[ajm222]

i think it’s probably fair to say that it’s a bit hyperbolic to suggest an adult weight lifter has lived with a tissue repair for 50 years, unless indeed that person had the repair as a child. i’ve seen a lot of hyperbolic statements from some quarters here recently, probably partially to get a reaction out of the readers, and partially out of exasperation or desperation. it’s totally understandable. but just saying it doesn’t do everyone else any good when exaggeration is employed. just saying we should try and be as precise and level-headed as we possibly can when sharing stories, and as detailed as possible, as we have seen that the devil is in the details. age, type of repair, type of hernia, past medical history, any other extenuating circumstances, and accuracy on all other fronts is most helpful when discussing successes and failures. hard to nail down those details most of the time, but the more the better. especially given the state of the science regarding hernia repair and some of the mystery surrounding it.

[ajm222]

i think we should be very careful with hyperbole. getting the numbers precisely right, especially when dealing with ‘anecdata,’ is very important on a forum like this. it’s admittedly very difficult though as individuals often even forget their own timelines in short order. but when people read that someone had a certain type of repair that only lasted a few years, and someone had one that lasted decades, they tend to take that to the bank. but the reality is often that these numbers are very inaccurate, especially second-hand. even careful scientific studies are often shown later to be incorrect. and definitely if one of your peers had a tissue repair 45-55 years ago, they were certainly a teen or younger. and people that age even today generally get tissue repairs (because they are still growing), and with greater success given their age.

i think the broader conundrum stands, though – that in the fairly recent past tissue repairs were the standard, and all of our parents, grandparents and great grandparents probably had tissue repairs, and i don’t recall a lot of problems being discussed. seems they generally worked fairly well. though older folks may be less likely to complain out loud about their medical issues. regardless, i know a number of people with mesh repairs, and when i’ve probed them they have admitted having issues in several cases to varying degrees. it really doesn’t seem like overall chronic pain rates and recurrences etc etc have improved all that much with the advent of mesh. but again, that’s just what I have personally encountered. many studies suggest that those metrics have indeed improved. though it may primarily be with the average general surgeon who doesn’t specialize.

also, it’s still fairly early. mesh repairs aren’t being followed super carefully, and many are less than 20 years old. jury is still out to some degree about long-term impacts. when you’re in your 40s and get a mesh repair, you’re told it should be a life-long repair without problems. but you may have that mesh for decades. we’re probably getting close to the point that some folks now in their 60s, 70s and 80s who had mesh repairs in the late 90s or early aughts are coming of age. tissue repairs can last a long time, but there seem to be a lot of folks who have failures after 20 or 25 years. do we know for certain yet mesh won’t be the same? and if mesh does fail at that point, what is the fix? removal? more mesh?

[ajm222]

I’ll also add that I’ve heard that the robot in fact makes visibility of the structures much better. Sort of a 3D enhanced zoomed in view. So I think just because they aren’t right in front of the patient doesn’t mean they have a bad view. I’m 46 and can’t see a damn thing even with my glasses on thanks to astigmatism plus aging eyes. The robotic view would probably make things much easier for someone like me. And the tools allow them to have better maneuverability inside the patient. I hated how I felt after robotic surgery, and I don’t think my stomach has ever quite looked the same. So I have issues with it. But I don’t think they’re sacrificing surgical ability using it. Likely the opposite on some level. But it also comes down to surgeon preference as well.

[ajm222]

I didn’t use cost as a factor, I just mention it as an additional benefit – compared to private doctors who won’t accept insurance at all and charge tens of thousands for a single surgery. it also suggests to me he’s not in it for the money himself. as for only going to the best, I think it’s pretty clear at this point based on your own post that there really kind of is no best, or it’s an unknowable thing. and even the best have stories of folks with less than good outcomes. you’ll spin your wheels forever if you’re trying to find the single best surgeon and procedure. at some point, if you need surgery, you have to make a decision, and it will always have pros and cons with an uncertain outcome. such is life.

• This reply was modified 1 year ago by  ajm222.

[ajm222]

“Is there a way to just sew these hernias closed without opening the inguinal floor and putting a bazillion layers of suturing in???”

This is what Dr. B did for me. Used absorbable sutures and determined that the inguinal floor did not need to be opened, and used a modified Bassini technique to tighten things up. That may largely be because my hernia was indirect. And it remains to be seen what my long-term prospects are, so I can’t say if it worked or not. Two months out and still have some discomfort and no clue if hernia was totally fixed. But I had some pre-existing discomfort since the first mesh surgery and then removal, and it may always be impossible for me to say what the source of any of my issues truly are. I am not currently in much pain per se. It’s more discomfort and mild soreness and weakness. Feeling tightness in the groin and like a heavy knot is just kind of sitting in that spot and tugging and pulling on things. The next few months will probably be instructive. And perhaps even a year or two as the tissue remodels.

At any rate, another reason I chose him (besides the fact that he’s an expert on hernias and abdominal wall reconstruction and knows the anatomy inside and out) is that he took a very conservative approach. His surgical notes carefully detailed his sewing technique to provide a strong repair but one that wouldn’t be too tight, and how he made an effort to avoid all critical nerves and other important structures. He’s no tissue guru, but he’s a bona fide expert, a nice guy, honest and practical and keeps it real, and he’s cheap and close by.

Dr. Kang also commented here how he also wasn’t sure why so many surgeons found it necessary to always open the inguinal floor when in many cases it’s just not needed.

Lastly, I do think with some of the techniques, even with permanent sutures the amount of permanent material is pretty negligible considering how thin the sutures are. Shouldice obviously will have more. I asked Dr. B what he recommended for me and I told him I was open to permanent, but he thought given my history it might be best to go with absorbable so there’s no question down the road about whether or not some permanent material is causing ongoing issues. He may have suggested that partially for his own protection, but he seemed to think a younger healthy person should be able to form enough scar tissue over several months to hold an indirect hernia tightly. And as I mentioned before, he did some extra work to strengthen the direct space.

[ajm222]

Thanks for the update. I am currently two months out from a tissue repair done several years after a robotic mesh removal. Worry every day about recurrence. My doc used absorbable sutures. The area isn’t particularly painful but it’s uncomfortable as I feel a large knot type feeling there, and it feels kind of weak. Sort of like when I had the hernia. Been that way though since the surgery and I suspect it’s all the work done plus scar tissue and may take a long time to feel more natural. Was hoping it would feel great by now but guessing I won’t really know for many more months. Glad you’ve had a good outcome.

[ajm222]

I also think pain is one of those things that feeds itself. Given neuroplasticity, we can get in a state of chronic pain that is incredibly difficult to get out of and worsens over time. But that same neuroplasticity is a potential road to healing as well.

[ajm222]

It’s definitely interesting that all surgeons I’ve spoken to, when asked about the risks of mesh and what they’ve seen, will say that either it’s under 1% and almost negligible, or they will tell you routinely they’ve NEVER seen a mesh complication or chronic pain in their 20 years of experience or whatever. Which is patently absurd. Meanwhile, I spoke to about 6 close friends that had hernia repairs over the years, and 50% have had issues of one kind or another – either chronic pain, a repeat surgery to fix a problem that was a nightmare, or ongoing issues of a more minor nature. I’ve also spoke to others who, when I tell them my problems, say ‘oh, yeah, my boyfriend had hernia surgery and it’s been an ongoing nightmare’ – or my own PCP who had a patient that developed chronic pain after repair and it never got better.

It’s my belief that people get these repairs, have problems, go back to their surgeon who then dismisses them 2-3 times or more by saying give it time or there’s really nothing you can do, before the patient realizes they’ve hit a roadblock and then they go elsewhere for help. Then the surgeon dismisses all the follow-ups and decides that because the person finally stopped coming, they healed or their problems were minor enough to disregard. They then tell future patients they’ve never seen any issues. Meanwhile, the tracking of the outcomes is admittedly bad. It’s mostly just a black hole.

I really think the problems are much more widespread. Maybe it’s ‘only’ 10-15%. But it’s certainly not 1% from what I’ve seen. It’s anecdata as I have not competed any true medical studies, but I’ve been speaking to lots of people for years now. And as has been said many times, if it’s only 10%, that’s close to 100k people per year just in this country. Year after year after year.

• This reply was modified 1 year, 1 month ago by  ajm222.

[ajm222]

That makes sense. Though I am always amazed at how many surgeries my surgeon does her in the US in a given day as it is, factoring in how involved and intense the whole process is. That said, he’s doing maybe 5 at most and not 10.

[ajm222]

I believe Dr. Felix said his initial tissue repairs lasted him 20-25 years. He got them when he was younger and likely a good weight. I am sure a lot goes into how long they last. Weight, age, activity level, overall tissue health, quality and type of repair. I know my grandfather got a tissue repair in the late 70’s or early 80’s when he was in his mid to late 50’s possibly. As far as I know it lasted him the remainder of his days (lived to 91) but can’t say for sure as we never talked about it. If he had a recurrence in his very old age he probably wasn’t bothered by it and didn’t mention it.

[ajm222]

I believe Dr. Kang’s ultimate hope for all this hard work is that like Shouldice, Desarda, etc, his method will eventually be widely accepted and practiced the world over. I believe he’s continuing to do studies and publish so that he has the evidence to present to a much broader audience proof that his technique works and should be done by others, who will come to him to learn. Obviously it’s not likely to make much of a headway into the whole mesh dominated world of hernia repair. But if it’s indeed as great as everyone says, eventually it will take hold with more surgeons in other countries. And I am sure he’s training his son to do it as well in the meantime.

• This reply was modified 1 year, 1 month ago by  ajm222.

[ajm222]

Thanks, Mike. I’m two months out and still feel weird – like a heaviness and lump in the area below the hernia and in the crease between testicle and thigh. And pulling sensations and tightness. Some mild soreness still. I don’t think my experience is typical at this stage and probably not a great sign long term. I’ve been here before. Just constantly saying to myself – well, let’s give it another month. And then another. And another. I will say there’s been some glacial improvement over that time as opposed to worsening.

That said, surgical team suggested it can take months for things to settle down and feel more normal. And I am SUPER sensitive to any and all discomfort, and tend to amplify it when stressed. I had a single stitch placed in the larger trocar hole where my mesh was removed because it had to be dilated more, and that was very uncomfortable to me for months. Finally resolved. So perhaps I personally just need a long time for my body to ignore these sensations. Very minor things can seem terrifying as a result of medical PTSD. Certainly far more was done in my groin for a tissue repair than just a single stitch. Anyway, everyone’s experience is so different.

Will try and stay calm for the next few months and see if I make steady but slow progress. Just don’t know why this continues to be such a problem. But I’ve had some medical issues in the past that also failed to heal (or maybe they healed but I didn’t anllow myself to move on) until I was able to take some medication that allowed me to stop obsessing. Perhaps that’s all I need. Mind-body stuff can be complicated. And I came into this surgery with some preexisting pain and discomfort to some degree that I can’t expect this surgery to necessarily fix.

[ajm222]

I hear you. I’ve often thought the same thing about having a job that requires manual labor. Hard enough just focusing on a desk job when sitting can be uncomfortable. And years of discomfort and pain, even if mild, just wear a person down. Seems impossible at this point to even believe I had a life before when I wasn’t dealing with all this.

[ajm222]

It can definitely take over a year. I’ve heard people mention continued improvement even after two or three years.

Bulge is visible but it’s slight, and looks like it did after removal but before recurrence. I’m also quite thin now so it may be more obvious than it otherwise would be. I may just have an area on that side that will always be a little puffy because of all the surgeries. Additionally, given everything I’ve been through, I’m traumatized enough not to even expect this is going to work for me. But I’ll give it at least a year or so before I come to any final conclusions.

• This reply was modified 1 year ago by  ajm222.

[ajm222]

Thanks, and all that makes sense. I am in a similar situation though my recently tissue-repaired hernia was a smaller indirect hernia, and I previously had robotic mesh removal. My surgeon used something similar to Bassini and absorbable stitches. I will be at two months Monday and still feel tightness with occasional discomfort and soreness, though it seems to be improving some. Certainly the testicular discomfort has improved and I’ve gotten much stronger, though the area itself still feels a bit weak. And there’s more bulging than I would like (though much better than early on). I am hoping in several months it continues to improve though who knows. I know healing can take a very long time.

[ajm222]

watchful – how are you doing at the moment, and when was your surgery again?

[ajm222]

Totally agree, GI. And the funny thing is, no one can tell patients how long mesh repairs are supposed to last. 30+ years may be unrealistic for mesh without complications. No one is bothering to track that. It’s just assumed they’re ‘forever.’ If someone did a good study, it could potentially be shown that tissue far outweighs mesh in terms of the very long term complication rates and even recurrences. But of course no one is looking at that, nor are they really able to yet as mesh hasn’t been the gold standard long enough.

[ajm222]

Correction – he mentions later the details of the tissue repairs. First hernia repair lasted 30+ years! Second one he says was 15-20 years.

[ajm222]

I was basing that on his interview he did with Towfigh. At the 39″ mark all he says is that he had tissue repairs done 30 years ago and 40 years ago that both eventually failed, and had mesh repairs to fix. I can’t glean from this how long the repairs held because I don’t know when he got the mesh repairs, and I don’t know the precise dates when he got the original tissue repairs and if they were similar in timeframe. Do you happen to have another source?

https://www.youtube.com/watch?v=mbgzMlPQcuU

[ajm222]

I believe I read on here (from him) that he’s done some of it. I will have to try and find his posts. Obviously, we just learned about the book he published. Perhaps it’s only handed out at the hospital. But I do think he’s been meticulously keeping records, possibly for the purposes of soon publishing some sort of paper on his success.