[Alephy]

Exactly! Always make/take decisions at home, never at the doctor’s office…..

[Alephy]

I guess my writing was misleading…I also doubt that there is hidden in the pile a not too bad mesh. I am just wondering what benefit the mesh registry might bring, other than shedding light on the implant pandemic problem (which seems to have surfaced anyway)…
of course I would be delighted if there was in fact a magic mesh that would fix the problem without any side effects, which is I think also the problem i.e. people wrongly expect/hope to get jumping few days after this type of surgery…

ps: As for the survey mentioned in the this forum on the top board, I find weird that some questions refer to whether the patient would like or not ALL the information: I may be naive but I would expect ALL the information to have to be provided under law, and failure to do so should prompt legal action in my opinion

[Alephy]

The diagnosis was of a small direct inguinal hernia…it was not clear or conclusive for the left side or umbilical. As to why Shouldice would not be an option it was not mentioned. From the reading I did I would say I am the perfect candidate for a tissue repair given weight and physical condition. I did say though that I do martial arts so I don’t know whether this prompted the mesh option based on the idea that it would sustain better stress….I would think the opposite but what do I know

[Alephy]

I already spoke to Dr. Hunkeler, but he considered only mesh in our discussion. But I can definitely say he gave me the impression of being very skilled and thorough (in fact of all the doctors I saw he is by far the be most competent by a great length)

[Alephy]

Also at the moment I have minimal pain i.e. I can walk/train etc. The discomfort is occasional but not stopping any activity yet (it is also true that I am 50 and I am not certainly running for the Olympics:)
This is to say that I would not bargain this with a worse off situation just out of doing it quickly….

[Alephy]

Well certainly better Shouldice than mesh. But I would like to try and find a surgeon who does the tailored approach that Dr. Brown discussed on the forum few times i.e. someone that can adapt to the hernia type etc. Say I happen to have an indirect one instead of a direct one, perhaps Shouldice would not be the right option or at least few less invasive ones might be on the table too. But even on the tissue only repair side of things, doctors often offer one procedure only (is this due to the fact that tissue only repair is not taught any more? probably)….

[Alephy]

@dianew indeed I will not! I wish I could have all this behind one day but in the meantime it will be watchful waiting…I’d love to go back to my previous routine without which it is like not being me, which is depressing…but I have urticaria and so I cannot run any risks….all the doctors kept saying it’s not a problem but even if allergy tests were negative there would be no guarantee…

[Alephy]

Hi Alan,

Well this is exactly the point against mesh i.e. where is the data? I mean, long term data showing pros and cons of the meshes (the very many that are circulating…)? I think many also made a point that chronic pain is mostly a mesh phenomenon (papers have been mentioned in the forum many times)…
As for the tissue repairs they have been around for a long time: all of a sudden someone came up with crazy figures for the recurrences (still do not understand where these numbers come from) and then mesh had to be somehow….

People correct me if I am getting wrong somehow…

[Alephy]

@pszotek Thanks a lot for your reply! You mentioned that at times you reinforce the tissue repair with a biological scaffold when the patient’s tissue is too weak: is this like a bio mesh that is reabsorbed or something else altogether?
It is the first time that I hear of such a reinforcement…

Thanks a lot again!

[Alephy]

Hi all thanks a lot for your comments! The problem is in Switzerland the health insurances cover up to a point so I cannot get surgery out of the country. All the surgeons I spoke to insisted on mesh (they may mention pure tissue repair but they don’t do it). One or two doctors 1h by train from where I live do Shouldice but have not seen them yet. No surgeon offered several options or a tailored approach or rather the tailored bit is how they would go in but then it is mesh. One agreed on shouldice with the condition that she could decide to opt out at surgery to mesh if she felt the tissue was not strong enough. So the watchful waiting bit comes from having not many options…I had an umbilical hernia 17 years ago and was done without mesh as small (didn’t know how lucky I have been) and even though it is back but still very small it never gave me any problems or pain: this is to say I am not entirely unprepared about hernia surgery….had i had the tailored option offered by some doctors here I would have done it 4 months ago already…once the Corona virus mayhem is over I will reassess the options for travelling. It seems in Europe only Germany offers tissue repairs with still a focus on one or two methods. What about France and Italy?

[Alephy]

Ah thanks I did not read through enough:)

[Alephy]

@drbrown can one stay on watchful waiting or should one have surgery asap for a tissue repair? I have read somewhere that the longer one waits the less likely a tissue repair can be done…

[Alephy]

Hi @good-intentions yes I read it, tragic and it kind of resonates with me…
I have not had any surgery yet and I am on watchful waiting. I also have no intention to get a mesh (even if all went well, it would remain at the back of my mind as a potential source of nightmares afterwards), but in case of an emergency (where pain or whatever spirals up out of control) it would end up being mesh…

My preferred course of action:
1) make it better somehow with exercise see if I can go back to some of my old life
2) try and get a tissue repair (preferably as conservative as possible, which would exclude Shouldice?)
3) try and get a bio (totally absorbable) mesh (some say it doesn’t work but yet many mesh removals end up with no further patching due to the scar tissue, so it might work)
4) still on watchful waiting if all above fails
5) mesh repair (Ovitex or some new one EU regulated in 5 years?) if all above fails and I MUST go under the knife that is

[Alephy]

Thanks for sharing! What was the mesh-less procedure you had on the left? Shouldice? (you may have posted it alreasy but the new forum is difficult to navigate)

ps: I can relate to the depression part, it is difficult (I keep blaming myself for the hernia as it keeps nagging me that I could have avoided it with more care)

[Alephy]

Hi All,

Thanks a lot for your replies! Yes I have been on this site long enough to have taken in the whole spectrum.
I asked lots of questions at the beginning and still more questions pop to my mind. I myself have small inguinal hernia(s) (the left one is not clear and at the very least without symptoms) and a small umbilical one. I have not had any surgery yet, and I know for a fact that it would not be possible to find an experienced surgeon that would do a tissue repair where I live (I spoke to a really experienced one in the area, and even though he does mesh I would surely have him operate on me if no other option was available).
This is why I ask after mesh repairs too, just in case I have to go down that road….so I am currently on watchful waiting…

Going back to my activity level before the hernia is one motivation to go for surgery, which is why I want to understand if this would actually be possible. Many people here had the same desire/expectation, only to be faced with reality. Having surgery, only to have the same discomfort/pain afterwards seems pointless (at the moment the level of pain is not debilitating in any activity)…

One more question: I have seen Dr. Towfigh mention in one of the live streams that the EU has adopted a tougher legislation to enforce mesh manufacturers to run animal/human tests and publish results (in a regulated manner I would hope) before marketing a product: does anyone see a future improvement under the mesh sky?

Thanks a lot!

[Alephy]

I am not sure I can attend given the time difference, but I would have few questions:
1) how come most doctors talk about a “hole” rather than a weakening when speaking of direct hernias?
2) why is there little consensus on watchful waiting? This also means that the advised treatment changes depending on the doctor…
3) It is often quoted that an hernia can only get worse: is this based on the number of people on watchful waiting that eventually seek surgery?
4) How will treatment change in the next 5 to 10 years? (I always wonder what technology might bring along in time)

I would have asked these questions before but the web site was not reachable from Europe for many days somehow…

[Alephy]

If I may ask,you went again for a mesh because you could not find a Surgeon for a tissue only repair? Or the hernias somehow were too big or complex?

[Alephy]

I would also like to know…

[Alephy]

So no one really in Switzerland 🙁

[Alephy]

I think for some hernias it could just be fine…for some others not if the tissue is too compromised. But this is what many are saying here including doctors: there should be a tailored approach rather than one fixes them all ie mesh. The number of cases is also a problem