[ajm222]

quote Momof4:

It is possible to be allergic to polypropylene, as well. I was allergy tested and had a definite allergic reaction to samples containing varying amounts of polypropylene, which I had a large piece of covering my lower abdomen. I am hoping, moving forward, that allergy testing is considered before implantation, at the very least, in patients with pre-existing conditions such as chronic urticaria or other known allergies. After seeing my reactions, the Allergist felt very strongly that I should have no foreign body implanted. She also suggested that even if you don’t react to a skin test, that doesn’t mean you won’t react to the material once implanted internally. I think this is a very interesting concept and I know Dr. Towfigh is leading the way in this area. It is unbelievable how many of the systemic reactions I was experiencing have improved since mesh removal (still working on the pain aspect). I hate to think of the damage done to my body by the constant inflammation and allergic reaction. It will take time to heal, but since mesh removal, 5 weeks ago, i am moving in the right direction!! Thanks dr. Towfigh!! I am interested to know if anyone else has known allergic reactions to polypropylene.

Very interesting, thank you for this.

So what do people who have mesh removal do to repair the original hernias? Is mesh removed and then non-mesh tissue repairs used to fix all issues?

[ajm222]

Thanks. Good to know. Great advice. Surprised at the size of the mesh. Very interesting.

[ajm222]

This is a good question and I would be interested in the response to the OP’s post. Was told yesterday I had some inguinal/abdominal weak spots but got the impression that maybe things hadn’t ‘broken through’ yet and were still contained by the ‘fascia’. Made me think perhaps if true one could prevent or delay final stage hernia development by continuing to keep weight down and exercise carefully. But like the OP, I don’t really understand completely from an anatomical perspective what that really means or if the question itself even makes sense from a doctor or surgeon’s perspective.

[ajm222]

quote Jnomesh:

Yes by all means don’t rush into anything-surgery should be a last resort and you should have a definitive reason for the surgery. I know of at least 3 people who had no symptoms and it was debatable whether small hernias showed up on scans. They were encouraged by their surgeons to have them repaired laparoscopically with mesh. All three suffered serious complications from the mesh (2 had allergic reactions that led to not only pain but other severe auto immune symptoms)
all three ended up having mesh removal and although all three are overall better since having the mesh removed they all still have some issues that mesh originally caused. They all say they wish they just waited Bc they all had small hernias ( or maybe not) and they didn’t have any problems.
again my advice is to skip the aberahebfemeral surgeon or even specialist and get and send your scans to someone who can definitely interpret what’s going on. The only two I know of are dr. Towfigh and dr. Belyanski. There was another thread of someone experience pain and dr. Belyanski diagnosed that it was a lipoma and not a hernia (still needed surgery) but that person was in pain.

Unfortunately I don’t really have any images at this point. I’ve just been examined physically by all the doctors. Perhaps if I do see this last general surgeon next week I can inquire about possibly getting some imaging, though I suspect he will say it’s unnecessary. I can’t say I have any pain, but just some occasional discomfort, and a small bump that gets a little bigger or smaller depending upon the time of day and activity. PCP thought the bump was related to the weakened area of the abdominal wall, but didn’t feel like anything had broken through yet I guess you would say. And I had read on the California Hernia Specialists website that up to 50% of small hernias may never progress or need surgery. I don’t know if this means they stay at a stage where they don’t fully come through the fascia, or if it means they just don’t get larger. I’m only 41 and I am suspecting that over time if I continue to be normally active, that eventually this is going to need attention. But I don’t really know for sure. I also need to get back to exercising and moving around normally again so that I can really gauge my pain and discomfort. Ever since the diagnosis by the surgeon I’ve been extremely cautious and scared to do anything for fear of making this worse quickly. So I don’t really know, but I think I’ve decided to cancel my 10/18 surgery because it feels premature. All have said that there is no serious danger in waiting. I don’t want to wait too long if I do end up needing it repaired, but another month or three should be fine.

Our of curiousity, are the three people you said you know with complications people that you know personally, or those who you’ve met online at similar forums? Just trying to get a sense of what kind of demographic we’re looking at here. I hear from someone like Dr Kang who almost makes it sound like all mesh hernia repairs may be doing damage inside the body but some just aren’t bothered by it, while most surgeons will suggest the rate of complications and truly chronic pain is probably only around 3% after a year or so from surgery (which is very small). It just makes it so hard for a person to decide what to do (not that there are many options – it’s mostly either live with a steadily worsening hernia or get a mesh repair, which may or may not be a bad thing). And I wonder if the description Dr Kang had about what the mesh is doing inside the body actually explains why the mesh is doing good rather than bad in many cases. You would think the whole point of the mesh is to actually get very incorporated into the surrounding tissue. While that could be bad for some people if it irritates or damages important structures like the bowels or spermatic cord or various nerves, you would certainly expect the mesh to be very much intertwined with things around it to strengthen the area and feel more natural. This of course is the challenge a patient has in making medical decisions – very little intimate knowledge of the anatomy and actually seeing all of these things in person, no medical training, and relying on a variety of different opinions from medical professionals.

The challenge for the average person when researching things online I suppose is that we don’t have the medical training or in most cases the scientific background to examine things critically in the same the way doctors do, and we don’t really have access to a lot of the medical papers and studies that many doctors use. We also mostly have to rely on corners of the internet where people are concentrated into groups that are probably overrepresented by 1. people who have had bad experiences or 2. those like myself who have a tendency to maybe over analyze things. To be fair, the latter category isn’t necessarily always a bad thing, because clearly people like myself will tend to ask important questions and spur discussion that didn’t occur to the average person and could be useful to people contemplating surgery. And those in the first category are certainly not to be dismissed. Anyone who has had complications or some kind of bad experience should be taken very seriously. But the point I guess is that the high concentration of bad experiences you see online gives the perception that MOST people have bad experiences, and this this surgery and the use of mesh is usually a bad idea. While that is DEFINITELY the case with those who have chronic pain, it’s not determinate of anyone else’s result.

Anyway, just rambling at this point I guess. I think at this point my main concern is this notion that Dr Kang mentioned suggesting mesh is often doing harm inside the body. I’d be interested to know if I misinterpreted his words, and maybe more detail about what exactly it’s doing in the body that is so concerning. I get the impression that many surgeons have in fact done emergency mesh removal at one time or another and have seen what mesh does in the body over the course of months or years. Perhaps some of them could chime in.

Sorry to be so wordy. Just had a large coffee.

[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.