[Alephy]

If this were true, I would expect the Shouldice clinic to treat the smaller sized hernias preferably, while it seems as though they opt out when the hernia is smaller than a certain size somehow…..

[Alephy]

I have Urticaria and also when under severe stress have severe nerve pain in the groin area (have had it since a child, it lasts few minutes but it is really debilitating; luckily removing the stress or e.g. stopping drinking coffee for a while resolves it, and it only happens once every few months).
So I am also extra careful on what goes into my body; or at the very least what goes it better stay there for as a short a time as possible…here in Switzerland where I live I mentioned my condition at a hospital and they wanted to run some tests to assess if I am “allergic” to meshes, which I did not do because of covid and the non conclusive results anyway. However I got the feeling that in an emergency situation they might opt for whatever procedure would resolve the hernia while not exacerbating the urticaria problem…so I am just wondering whether in your area a hospital with other doctors and expertise might push for a non mesh option because of your other conditions….

ps: I am still watching my hernia as at the moment symptoms are minimal

[Alephy]

When choosing a doctor, try and go for one that uses all the techniques available. It happened to me to consult with one who in his website mentioned Shouldice and non mesh procedures, only to be told during the visit that he will choose a technique which he is proficient/skilled with, which turned out to be mesh (he did not perform Shouldice etc any more and would not use them).
This is basically the problem: going for an expert that can tailor the surgery to your needs might just not be enough, if the expert is only expert on certain procedures….

As far as I could read about collagen, nobody knows yet how this problem evolves (some evidence suggests it is in the dna) or whether it can mitigated in any way (e.g. with a diet change, although I would not be surprised if this was possible) and there is controversy on the supplements (although some say there is some evidence that they are beneficial in general against bone narrowing when ageing for instance); I think it was mentioned before on the forum that when taken as pills they might not even make it into the body…having said this, as long as they are not super expensive I myself am thinking to try them…

[Alephy]

Thanks for the answer! I was kind of wondering whether the peritoneum divided areas of the body that might behave differently, but I guess not from the inflammation point of view….

[Alephy]

It would be interesting to know how much it costs (I mean a standard surgery) and whether she is always leading the surgery or (more likely) her team takes over most of the time….

[Alephy]

Hi James,

One thing to bear in mind is that the vast majority of hernia surgeries are done with mesh, so the tissue repairs numbers are very small, and therefore the number of complications even smaller as a result…

[Alephy]

There is a human component to the problem, as well as a “system” that got funnelled in place by the market and the need to streamline these types of surgeries (e.g. population is getting older and older so you will see more and more hernias).

For the human component, surgeons are educated/taught in a certain way i.e. mostly mesh (and the young ones do not necessarily know what it looked like before). They also assume they play the biggest role e.g. if you listen to the weekly discussions with surgeons, they all more or less mention that the surgeon makes the biggest difference (“it is the golfer that swings the club, not so much the club itself”): on this tenet and considering that all surgeons think of themselves as brilliant, the mesh is assumed to be inherently safe in the hands of such brilliant surgeons…..
I personally think the surgeon does make a difference, but only “up to a point”: after that it is hoping for the best as the unknown (by which I mean lots and lots of poor medical studies aka rubbish) kicks in….

[Alephy]

Hi James,

The way I see it, it is not so much why they use mesh: what really makes me wonder is why many doctors (this is true I believe) would talk about mesh as a very safe, secure and complications free medical device. There are situations where mesh is the best option, and I would even be inclined to acknowledge that a doctor might not know any other way to fix an hernia…However, this does not mean that they should sell it the way they do, this is truly unacceptable!

[Alephy]

The knee comparison is a good one. Know that in the 70s/80s surgeons still believed that the meniscus was a relic of evolution and that did not play any role -> after an injury they often suggested full removal: it is not needed (they said) and you will be perfectly fine without it (they argued).
It is with this historical view that you should look at and listen to any surgeon these days: they might look equally naive in 40 years time…
Knee and back problems are often tackled these days with PT: what I mean by this is that PT is indispensable even after a surgery.
I personally think that after every injury you never are the same person no matter what: you may be “worse” in certain aspects but might have learnt and improved your body mechanics in the process of tackling the injury, which might make you better in other ways….(I don’t know about professional athletes, but I have seen this in martial arts, me included)

As for the pain, I guess it is difficult to understand where it is coming from (sometimes not even from the hernia itself apparently) and so there is a higher chance that the surgery might not resolve this issue, which might mean a (long) time is needed? (again I am no doctor) Time is actually the outrageous thing in all this: it takes a long time to get better after a surgery, and those who say you are up lifting a car (just kidding here:) two days after surgery should have their license stripped (this bit I learnt very much early)

[Alephy]

I bet in 20 years or so they will find out that for small hernias proper PT might just work fine…so much for the mantra that surgery is the only way….(hopefully not the famous last words for me, in case I end up under the knife:)

ps: who among the doctors in this forum did actually get an hernia and a mesh/pure tissue surgery to fix it?
considering the high probs for this problem, I would expect the other half of the sky to be affected too…just curious…

[Alephy]

I asked this very question in an old post, and was told that this would not be such a bad idea, but that the the financial cost would be much higher and therefore people don’t do it…

[Alephy]

The way I see it, the ultimate mesh would foster healthy tissue regrowth, as opposed to scar tissue, and eventually disappear. Some meshes apparently have this property, with a bunch of unwanted side effected unfortunately…It seems no “device” can do better than our body, so we might as well accept that and try to make our body fix the problem the best it can….

Also, at the moment some situations I think warrant the use of mesh (like very complicated hernias etc)…

ps: Does anyone know what the situation is in the EU with regard to the new guidelines whereby a mesh can only be used if trial data is produced to its effectiveness?

[Alephy]

I wonder, are these data specific for incisional/complex hernias? From the small reading I did it seems as though 20% recurrence rate in this case is understood to be expected…the Italian study even concluded positively in considering the Phasix mesh a valid alternative.
I guess my question is: could these meshes be an alternative for uncomplicated inguinal hernias too?

ps: I have also another question: are these (bio and not) absorbable meshes also placed laparoscopically? If so in this case a bigger mesh would be used, as opposed to an open repair?

[Alephy]

In fact, on the same line, is recurrence then a potential problem for those who had their mesh implants removed (because of chronic pain etc) i.e. are they at higher risk with time? I cannot quite understand some statements whereby when the mesh is removed the scar tissue left is strong enough to stop future hernias, but somehow the same does not apply to (a subset of?) re-absorbable meshes…

[Alephy]

If you are in an emergency, you might try and find an older surgeon who did use a non mesh technique in the old days…..the other option would be to find one that uses a “normal” mesh…

These days online consultations are also an option (although I am with you when it comes to claiming back expenses, especially after a surgery)…

[Alephy]

I also think that exercising with an hernia is mostly ok, and in fact I would argue it should be recommended! Movement will keep the body healthy in general and prevent other problems…
There are many (among doctors) who claim exercising will make an hernia worse, I wouldn’t be surprised if it was in fact the opposite….at the very least it could get worse whether you exercise or not, so you might as well do it:) (and for some sports/physical activity is a fundamental part of their identity, me included)

[Alephy]

I also read not so long ago of a new 3d mesh that allows for healthy tissue regrowth (no scar tissue). I am wondering if 3d meshes are coming back somehow, without the terrible side effects of the first ones hopefully…

[Alephy]

Hi Katherine,

I read you. There are very many different meshes, and sure enough the wrong one used for the wrong procedure is likely to break havoc….I am wondering now if the meshes people have been talking about for hernia repair that get reabsorbed, do indeed leave behind something (I was under the impression that they were designed to disappear entirely), although indeed there are some that get reabsorbed only partially ie they have a small content of a permanent part (polipropilene?)…incidentally one reason I would want to avoid a permanent foreign body is that I have Urticaria, and I would rather not run the risk of an adverse reaction of the body (it is not pleasant when it happens) ie between a smaller permanent content and a full sized mesh I would still opt for the first one…

[Alephy]

Hi Katherine,

I live in Europe, and I also have a constraining health insurance so options are limited…

ps:
If I myself decided to go for a mesh repair, I would definitely go for one that gets absorbed completely ie it disappears as it causes less inflammation (according to the studies) and in case of problems does not remain in the body anyway (hopefully a less severe problem than peeling off a permanent mesh off your body); and I have not yet found any study indicating that the long term rate of recurrences is (much) higher….

[Alephy]

Hi Katherine,

What are your symptoms if I may ask? You did not seek treatment back in 2018, did it get better afterwards?

My experience is that most doctors will tell you that: 1) the hernia is too big for a pure tissue repair or the tissue is too weak 2) that is better to operate sooner rather than later as watchful waiting is not recommended anymore 3) that it will only get worse and that 4) exercising makes it worse…one even said that waiting to fix the hernia on my right side will cause an hernia on the left one too.. and of course they will more or less all say that 5) the % of their patients with complications is very small (because they are obviously very good surgeons) although one doctor who works in a hospital did mention to me a 15% complications rate…

I have read many posts on this forum in the past 12 months, and I am no wiser than you are, but I can tell you what would guide my choice of a surgeon: He/she must be ok with answering ALL the questions, even after the visit (if at all, I know I will be able to ask questions if there is a problem afterwards), the surgeon should have followed up on his/her patients for a long period of time (otherwise any statistics of success/complications is meaningless), and when asked they should tell you a ballpark number of complications that is reasonable…whoever tells you they never saw complications is selling you a lie…same goes with those who tell you that the mesh is inert etc etc…my 2 cents