[ajm222]

quote DrBrown:

[USER=”2051″]ajm222[/USER]
If the patient is thin, then the mesh can often be palpated.
Also, a needle can be used to assess the the mesh. I will push a 22G needle through the skin. When the needle hits the mesh if the mesh is soft then the needle will pass through easily. If the mesh is scarred then the I have to push to get the needle to pass through the mesh.
An MRI can also determine how much scarring is around the mesh.
Regards.
Bill Brown MD

Thanks again. I take it a harder mesh would be a problem possibly related to an excessive foreign body reaction, could also often explain pain, and removal would be necessary as I’m assuming that’s not a reversible state.

[ajm222]

quote DrBrown:

[USER=”2987″]dh305[/USER]
There is a good chance that this will resolve with time.
But it would wise to ask your surgeon to check that your mesh is still soft and that the nerves are not scarred and that the spermatic cord moves smoothly.
Regards.
Bill Brown MD is

How can you tell if the mesh is still ‘soft’? Is it ideally supposed to stay this way? Is this where ‘fibrosis’ comes into play? I don’t mean to hijack the thread. Just curious.

[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.

[ajm222]

Dr. Belyansky and others apparently more often than not find that there is no hernia present after they remove the mesh. There is still enough scar tissue remaining after removal that has built up over time that usually another repair isn’t necessary. And that scar tissue is apparently enough to hold things for a long time if not indefinitely. I have seen him quote someone else that they would have about a 10% lifetime chance of recurrence after removal. But I think he and others will sometimes reinforce the area with tissue depending upon the circumstances, or if they notice a weakness of any kind. Not sure of the technical details. And if a whole new hernia repair is necessary, I don’t know all the details about what is usually done.

[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

[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

[ajm222]

quote drtowfigh:

Scar tissue from the hernia repair can cause a rise in the level of the testicle. Mesh removal is not necessary not recommended. In extreme situations (yours does not sound like one), release of the scar tissue can help lower the testicle to a more normal position.

Penile positioning should not be related to any hernia repair.

Thanks, Dr. Towfigh. The consideration to have the mesh removed is unrelated to the position issue. I’ve had regular pain and tightness and discomfort for most of the last 21 months or so. Dr. Belyanski (who I have seen twice now) agreed to do a removal if I wished, because of the regular nociceptive pain and foreign body sensation I seem to be having. It makes sense what you’re saying about the scar tissue because the right testicle is definitely higher now than left and perhaps that’s the only thing pushing everything else off to the side. I guess that means it’s unlikely to resolve any positional issues if the mesh is removed then. Which is fine. Everything works as it should.

Just spending some time weighing risks vs. benefits in terms of the getting the mesh removed now for those other reasons. He strongly stressed loss of testicle is something to seriously consider, though he did also say it’s never happened under his watch and I know you yourself have suggested it’s pretty rare if removal is done by a skilled surgeon who regularly removes mesh. Sounds like the other big complications would be numbness from damaged nerves or complications from scar tissue and healing that occurs after removal. It’s a gamble.

Thanks again

[ajm222]

quote DrBrown:

@amj222
Since your changes started after the operation, it is probably related to the operation.
Since the changes are not causing your much trouble, I would not advise you to have anything done at this time.
Wait until you have healed from the mesh removal operation.
Regards.
BIll Brown MD

Thanks, Dr. Brown. Do you mean to wait and see how things are after removal, to see if they improve? Or expect things to stay about the same but maybe do something about it after the healing from removal? If the latter, what could be done?

[ajm222]

that’s awesome! seems you’re in great hands. hopefully this is completely life changing. good luck!

[ajm222]

quote DrBrown:

To celebrate Mesh Month I have uploaded the photos of the mesh removed this month.
Regards.
Bill Brown MD

Hi Dr. Brown,

I am considering removal as my robotically inserted progrip mesh has been giving me mild pain and discomfort (sometimes moderate) for well over a year and I am now at 1 year and 8 months. In your experience, how long does it take to recover from removal on average? I can’t likely take off much more than 2 weeks before needing to go back to the office and wondering if that’s ridiculous. I hear some people say they felt the removal surgery was easier than the initial surgery, while others have taken months and months to get back to normal. This not being a routine thing, I guess it makes sense that every case is different.

I only have one side that needs to be removed, and Dr. Belyanksy says that he will not use more mesh when he removes it robotically, and that I likely have enough scar tissue to hold things without needing any more repairs (though I know he will sometimes do some kind of tissue repair to strengthen the area if it appears weak). I know he has quuoted others as having a 10% chance of recurrence with just the natural scar tissue, and that it should hold well for quite a while. Do you agree in your experience that enough scar tissue is often present to cover any hernia? Do you remove mesh robotically or only laparoscopically or via open method?

Thanks

[ajm222]

Also, I still shudder at the thought of a road ahead that’s as long as the one i’ve already been on. But I guess if I feel like it continual improvement, that’s ok.

[ajm222]

Thanks for this. Dr. Belyansky didn’t seem to think he’d be cutting any nerves unless absolutely necessary. I’m guessing in some cases that things get entwined with the mesh and it might be necessary. But he also says he would in some cases leave some mesh behind as necessary to avoid anything drastic that he thought might cause problems. He seemed to think the major issue I was having was the perception of the full size and movement of the mesh as a whole unti, and that leaving some behind (probably still unlikely) would be ok because my reasons for removal aren’t auto-immune.

He said that give my size and athleticism that he would have been a little more likely to have done a pure tissue repair via open method if I had found him originally. Really wish I would have stumbled upon him in the first place, but hindsight is 20/20. Can only move forward.

Still having trouble deciding as my wife and others probably think I am crazy for even considering it. But as you know, a small amount of discomfort and disability builds with time into something much more. Even Dr. B tried to explain to my wife that it’s like someone asking you to hold their huge key ring in your pocket. At first it’s totally fine. Then it’s uncomfortable and you want to take it out and give it back, and just imagine if you couldn’t for the rest of your life. My wife didn’t quite get it, but I think it’s because she’s convinced removal surgery will permanently disable me or cause some other issues that plague me mentally.

Good to know you are feeling improvement with the scarring. I wonder if that will continue to improve. Tightness and discomfort above the actual mesh has been a problem for me and something I was hoping might immediately be lifted with removal.

[ajm222]

Keep us posted. I’m considering a robotic removal soon. Just mild pain and lots of discomfort that hasn’t improved in 20 months. Can’t imagine living like this forever. Terrified about making anything worse. But not happy with the outcome I have. Rarely better than things were before the surgery. Just tired of it.

[ajm222]

A month is still early as well for such a major surgery. Hoping he gets better. Thanks again.

[ajm222]

My surgery was originally done robotically, using progrip mesh. Was this younger person someone on one of the forums or Facebook groups? Might be useful for me to follow up with him.

[ajm222]

Well it looks like the site is back in business.

Thanks very much for your comment. That’s a very comprehensive list of complications.

Dr. Belyansky does removal robotically, and his patients seem to have very good results. He told me just to give him the word and we can schedule the removal. He just made sure I fully understood the risks from his perspective. Mostly just the possible loss of testicle (not yet happened to any of his patients) and possible nerve issues (mostly numbness). But he also seemed to suggest there are some unknowns as all cases are a bit different. I’ve gotten to the point where I feel that while my problems are minor to moderate depending on the day, I’m not willing to go on like this forever. And at 20 months it’s not likely to get better. He seemed to think no new mesh or even a tissue repair would likely be necessary afterward. But I’d be a little more prone to hernia later in life. But he said he places no restrictions on his patients, and that the ‘scar plate’ left behind should hold for a long time in most cases. Said the recovery is similar to the original surgery. I was kind of surprised at that comment. And he said it shouldn’t cause disfigurement or any other issues. I also don’t seem to have any neuropathic issues so hoping no nerves need to be cut, but I guess that changes if they’re stuck in the mesh.

I still have a huge decision to make though and welcome any other comments about risks. Thanks again.

[ajm222]

quote DrBrown:

[USER=”2998″]Ericajane1987[/USER]
You could have a spigelian hernia. They are often not identified on imaging tests.
But you also need to be evaluated for adhesions, pelivc organs, and colon.
See your surgeon and get a complete evaluation.
Regards.
Bill Brown MD

can imaging adequately detect adhesions?

[ajm222]

quote DrBrown:

[USER=”2051″]ajm222[/USER]
Dear AJM
If you had a nerve block than can affect motor function, but should resolve with time.
Distending the abd with C02 can also stretch the muscle, but this should resolve with time.
You could have a hernia at the trochar site.
Follow up with your surgeon.
Regards.

thanks, dr. brown. no nerve blocks. i’m 19 months out, so definitely not the CO2. been examined already for hernias at trochar site and nothing there. must just be my anatomy. may have been there before the surgery. thanks again for the reply.

[ajm222]

all true, though i think it’s useful insofar as it simply suggests that there continues to be some reported improvement, however small, even after particularly long periods of time, which seems consistent with a number of other studies. as opposed to the notion that after 3 or 6 months, or after a year, or whatever, you’re basically screwed. to be sure, 3.5 years is a long time to be dealing with any kind of pain. but i have to imagine that pain that CAN be ignored is fairly insignificant. otherwise, you couldn’t ignore it. pain that can be ignored is of course subjective. i’ve had several injuries or surgeries that have healed but would occasionally cause issues once in while, even years afterwards, but they weren’t impacting my life in any way. and all eventually completely resolved. actually, once in a blue moon an old ankle injury from 27 years ago pops up for an hour or two with some mild soreness and then goes away again. at the same time the pain and discomfort i’ve had since my hernia surgery has in fact impacted my life, off and on. and on a survey like this i’d certainly say so at this point.

and 5-6%, at least in this study, is indeed unfortunate. though i wonder what the chronic pain prevalence is for other similar types of surgeries or implants after that many years. maybe this is pretty typical. just googled one study suggesting any type of surgery can have between 10-30% of persistent pain being reported after a year. that’s pretty consistent with a lot of the chronic hernia pain percentages.

i’ve always been frustrated that medical studies seem to often suggest that anything greater than 6 months or maybe a year = eternity, or ‘permanent’. i think i understand why, but for a layperson googling things it can be depressing. you see this in lots of different medical studies. it’s always nice to see any of them doing a follow-up that isn’t limited to a year, regardless of the results.