[Alephy]

From my (ignorant) side, what caught my eye was all the different “surgeries” that were mentioned, some of which I never heard of….

BTW are 3d meshes all considered a no-go, or the problems were associated to only a particular type? This also I found confusing, as it seems on the web site that 3d mesh is considered as a viable mesh, but as pointed out by Good intentions, one of the few agreements on mesh is that the plug mesh should not be used…..

[Alephy]

Yeah, I am just wondering though whether there are people out there who are researching hernia treatments that do not fall into the two categories of pure tissue hernia vs mesh (surgery) repair….I would be curious to hear what researchers are thinking that might come in the future as an option…

[Alephy]

Hi Watchful, what symptoms do you experience now, as opposed to before you did the core exercises?

I have always wondered what could increase the pain of an hernia, and barring nerve inflammation the only thing I can think of is that the “defect” got smaller, while the hernia tissue got somehow more trapped than before…but I am wondering whether exercising can ultimately reduce the pain in the medium to long term (this was also mentioned by Dr. Towfigh if I am not mistaken i.e. exercising may reduce the hernia and make it more manageable)….

I would not neglect the fascia i.e. there are some people out there who actively focus on the fascia as a means to get better athletic results, and I personally think it does help with hernias too (at least with mine it does:)…in fact I train the core indirectly by focusing on the fascia….

Last but not least, I would not just train thinking of the hernia, but really looking at the whole body (for the fascia this is important)

[Alephy]

The way I see it, there are lots of variables at play e.g. the skills of the surgeon, materials, patient’s anatomy etc etc….there is one thing though that people seem to agree on: if the mesh needs to be taken out, it is really a difficult procedure and requires a true specialist! Also the recovery from this procedure may take a long time too (to see improvements that is). Personally this is the reason why a mesh that would disappear after a certain time seems (to me laymen) a better compromise, so as to reduce the odds of a potential major problem with the mesh…of course I would still argue that people eligible for that should also be offered a pure tissue repair, but this may not be viable to all…

[Alephy]

It was indeed a great session! May I ask when are these new studies on biological or absorbable meshes coming out? Some papers were mentioned with promising results on those….

[Alephy]

@pinto I can understand your point about a University hospital. The question is: was the patient informed before surgery that it would have been handled by other surgeons, with the occasional supervision of the chief surgeon? The article criticising what had happened described the way the “many surgeries” were handled as not acceptable and I agree with this: the criticisms were on the procedure and process, as well as the “volume concept” and I think they stand.

I think you are right that this case was settled out of court.
I also agree there is a bias against mesh, but this is probably due to the many more mesh surgeries than pure tissue ones….
However, I also think that as you said some cases warrant indeed the use of mesh.

Last but not least, the criticisms against doctors come from their (the vast majority of them) conveying wrong information to the patients e.g. that the mesh is inactive, that the patient will be able to go back to full contact sports in few weeks, that the % of chronic pain is smaller than 1% and that it all depends on the surgeon technique etc: it is this behaviour that causes the mistrust!

[Alephy]

I read the second article where another doctor openly criticises Dr. Ramshaw, and I totally agree with the comments therein! I do not understand how the description of what happened could not be the subject of a lawsuit, and one that would be very easy to win!

Going back to the volume tenet, and the idea that the medical corporations push for more surgeries, how do they do it exactly? Because if money is the tool, then that is called bribing/corruption in my book, and I will most definitely not pity the “victim surgeons”, whether with a burn out or not! I cannot think what my anger would be if I learnt that my surgery went south because my surgeon jumped from one OR to another: I have a feeling I would have serious problems controlling it (in fact I would be furious), so the part where such doctor would apologise would also go very south….

[Alephy]

I can understand that, but I still think the “risk” of unexpected problems after a mesh repair should be factored in together with the recurrence rate….

Having said that, < 13% seems low enough to me, considering that it is similar to the mesh figures anyway: or am I missing something basic here?

[Alephy]

Well there are plenty of nerves in the inguinal area, and so any increase in pressure or movement might trigger some of them….just out of curiosity: is the itching present at all times? is it severe? Is it at the skin (surface) level, or deeper? I bet some doctor on the forum might chime in when given more details…

[Alephy]

I have a feeling of weakness at times and minor pain if I train hard…at the beginning I had minor pain more often than not but that I have not had for a long time now (minor i.e. nothing at rest, not severe enough to stop me doing things or distract me, and has not affected my sexual life either) …some surgeons here would say it got bigger and therefore less painful, I honestly don’t know: I think it is not “big”, as I still can only see it when I stretch the skin…

BTW I am not sure that a “bigger” hernia means necessarily a bigger operation (unless we are talking extreme cases), certainly if you end up with mesh this is not the case. For a tissue only repair, I understood that more than the hernia size what matters is the tissue quality, but I might be wrong

[Alephy]

I don’t think it is a question of ‘how much weight’….do you train the whole body? Are the core muscles engaged?

My rule of thumb is: the more I want to do, the more I need to train all the muscles so I can do it.
Which would translate in: the more weight you want to lift as part of your exercise routine, the more overall training you need to put in upfront e.g. with the core muscles…

I consider this rule true whether you have an hernia or not…again we all age, so we all have some physical problems. Even the professional athletes (even in their prime) may have some cartilage problems that have not manifested yet: you train your body as if your (sports) life depended on it.

Do this and it does not matter anymore how much you can lift (my 2 cents:)

[Alephy]

I think the question of what one can do with an hernia is not so simple. First of all a direct hernia is e.g. not really a hole, but a deformation. Also, muscles work together, which is already a very difficult problem to fully understand. If you add then the fascia in, which connects seemingly distant and unrelated parts of the body, the picture becomes daunting to say the least. I think it is not just high pressure => bad for your hernia, but then again what do I know?:) this is my personal opinion, and I am no doctor.

Speaking of which, I am not sure that the average surgeon/doctor really knows about exercising and what may or not be ok: in this respect a sports doctor would be my bet if I needed some answers in this domain…

I think that it greatly depends and changes from person to person.
I personally go by trying something and checking how I feel immediately after and the next day…

my 2 cents

[Alephy]

I think in this case the mesh materials (even when fully re-absorbable) are probably manufactured by somebody else or are the usual ones in the market; the shape is what makes the difference in this particular method: can you patent the shape? maybe you can, I am not sure…..

When I have time I will look up few of the major hospitals in Italy, to check if the method has been adopted more broadly since last time I checked…in any case at least two major hospitals in Milan offer it regularly (which would fit me:)

[Alephy]

This is why I got interested in the technique too, i.e. the mesh shape as well as the tissue repair part
are combined in a unique way…

It kind of reminds me of this other technique somehow

https://maplespub.com/article/Minimizing-Retained-Foreign-Body-in-Hernia-Repair-Using-a-Novel-Technique-Reinforced-Biologic-Augmented-Repair-ReBAR

ps: I tried to get some feedback from some Italian fora on the outcome in terms of pain and foreign body feeling in the medium term, but could not find much info, which makes me think that the technique is still offered in only few hospitals; it could also mean that the patients are satisfied and do not go online asking for help though…

[Alephy]

The technique is used in some hospitals in Italy as the surgeon who introduced it is Italian. I had the chance to speak to him, and he mentioned that he also uses absorbable meshes…it can very well be that the technique is also offered in other countries as well….

I would also mention that he called me to explain what he does and how, which I found helpful and nice…

In the end I did not go for surgery, but he is on my list should I decide to go for it…

[Alephy]

It’d be interesting to have some stats as to who does better after hernia surgery….

As for the athletes, they may be the ones putting more stress on the repair, and also complaining on their body limitations, but they are also the ones who train more their core in general, as well as the other muscles, which protects the hernia area (with or without surgery)…It may also be that training affects (improves) the fascia as well as the overall nerve pain sensation, which may improve the overall repair feeling….

[Alephy]

I wish I could get 1 euro for each time I read a comment by someone appalled by the state of affairs in the medical industry (notice the word industry, it should be telling:)…

BTW there is a Netflix documentary about mesh, I recommend watching it (disclaimer: you will be angry afterwards)

[Alephy]

@good-intentions I agree 100% with your post!

I wonder whether in the future genetic engineering of the problematic tissue might provide the ultimate cure to the problem…whether this will happen or not, the PT component will never go away i.e. one should always exercise the body, whether with or without an hernia, or after an hernia fix…
and of course adjust to what one can do at any one time…

As for the doctors providing wrong information and expectations, I think this is close to criminal practice (I saw one such doctor, who turned out to have an infamous reputation among his peers too)

[Alephy]

@william-bryant At the moment I would rather avoid surgery if I can. I should mention that 20+ years ago I had hernia surgery for an hernia few cm above the belly button which was repaired with sutures (it was small and the surgeon decided not to use mesh), so it is not that I am absolutely against surgery per se.
The inguinal area is tricky and prone to problems, and as I have still minimal symptoms I am still considering available options (I mean, once every 4 weeks or so:). The moment I get back on the mat training martial arts will be the one where I am pushed against the wall for a decision, unless I end up being able to train still despite the “problem”, in which case I will happily read the forum here and stay put:)

[Alephy]

@Wim From what I saw in videos etc the mesh they use seems very small. As mentioned before the mesh shape and not the size are touted to make the difference here…