[ajm222]

This is fantastic, thank you so much.

I feel the same thing in terms of worrying about a recurrence, and feeling soreness and weakness in the inguinal area, and tightness and fullness and tugging here and there all over the abdomen, at four and a half months after robotic removal. I also have the gurgling stuff as well. Sounds like I’ve got quite a bit longer before I know how things will settle. And who knows long-term what things will look like. I’ve suspected based upon Dr. Towfigh’s comments that scar tissue can only hold for so long (though Dr. Belyansky suggested scar tissue covering indirect hernias could potentially last).

I started running regularly again after three months, but stopped recently and switched to walking as I was scared I was potentially going too fast and doing damage and possibly creating more scar tissue or adhesions. My abdomen feels kind of thick and firm and puffier than usual, and it jostles more than I’m comfortable with when I run. I still do lots of yard and house work though.

Like you say, even the best surgeons say almost nothing about how best to heal internally. I don’t think they know, and maybe because everyone is different.

I know another removal patient who posts here a lot suggested that movement and exercise are necessary to break up scar tissue and stay healthy.

I need to incorporate some stretching and stay active, and try and be patient. It’s just tough to continue feeling off after so long. Occasionally exhaustion and depression kicks in for a few weeks at a time and I feel less hopeful and more anxious. It’s as much mental as physical.

Thanks again.

[ajm222]

It’s indeed hard to fathom. Who is the “expert?” Feel free to PM me.

[ajm222]

FYI – I had my robotically-placed progrip inguinal mesh removed by Dr. Belyanksy in February, and it was removed robotically.

[ajm222]

thanks for the encouragement and thoughts. i do agree. i think i made a good decision at the time based on the info i had. just doesn’t always work out. then made another decision and will be hoping for the best. and i’m hoping your issue gets resolved eventually as well. keep us posted.

[ajm222]

Ah, so a tissue repair. Very interesting. Yeah, that’s a head scratcher. Regardless, you’ve been treated terribly. Totally unacceptable. I’d go elsewhere and just forget about your original surgeon.

I’m doing well. Almost four months post-removal. Have good days and bad, though bad days aren’t bad-bad. I’m not in pain really. Just have some discomfort and tightness that I am hoping will loosen up long-term. Some in the groin, some still all the way up to my rib cage, and some around my trocar incisions. These robotic surgeries I think are a lot rougher on some folks than advertised. Some days I feel really good, and other days not so much. But I feel like I’ve been making progress. Heard from several folks that a year or even two years isn’t unusual when it comes to the baby steps that lead to feeling more ‘normal’ after mesh removal. Still think it was probably good to get it out, but no idea what the long term picture looks like. But I’m basically just living my life and working and doing all my usual stuff around the house and yard, with no major trouble. It just feels more normal on some days and less on others.

At this stage I have harsh opinions about both mesh and robotic surgery. I think the robot was probably necessary to get my mesh out, but they make it seem like peeling all your fascia apart and puffing your entire toros with CO2 is just a walk in the park, when I think for some it can be life altering. I’ll probably never know exactly what was responsible for all of my issues, but I’m starting to think it was both the mesh and the robot. And to think I could have simply had a small incision in my groin and a tissue repair performed in the first place and avoided all of this.

Anyway, I guess even tissue repairs can occasionally have complications. “It’s not just a hernia” indeed. Really wish the medical community would treat hernias much more seriously.

[ajm222]

that’s terrible, but not unusual unfortunately.

i didn’t realize you had surgery. what was done? and is this a surgeon that’s widedly known on these forums?

[ajm222]

I’ve actually gotten really good at avoiding a sneeze by pinching my nose. Just pinching both of my nostrils together, if I do it quick enough, and then just focus on not sneezing, tends to work for me the vast majority of the time. Seems to stop whatever that tickle is that then starts the cascading events that lead to the sneeze.

[ajm222]

A lot of these symptoms actually don’t sound like hernia symptoms. Blood in the stool certainly wouldn’t be one, and the extreme rectal pain. that sounds like something else that needs to be very carefully examined further, either by your regular physician or a GI doc.

[ajm222]

I also see people on Facebook groups saying their mesh migrated to other parts of their body, like into their legs and such. Always seemed kind of ridiculous. Can pieces of pelvic mesh though dislodge or break free and move into other parts of the body?

[ajm222]

Something I’m still not sure about – can any imaging accurately detect scar tissue and/or adhesions?

[ajm222]

There’s a lot of talk around here about scar tissue remodeling and being more natural than mesh, which certainly is true. But it does make you wonder how much scar tissue can ultimately remodel and how long it takes. Seems there are lots of folks with scar tissue and adhesion issues that have problems for long periods of time.

I’ve also spoken with Howard Schubiner, a leading pain specialist, who said scar tissue really shouldn’t cause any pain. Though I’ve often had a hard time accepting that myself.

[ajm222]

would love to listen in on this one:

4:25 PM Mesh or No Mesh for Adult Inguinal Hernia Repair

[ajm222]

I’m guessing it’s similar to any product – dozens of options but little to no tangible difference between them all besides branding and marketing. It all ends up performing in much the same way. Obviously certain “innovations” can end up causing serious problems, and I would doubt that any “improvements” really make much of a difference. It’s all mostly the same stuff. Just plastic scaffolding. And yes, I think hospitals have contracts that are probably largely based on price or existing business relationships. But I agree – it’s weird that there are so many options for something like this. But when it comes to capitalism, anything that has such a huge profit margin (I am assuming this is the case as it’s mostly just plastic, and hospitals in the US seem to pay an absolute fortune for everything way beyond what it’s worth) is going to result in lots of companies trying to get in on the deal.

[ajm222]

I think the idea with regards to CBT and pain is that given that the perception of pain (and intensity) actually comes from the brain, there are ways to address pain with things like CBT. there is a whole school of thought that has investigated pain that is completely or almost completely independent of existing physical damage or other physical processes. look to John Sarno and his work with back pain, and those who’ve come after him who call this “TMS”. pain pathways can be created by physical problems, but then persist long after an injury has completely healed. they can also be reactivated after a long dormancy, as those connections usually remain even if they’ve been deactivated. the brain can reinforce those pathways and prevent the natural course the body normally takes to turn off those signals. the brain can also prime a person to anticipate pain, and then create expected pain, or intensify it, even if there is nothing wrong. it is even thought that emotional circumstances and tension can create pain as a distraction in the absence of anything physically wrong.

but all that having been said, we also know that in many cases mesh absolutely can cause persistent pain of it’s own that has a definite origin, and sometimes removing the mesh or doing some sort of other revisional surgery is the only way to address the pain. and surgeries of other kinds can create pain for a variety of reasons, usually related to nerve damage.

[ajm222]

I’ll say in my case I don’t really notice any big difference in the pain in the inguinal area after all the surgeries. That’s been pretty consistent no matter what. Again, just in my case. I assume every case of mesh removal could have different results.

Speaking of scar tissue, someone posted an interesting MRI image the other day that seemed to very clearly show scar tissue, and involvement of some nerves in said scar tissue. I wonder if MRI imaging 6-12 months (or longer) after mesh removal could be at all useful in determining whether it would be worth ‘cleaning up’ scar tissue or adhesions, assuming there are symptoms. I had assumed you couldn’t actually see scar tissue very much regardless of image type.

[ajm222]

Thank you, Dr. Towfigh. Yes, that’s helpful.

I guess in my mind I was thinking that with robotic/lap surgery, it’s always been my understanding that at least in terms of inguinal hernia repair, a very large amount of the fascia is peeled away from the abdominal wall. I know fascia apparently regrows quickly, but I’ve also read it’s quite important to how abdominal contents are held in place and positioned, and I wonder if that process of peeling it away is more invasive and potentially problem-causing than is often appreciated. But perhaps not.

[ajm222]

Re: Dr. Chen – I have heard mixed things. He seems to be a big proponent of cutting nerves to improve pain and people have very different experiences with this – some good, some really bad. I initially had thought he was one of the top people for these issues, but others have told me they’ve seen a number of bad outcomes from surgery with him. So I can’t say for sure from my own experience, but I would advise caution.

[ajm222]

Hey JR – sounds like Dr. Towfigh is answering some of your questions on the other thread. Who did your surgery by the way? Feel free to private message me if you’d rather. My mesh was inguinal and I think the situations are too different for me to be able to speak with any intelligence on what’s going on. I’m actually surprised in my case I have any of these abdominal/umbilical issues while the groin area is mostly fine. But mine seems to be getting a tad better each week with time. And my surgeon did say it could take a while for things to settle down. Most of the swelling has subsided but the abdomen still feels a bit bigger than before, and there is still some internal tightness and sensitivity. But as I said, it seems to be improving very slowly. I think you have to give things a few months, particularly where nerve pain of any kind is involved, to see where you land. In fact, that sort of pain can take even longer (years in some cases) to fully improve. But if after a couple months you’re still suffering in the same way, some sort of medication or injections should probably be considered. If the mesh was in fact the direct cause of those symptoms, they should improve.

[ajm222]

@good-intentions – just sent you a PM regarding your healing trajectory

[ajm222]

his situation mirrored mine and that of many others – there was no obvious hernia after mesh removal – when the surgeon peels and cuts away the mesh, they leave behind a ‘scar plate’ that covers the defect. no repair is necessarily needed at this time as a result. some tissue is removed though to get the mesh out, and the scar plate is of course not as strong as the mesh repair. i also had my mesh removed and did not have any sort of additional repair.

the question then is how long will this last. my surgeon said that for many patients who originally had an indirect hernia, the scar plate has held for several years for most (the 3-5 years since he’s been regularly doing robotic removals). i also know some folks that had a direct hernia, or both direct and indirect, and are years post-removal with no additional repair and still don’t have another hernia. but my surgeon also said he’s seen a number of patients that recurred within just a few months. most of these were originally direct hernias that had been repaired. something about the anatomy of an indirect hernia makes it less likely to recur, at least for a while.

in my case and others it remains to be seen if this will last a lifetime, or if an additional repair will be needed someday in the future. i know i can still get an open tissue repair in the future if something happens. but Dr. Towfigh and some other surgeons have also suggested that the scar plate isn’t nearly as strong and they expect another hernia to show up eventually in most cases. but it’s also hard to say for sure as i don’t think enough people are tracked and not enough time has elapsed since removals have become a little more common.

i do think the idea of a fully absorbable mesh is similar in that the mesh serves as a lattice for collagen to form around it and connect the edges of the hernia, and eventually the mesh disappears leaving the hernia fixed vy scar tissue. seems like the perfect solution, but for reasons I am not well versed in, the practical realities of this option apparently leave a lot to be desired and don’t work as well as you’d hope. otherwise this would obviously be the way to go. you’d have to google why or search here and have one of the surgeons chime in to explain.