterior and removed robotically. but it sounds like it was a mesh placed openly for the most part originally?