[ajm222]

Just got another opinion from my old PCP and he says the same as the first – that it doesn’t appear that things have broken through just yet and though there might be some weakened areas in the abdomen/inguinal canal, he’s not detecting a full hernia yet. Very small weak spot that may or may not eventually become a full hernia. So two opinions from non-surgeons saying leave it alone, and another opinion from surgeon saying repair it (and that i likely have bilateral). Very confused at this point. Made appt with another surgeon at another practice to see what he says and then will decide probably one way or another. Would be a real shame to get surgery while having minor or no symptoms most of the time and not have a full blown hernia.

[ajm222]

quote LeviProcter:

Polypropylene (PP) has been used since the 1960s by Usher for hernia repair (Read, R.C.: Milestones in the history of hernia surgery: prosthetic repair. Hernia 8(1), 8–14 (2004)). PP itself is relatively inert and does degrade mildly overtime.

Thank you for that reference. I’ll see if I can find that paper now.

[ajm222]

Well that’s a bit concerning (especially considering I feel as though my options are almost exclusively limited to get surgery and getting it done with mesh), but I appreciate your candor and response. My father had prostate cancer so that kind of hits home for me. My potential surgeon does Desarda as well but doesn’t seem to think it’s the best option.

quote drkang:

Hi, ajm222

Yes, I have a lot of concern with the mesh inguinal hernia repair. In fact, I performed more than 6,000 open hernia repairs using a mesh plug until the spring of 2013. Sadly I have no exact my statistics of mesh complication, but I had quite many patients who complained of chronic pain after repair. I agree with the statistics saying that the chronic pain after mesh repairs would be over 10% incidence.
In 2012, I performed the first mesh removal for the patient suffering from very severe chronic pain after receiving a mesh repair at other hospital. His pain was so severe that he couldn’t do even normal daily activity. That operation was terrible experience to me as well. As the mesh was so clumped with the surrounding important structure that the operation was too dangerous. After that operation, I got sick from mesh repair and I began to make a lot of effort to develop a new no mesh repair with low recurrence rate.

I think every surgeon performing mesh hernia repairs should try an experience of removing the mesh which he himself inserted. I am sure if they learn from experience how terrible the state of the inserted mesh is and how dangerous mesh removal is, then many of them would stop doing mesh operation any more. But they do not really try to do that.They always tell the patient suffering from chronic pain that there is no recurrence. They don’t like to take the responsibility to solve the patient’s problem by removing the cause. That’s a pity.

Anyway I have removed more than 50 meshes so far ever since. But I have more patients who are still suffering from quite severe pain after mesh hernia repair.
I totally support Jnomesh’s and Good Intention’s claims. I think their knowledge and assertions are very accurate and are based on facts.
And just one more thing to know. Laparoscopically inserted mesh might hinder the future prostatectomy for prostatic cancer.
Thank you!

[ajm222]

Do they just say this to avoid lawsuits because they themselves haven’t tested these products in the body? Seems I also read something about how the material passed the FDA’s approval process (for a particular product that was actually voluntarily recalled a few years later).

I’m assuming we have no idea really about long-term performance (10, 15, 20 years). Then again, haven’t synthetic meshes been used since the 1950’s? I guess maybe polypropylene has only been used for 20 years or so?

[ajm222]

i didn’t really ask specifically about chronic pain which is why he didn’t address it. i asked about recurrence rate. but i’ll see what he says when i bring that topic up.

[ajm222]

Interestingly, my aunt had an umbilical hernia repaired that she had left alone for like 25 years. And the surgeon didn’t use any kind of mesh to fix her up. Just spoke with her. Very large umbilical hernia and just stitched up presumably with tissue. If that’s possible, it would seem the same could be done with a smaller inguinal hernia without issue, especially considering the study mentioned above. Sort of surprised mesh is still the gold standard for what sounds like 95% of all inguinal hernia repairs when non-mesh repairs seem to be pretty successful. Maybe it’s just not enough people trained to do it. I should ask this surgeon why he doesn’t do more non-mesh repairs.

[ajm222]

I do like that this surgeon said he’s been using the same mesh for ages (at least a decade I believe). He gave me the name but I’ve forgotten and plan to ask him specifically what it was. And he also did say he’s happy to do the non-mesh repair if I choose. And he said one study suggested mesh versus non-mesh at three years had the exact same recurrence rate. No better or worse. They just don’t really know beyond that perhaps what the recurrence rate is. He did say it looked great, though, and he seemed confident in that method.

[ajm222]

This is very interesting and good to know. The surgeon I initially consulted with does do the Desarda technique, presumably on both direct and indirect hernias. But he says he only does that when patients are very determined not to have mesh because of what they have read on the internet. Perhaps because my hernia(s) are indirect I should likely go ahead and get the mesh. I really don’t want to wait because I am now already more uncomfortable and just cannot distract my mind from the fact that I have this damage to my body that I am worried will quickly get worse and/or cause complications. Most people I have talked to have not had any issues with mesh and consider themselves back to normal and pain free several years after surgery with no recurrence. Some had a longer than expected recovery, and some light twinges and pulls of pain up to a year or two after the surgery. But all seemed to eventually see even that disappear.

I understand that people can have major problems with mesh, and that’s definitely a big concern. But it seems the vast majority are fine. There doesn’t seem to be any way to predict ones reaction. And clearly in the US it is very difficult to find surgeons who do tissue-only repair. And because of the way insurance in the US works, it’s not as easy as just finding someone on the other side of the country and traveling at ones own expense and paying much more money for an out-of-network doctor to do a consultation and then scheduling a procedure.

Dr Kang – do you have any concerns with mesh? Do you do mesh repairs, and if so how often do you see issues and people returning for removal and chronic pain more than a year or two later?

Thanks!

quote drkang:

Hi,

I understand why some people prefer to wait and see if they have an asymptomatic hernia. This may be due to fear of complication of mesh repair.
But strictly speaking, asymptomatic hernia cannot exist. Because hernia buldging itself is a symptom (actually a sign).
So it’s just the difference between having or not having pain.
However, the presence or absence of pain and progress of the hernia are not proportional. A large hernia may not have pain at all, and pain in the early hernia may also appear. And a painless hernia can also cause severe pain with sudden incarceration or strangulation at any moment. It’s an emergency.

I think you can wait and see a little when it is a small hernia. But eventually it will grow bigger and require more extensive surgery. So, I think it is better to have surgery as early as possible when considering the hernia itself.

The only obstacle is the risk of mesh repair. But there are actually other options, though not easy to find. Shouldice or Desarda repair is the one that does not use a mesh. These repairs are used for both indirect and direct hernia. However, if you look for these surgical procedures on youtube, most of them show only direct inguinal hernia surgery.
Why not indirect?
This is because these operations, which are known as typical tissue repair, are actually suitable for direct inguinal hernia. Not only these but also other tissue repair methods, such as Bassini, McVay, Ferguson, etc., are the same. It means that indirect hernia, which accounts for 70% of the inguinal hernia, does not have the appropriate tissue repair procedure. I think the limit of existing tissue repair, such as high recurrence rate, is due to this fact.

But in fact, there is an appropriate tissue repair procedure for the indirect inguinal hernia. It is just forgotten and ignored. That’s the Marcy operation.

I am a surgeon who strongly advocates tissue repair. And I am trying to make up for the shortcomings of tissue repair and to get better surgical results than mesh repair in all aspects. As part of that, I have devised and implemented different hernia repair procedures for both indirect and direct hernia. Somewhat similar to Marcy operation and Desarda repair, respectively.

I do not know if there is a doctor in the US doing Marcy operation. (Actually, Marcy is an American surgeon who was active in the early 20th century.)
Anyway, if you have an indirect inguinal hernia, I recommend you to seek a doctor who performs Marcy-like operation, and if you have a direct hernia, find a Desarda repair. I think Shouldice is unnecessarily invasive.

In my experience, I do not think that the choice of surgery should be changed according to the size of the hernia. The patient’s body weight and activity also have no significant effect on outcome.
If you can meet a surgeon familiar with the above tissue repair, you will get the best surgical results without fear of mesh.

Thank you!

[ajm222]

Very quickly I’ve gone from feeling like mine are asymptomatic to noting a significant amount of aching and soreness particularly in the testicle when standing even short periods of time. Not sure why it went that quickly but at this point I feel like I can’t get it done soon enough.

[ajm222]

Thank for all the advice. And yes, that’’’s it – Desarda. I’’’ll try and find out how many he’’’s done. He quoted an interesting study suggesting at three years that method had same recurrence as mesh. No more, no less.

[ajm222]

Thanks. This surgeon said it appears I have it on both sides (indirect inguinal) and suggested a laparoscopic robotic surgery with a mesh they’ve been using for well over 10 or 15 years. He had a colleague in this practice that apparently did it recently. He did say he does the open no mesh surgery method that starts with a D (can’t remember name) as well.

[ajm222]

Very sorry to hear that. I had one friend who had open for one repair and laparoscopic for another. He said he has no issues now but did mention the open method was actually easier recovery, mainly because the lack of bloat that took a couple of weeks to go away. Another friend has had two surgeries. Said the first wasn’t bad but the second took him a month to leave the house and he had nerve damage in legs, which eventually resolved. He was out of work for two months. He said he’s now recovered. Another friend had three surgeries and he says no problems now but I haven’t really talked to him at length yet for details. And the last said he gets anoccasional twinge or discomfort I guess but feels mostly fine. I don’t know what he had done. But I believe all had mesh repairs.

It’s good to be informed but also scary. Went to a law firm website for worst case scenarios and scaremongering and saw stuff about teeth falling out and bowel obstructions and brain damage. But I also know this is one of the most common surgeries there is and has been done with and without mesh for a century. But that doesn’t really matter I suppose if you’re in the bucket of folks who have complications. I know my grandfather had hernia surgery as a middle aged man and never heard anything about complications later in life (he lived to be 91). But I have no idea what method was used for repair. Sigh. So much information out there and so hard on someone like myself who has trouble making decisions. Will see what surgeon(s) say. Thanks again for all your thoughtful responses.

[ajm222]

By the way, did you have a bad experience? Having trouble finding previous posts. Thanks.

[ajm222]

Thanks! That’s great info. Most friends who’ve had the surgery always say ‘sooner rather than later’ but perhaps they simply weren’t aware of the possibility of ‘watch and wait’ or had very symptomatic hernias. I imagine if I DO get surgery I should find someone that seems aware of all the things you’ve mentioned and have considered them. Must be some knowledgeable and experienced surgeons aware of these problems and care enough about their patients to discuss them. But I’ll be sure to bring this up. And perhaps try and steer clear of any cutting-edge, latest-and-greatest mesh products and ask for something tried and true if possible. Will find out tomorrow hopefully what’s going on and start considering what to do.

[ajm222]

wonderful that’s great to know thanks

[ajm222]

Thanks! Very helpful. I know three people now who have had this surgery, two locally. I will ask them how it went and who they used. Though it seems everyone had some complication or another or some minor lingering issues. But they seem satisfied ultimately.

By the way, does mesh need to eventually (over years or decades) be replaced, or is it intended to be permanent? Thanks again.

[ajm222]

quote drkang:

Hi,
To see if it is a hernia, you can take an inguinal ultrasound exam.
The test should be done in a standing posture with valsalva force.

Thank you!

Thanks! I’ll mention that when I go for a second opinion next week with another physician. Though I am wondering if I should go straight to a general surgeon instead.