[Alephy]

I wonder whether one can differentiate between scar tissue problems and the mesh itself….from reading the forum it seems those who had mesh removal were fine afterwards, with the scar tissue stopping the hernia from recurring…the problem with inguinal hernias is they occur in a place that is key to movement so anything static can cause lots of problems….some doctors are trying to find a way to regenerate healthy tissue at the same time avoiding any static hurdle in the area

[Alephy]

I searched the mesh type and I am not sure it dissolves over time. I think the fixation idea behind it has been discussed in this forum before, maybe try and search for it…another thing I seem to remember is that the mesh surgeons recommend a minimum period of time before they would even consider removal: before they advise on pain control (again the doctors here will be able to expand on this). How bad is the pain at the moment btw? is it constant?

[Alephy]

Hopefully doctors will chime in and comment, but I would consider pain after exercising “not normal”, in the sense that it is not in line with what doctors tell patients about mesh repair; but I guess it is normal in the real world where mesh repair is NOT a routine surgery (by which I mean, with very little rate of complications). Hopefully the doctors here will be able to tell you which exams to go for, to understand if something is up other than a mesh reaction….Are you located in Germany by the way? I am also considering Dr. Muschaweck for inguinal hernia repair (and watchful waiting in the meantime)…

[Alephy]

What I found interesting is the claim that the tissue growing on their 3d scaffold is of higher quality than the standard meshes i.e. it is not scar tissue. If this is true I am wondering whether they could also use then a mesh that is reabsorbed (yes, my obsession:) in the end, although this is a 3d scaffold so I have no idea if this works similarly (or can in fact). It is interesting that Italy seems to have a very active community of researchers in the field of hernia surgery/treatment, albeit focused on mesh techniques (did not see pure tissue ones being explored)

[Alephy]

I wonder if the doctors on this forum could comment on their patients, and how many of them suffered from chronic pain..of course assuming there was some follow up…

[Alephy]

Well I just looked at some papers around that were comparing synthetic meshes vs the bio ones e.g.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569804/pdf/fsurg-02-00048.pdf (this one suggests they should be used in a contaminated field)

or

https://journals.sagepub.com/doi/abs/10.1177/1553350617697849

Other than objecting that they are too expensive, or that they are on par with the other meshes, one discussion point is whether they induce less chronic pain (I guess this is the key point in fact, at least for me).
I never saw a paper showing an overall (much?) higher recurrence rate, could you send me some links? I am still considering this as an option so I would be interested to read them…

Thanks again!

[Alephy]

Nice blog!lots of useful information for patients

[Alephy]

Interesting as I would have thought the smaller the mesh the less the possible adverse reaction of the body…so you see cases of complications because of a too small mesh?

[Alephy]

I find it strange that the students do not question the teaching in the first place (or maybe they do?). Not only because they should be at a point in their studies where the skill to independently assess and judge something rationally should have been acquired, but also because many of them probably know somebody who had an hernia repair, and possibly even somebody with serious issues from it…

[Alephy]

I am no expert or doctor so take it for what it is ie my personal opinion:

1) watchful waiting is an option, certainly to buy time before you can see a doctor (or to avoid mesh, this would be my case btw)
2) an expert might be able to correctly say if it is a direct or indirect by e.g. using ultrasound, but it is not 100% precise (same goes with the size I think)
3) a tailored approach means you will get the surgery that is best for you, which might mean Shouldice or another procedure: any reason why you absolutely want Shouldice? if I could do it, I would go for the tailored approach

How badly is your life style affected? leaving aside the danger of incarceration that ALL surgery sites/surgeons mention in bold as a reason to get surgery as soon as possible (apparently the chance of this is pretty low), I am not sure how founded it is that the hernia gets bigger quickly and this will mean you cannot get a tissue only repair (somewhere in this forum Dr. Kang mentioned that a tissue only repair in his opinion is almost always possible, barring some cases with other morbidities): I may be wrong on the tissue only repair being almost always possible, which I would like to hear some opinions from other more knowledgable members…

As for the testicle being affected/compromised I cannot say: I would have thought that so long as the blood supply to the testicle is not compromised there is no damage…

My 2 cents

[Alephy]

Can someone send me some links of the fb pages to the patients organic bio mesh complications?

[Alephy]

From the chronic pain point of view, the formed tissue around the mesh can also cause problems even when the mesh is gone? I just wonder whether your own tissue could also entangle the nerves and cause pain…🤔

[Alephy]

Yes sorry you are right. I guess at one point I was putting in that category all the meshes that would disappear after a while. But I guess the bio naming applies only to the non synthetic ones…so do meshes made from animal tissue “work”? By this I mean in terms of recurrence and infection prevention only….

[Alephy]

This is interesting as I understood bio meshes were originally targeted as a better option in case occurring of an infection was a possible complication…for the recurrence rate all the studies I saw seemed to imply the rate is low…there was a German study though where the benefits of bio meshes were dismissed as minimal or inexistant

[Alephy]

The misleading line is that they do not quantity pain ie somebody with some pain ending up with more pain after surgery is valued as neutral it seems…24% pain rate is very high!

[Alephy]

I watched a public appearance on tv of the doctor that invented the technique: he said that the mesh they use is 1. smaller 2. of a particular shape so tailored to the area 3. 70% reabsorbed so only 30% is left in the end.
Their aim was to reduce chronic pain (he mentioned a 10% rate of chronic pain with the normal procedures/protheses, acknowledging that it is a real problem) and the sensation of foreign body presence, as well as having a simpler procedure (they seem to have an easier life avoiding to touch the nerves, also the mesh is not in contact with them somehow)

I will send him an e-mail, I wonder if they can also use fully re-absorbable meshes (if so I would consider them).
I think I read somewhere that the recovery time they observe is quite fast too. I have also read that the head of the hernia center is also an advocate of tailored surgery, and they also include tissue only procedures when warranted. Considering that it is not far, and possibly not too expensive it might be a good option

[Alephy]

Yes, and I am also wondering whether they are continuing with this method trial fashion or whether it is now regularly used. I will try and find out. I would still object to a permanent mesh though…

[Alephy]

I found this paper on this method

https://pubmed.ncbi.nlm.nih.gov/28851612/

I am just wondering whether they also use bio (absorbable) meshes too….as long term any mesh is likely to cause problems no matter what, I am just wondering whether a method that would protect the sensitive parts long enough for the mesh to go away might work at least better than the current options…

[Alephy]

And here is a video

https://youtu.be/_zNI7-P05cI

[Alephy]

Here is one link

https://www.sciencedirect.com/science/article/pii/S1015958417301628