[Chaunce1234]

quote Jnomesh:

Amongst other things it would be a great step if surgeons would also consider mesh “type” and procedure “TAAP” vs TEP in regards to how easy or difficult it is to be removed/explanted.
i too have heard that a TEP procedure of implanted mesh is much harder to remove as one top removal surgeon said it would be much more difficult and like “filleting” the patient open.
The same removal surgeon also told someone the type of mesh he had was a kind that was berry difficult to remove.
Since we are dealing with a device that is meant to be permanent it seems logical that the only criteria shouldn’t be how well theoretically the mesh can fix the hernia but god forbid if the mesh needs to be removed how easily can it be.

It sounds like the important part for optimal outcome for these surgeries is using the same method of the original surgery – open for open, laparoscopic for laparoscopic.

I believe Dr Towfigh and Dr Belyansky both have significant experience with removing mesh that was placed with TEP (and presumably TAPP), on this forum I think [USER=”2029″]Good intentions[/USER] originally had a TEP repair that was successfully removed from Dr Billings. So I think it can be done with sufficient experience.

I agree that significant consideration should be put into how easy the products are to remove, not just to be place, in the event they need to be removed for any reason (pain, infection, complications, etc). I suspect that would require a redesign of mesh and maybe usage of different materials, or a combination of different materials. Maybe something like a patch where the edges are intended to be integrated into the tissue so it holds in place, while the interior of the patch is something truly inert (titanium?) that does not integrate at all? Or maybe there’s a material that would bond well, but easily be removed with the application of some adhesive removal? I don’t know, hopefully someone is doing heavy research on this stuff.

[Chaunce1234]

Thanks for the replies [USER=”2608″]dog[/USER] and [USER=”2580″]DrBrown[/USER] it’s certainly interesting to have both the patient and surgeon engaging in a discussion like this about a surgery.

[USER=”2608″]dog[/USER] I noticed you said you originally had hernia pain in the lower part of the stomach, testicle, and leg, has that pain changed or resolved since having the surgery? Or is it too early to tell if anything has changed?

[Chaunce1234]

quote bmul100:

On my follow up the surgeon said that it’s one that shrinks a lot. I have spoken with another surgeon who said it was regarded as more difficult to remove due to it having two layers. Basically removing it leaves you with no flesh. But I am sure some of those comments vary based on the surgeon and their technique.

Have you tried nerve block and/or steroid injections or anything of that sort? If so, did it provide any relief? It might be helpful to find a doctor with significant experience in dealing with post-hernia surgery complications.

If you’re considering a re-do surgery or thinking about mesh removal, find an expert on those specific surgery types. There are not many surgeons with a ton of experience removing hernia mesh or dealing with PHPS problems, and so you would want to speak with one who has managed the conditions, done the related procedures many times and preferably with the same type of mesh you have, and of course with good outcomes.

If you feel like sharing your general location, perhaps someone on this forum could offer a doctor that is somewhat near to you. You may need to travel to find an expert with sufficient experience.

[Chaunce1234]

quote DrBrown:

Dog is very kind with his comments, but he made my job easy by working with me every step of the way. He did ask a few more questions than usual or maybe a lot more questions than usual, but I believe that the more the athlete understands the injury, the anatomy, the operation, and the recovery the better he/she does with surgery. So I am always ready to answer questions.
Dog did have an indirect hernia, but there was also weakness of the inguinal floor that also required repair.
Regards.
Bill Brown MD

Thank you [USER=”2580″]DrBrown[/USER] for the additional insight on [USER=”2608″]dog[/USER] and his surgery. Can you offer some more detail about how the weakness/direct hernia is handled in this situation? Is it a typical direct hernia repair at that point, in conjunction with the indirect repair?

[Chaunce1234]

I’m sorry you’re going through this, hopefully your situation has improved a bit since your post yesterday. I wonder if it’s possible that inflammation from the surgery is pushing on a nerve?

Please keep us updated on your case and progress, and let us know what you hear from your surgeon.

[Chaunce1234]

Another way to ‘calculate your risk’ of pain after inguinal hernia surgery is with an app called CeQOL, available for all major phones. I don’t know how accurate it is, but it attempts to quantify chronic pain risk after you answer a few questions. I think it assumes a mesh hernia repair since that is the most common, I am not sure if the risk would be different with non-mesh hernia repair.

It’d be interesting to know if surgeons find the CeQOL app to be a good estimation of chronic pain risk. The risk percentage chance shown is usually high, at least in my opinion.

For iPhone

https://itunes.apple.com/us/app/ceqol-inguinal-hernia/id566313832

For Android

https://play.google.com/store/apps/details?id=com.carolinas.CeQOL&hl=en_US

There is also a similar app for assessing risk of complications with ventral hernia repair:

https://play.google.com/store/apps/details?id=org.carolinashealthcare.ventral&hl=en_US

[Chaunce1234]

quote ajm222:

I’m pretty sure I’m also carrying myself differently as a way to sort of protect myself and the repair from any damage, or trying to not trigger any uncomfortable feelings/sensations. That could be causing some of the stiffness and soreness, because I’m getting it in my back on that side as well.

Have you considered targeted physical therapy? After an injury or experiencing pain, people may consciously or unconsciously change their movements or postures as a guarding mechanism. I wonder if that might help in your situation?

[Chaunce1234]

[USER=”2608″]dog[/USER] Thank you for sharing this very detailed and personal report, it will undeniably be helpful to other patients searching for a similar surgery.

I look forward to reading more about your experience and hearing of your progress going forward.

[Chaunce1234]

[USER=”2051″]ajm222[/USER] I can’t recall if you had mentioned it before, but did you have pain or discomfort in the hernia area prior to your surgery? If so, did those symptoms change at all after the surgery?

One of the (many) things I find frustrating about chronic pain data is that there is often a lack of context about the pain, pain severity, pain specifics, type of pain, pain location, patient specifics like general health, weight, age, or activity levels, and even the details about pain specific to the procedures that were performed. To me that all seems like relevant data. I would assume that different procedures have different specific pain risks for severity, types, and locations of the pain, and that data should be tracked and published too. Maybe some procedures have pain that is easier to treat than others? Wouldn’t that be important to know?

And much to your point, the longterm follow-up and outcome data is missing, which is clearly relevant. How do these patients do a year, three years, five years, 10 years, 20 years down the road? Did the pain improve or go away on its own? Do some procedures have better response to certain pain treatments than others? Do some specific procedures have better improvement in pain over time than others?

There are so many variables involved on the input side, so these are tough questions. But the output is ultimately patient quality of life, so regardless of how difficult the questions are, the answers matter.

[Chaunce1234]

How did the ibuprofen work for you? If you get some relief from ibuprofen, and if your general health can tolerate NSAID use, you may want to talk to your surgeon about a prescription strength NSAID course to reduce inflammation. Often these are taken for 30 days to 60 days continued every day, regardless of whether you feel like you need it on a given day or not, it can be quite helpful.

Another thing to consider and talk with your surgeon about would be targeted physical therapy, as it might help to figure out what movements, muscles, etc are involved in the pain, improve mobility, and can often help to reduce pain/discomfort too.

Keep us updated on how you’re doing, and what you hear from the surgeon.

[Chaunce1234]

Did you have open surgery or laparoscopic surgery? Do you happen to know more details about the procedure and the types of hernias repaired? Are you male or female? Did you have any pain before the surgery? Is the intense pain only on one side or both? Is it only walking that triggers the strong pain or do other activities? Just wondering as sometimes these questions can be informative.

It’s a good idea to consult with your surgeon, they will certainly offer some helpful advice. I’m not a doctor but considering that you’re three weeks out of surgery I would think it is certainly possible that you are still experiencing some nerve irritation or residual inflammation from your body adjusting to the procedure. With your doctors approval and if your health is permitting you might try an extended course of prescription strength NSAID anti-inflammatory medication.

Please keep us updated on your case and progress.

[Chaunce1234]

– Dr Jonathan Yunis in Sarasota, FL performs a Shouldice repair for select patients

– Dr Robert Tomas in Fort Meyers, FL performs a Desarda repair on most patients

I am not sure of others in Florida, but if you do find any surgeons offering Shouldice in Florida then do report back who and where they are.

Please keep us updated on your case and decision making regarding hernia surgery.

[Chaunce1234]

Vaginal prolapse repair with vaginal mesh carries high risk for chronic pain and horrible complications. Fortunately women have been incredibly effective at advocating for changes in that field, but thus far men and women have had little to no success advocating for changes in groin hernia repair.

My hunch is that some patients do not respond well to having an object placed into a highly innervated region, such as the pelvis or the groin. The pelvis/groin is one of the most sensitive areas of the human body after all. But then some patients do fine, who knows why that is. I am not sure anything will ever be able to predict who will do well or not with these surgeries, because sometimes you can have the same patient with the same repair on both sides and only one side is problematic, and who knows why that is.

I do think it’s interesting that there are some other mesh repairs that do not have the high of chronic pain problems; umbilical hernia repair and other upper abdominal hernia repairs with mesh are fairly routine and apparently have much lower chronic pain rates. My assumption is that’s because those areas are not full of nerves the same way the pelvis and groin is.

Some people report problems with breast implants, though it appears to be at a significantly lower risk incidence. And I believe those are easily removed if needed to be.

Other abdominal surgeries like c-section birth, appendectomy, or cholecystectomy are incredibly common with very low chronic pain risk.

And of course surgery for broken bones and fracture repairs are incredibly common, with very low chronic pain risk for most broken arms, legs, etc.

[Chaunce1234]

Is there any reliable way of knowing the outcome of a neurectomy before performing one? Are nerve block injections predictive?

[Chaunce1234]

quote Good intentions:

I wrote half a page Chaunce but I’ll try to condense it. Before the mesh I was a very active member of society and family, engaged in many ways. With the mesh, my life slowly shrank down to a daily check of the state of the mesh site, and a plan for how I was going to try to make it better, today. I wouldn’t say that I was clinically depressed but I knew that my life was much worse. I was more frustrated and angry than depressed.

Now, with the mesh gone, I am planning weeks, months, and years ahead. I’m getting better, physically, every day, and that allows me to be healthy, mentally and emotionally.

One important thing for me though was that I had resources, money in the bank, and time, to solve my new mesh problem. So I had hope. The problems that you are describing will be made much worse for people who aren’t as lucky as I am. I had the ability to find a solution. Many people don’t, and their symptoms are denied when they seek help, as has been documented in many stories.

I think that if this situation was a project under a single entity, like a large corporation, it might have been halted already, just based on a comparison of the old way of hernia repair versus the new way. The new way is full of problems that never existed before.

That makes perfect sense and it follows my belief that the “psychological” symptoms are a result of the discomfort/pain/etc – how can someone be in constant pain and not be bothered by it? Of course there are different brain-level things that can occur when chronic pain has caused changes to how the brain processes pain or sensitivity, and I am not sure how that is addressed or if it’s being studied with regard to groin pain and/or post-herniography pain. Some practitioners believe in treating the pain first as if it’s a separate entity, but how does anyone really know if the pain is caused by the hernia, or the mesh? And what if it is caused by that, how could that be treated first before having a surgery?

“I think that if this situation was a project under a single entity, like a large corporation, it might have been halted already”

I certainly agree with that statement. My particular industry would fail immediately with even a 1% failure rate, as I think most other fields and businesses would fail too. So it’s hard to imagine it acceptable for 15% to 35% of surgeries to be failing in some way or another in a catastrophic way with chronic pain and that is considered normal or tolerable. It’s all the more absurd given the ongoing assault on chronic pain patients, nobody would be needing the pain pills or expensive and tedious pain management if they did not have the chronic pain to begin with.

[Chaunce1234]

Is your hernia inguinal, femoral, umbilical, or other? It’s fairly difficult to find inguinal/femoral non-mesh repairs, whereas it’s easier to find non-mesh umbilical hernia repairs.

Known non-mesh inguinal hernia surgeons in southern California and the southwest USA include the following:

– Dr Shirin Towfigh in Los Angeles, CA

– Dr Edward Phillips in Los Angeles, CA

– Dr Robert Burns in Newport Beach, CA

– Dr William Brown in Fremont, CA

– Dr Kevin Petersen in Las Vegas, NV

– Dr Zafar Parvez in Gallup, NM

– Dr. John Etlinger in San Antonio, TX

There are certainly others, perhaps others can share more providers offering these treatments.

Good luck and keep us updated on your case.

[Chaunce1234]

quote Good intentions:

I mentioned in the first post, quoted below. I do not have any psych problems that I know of. No treatment, or thoughts of seeking help. I’m lucky. I thought that I would get my simple direct hernia problem fixed and be back to living my full and healthy life.

” My neural wiring was well-developed to have a fantastic outcome when I had mesh implantation. I actually had to overcome that neural wiring to realize that I would have to deal with the real physical problems that the mesh caused.”

By that I meant that I believed that I would be okay. I had the bias that many healthy people have toward others with problems, that they must be unhealthy or out-of-shape, or old, or whatever other rationalization that people use to believe that they’ll be better off than the unlucky ones. I had a friend who was a surgeon who had had his own hernia in the past, who recommended the surgeon who did the repair. The surgeon was accomplished, well-respected, chair of surgery, at a big clinic. I had the state-of-the-art TEP repair using light weight Bard Soft Mesh. Everything said that I should be a poster-person for how to make the right decision and get a good result.

My issues, besides the discomfort and pain, were some that I cannot imagine are psychological. Penis issues, not just ED, bowel issues – bowel movements the size of a cats, physical manifestations like a very tight and flat abdomen, almost like a drum head. Feeling the edges of the mesh poking in to my groin, and irritated at the center where they had originally overlapped.

I even tried to work up some sort of routine where I could do healthy things like biking or running, then wait a few days for the problems to disappear. But the overall trajectory was down, getting less and less healthy, unable to focus on things after exercise, realizing that whole weeks were passing by where I hadn’t really accomplished anything. I was taking care of my mesh, like it was a baby, it was my sole focus.

The main reason that I am more active here is because the mesh is gone.

For clarification, I don’t mean to suggest that pain is a psychological problem or in the realm of psych issues. I’m strongly of the opinion that pain is the primary symptom of a problem, and that experiencing pain is what might then cause a brain-related or psychological side effect. If someone is miserably uncomfortable or experiencing pain all the time, or had a failed surgery, it is no surprise (to me) if they might then feel down, depressed, anxious, have insomnia etc, as those are simply side effects of experiencing the pain in the first place.

More specifically, I meant to ask you if your experience with feeling pain and discomfort impacted you in any mental or psychological fashion, basically as a side effect of experiencing the pain. For example, did you develop any sort of depression or insomnia due to the pain or discomfort you experienced? Or anything of that nature? And if you had, did you find those psychological side effects of dealing with pain to change again after your second procedure to remove the mesh?

Where I think pain gets more complicated, and into the realm of neural plasticity or some other brain change, is when pain persists despite the cause of the pain being remedied through corrective surgery, and it’s for those situations where I wonder if the cutting-edge pain management therapies aimed at neural plasticity could be particularly beneficial.

[Chaunce1234]

quote drtowfigh:

Dr Ramshaw’s discussion abaiut neural wiring is based on his research and that of others:

Patients with chronic pain suffer from somatic and neuropathic pain in their body. They also suffer psychologically from the chronic pain. This manifests in depression, PTSD, anxiety, insomnia, etc.

he he has shown that patients who can get attention to the brain-related negative effects of chronic pain will have a better outcome from the surgical approach to treating the chronic pain (eg, by mesh removal). As you know, many undergo what we believe is the right approach to address their chronic pain but they are not cured of their symptoms. Dr Ramshaw has shown that that negative result may be related to the unaddressed neural wiring side effect of chronic pain that is not addressed by the operation.

This is fascinating, that might suggest for patients with chronic pain it may be beneficial to follow corrective surgery with some of the more cutting-edge pain management approaches that are aimed specifically at neural plasticity.

Things like intensive learning focused on mentally taxing endeavors (like math, programming, puzzles, learning foreign languages, learning to play music), ketamine infusion therapy (currently cost prohibitive for most), medical marijuana, neurofeedback, transcranial magnetic stimulation, physical therapy and exercise, etc might be particularly helpful for those patients. Hopefully studies will be done on this, it’s a very important topic.

[USER=”2029″]Good intentions[/USER] do you mind sharing if you had any of the brain-related aspects of chronic pain, and how or if they developed or changed before and after your particular surgery?

[Chaunce1234]

quote Good intentions:

At the end he suggests that open pure tissue repair should be an option for patients that don’t want mesh, and that the possible complications of that approach should be discussed with the patient.

I wholeheartedly agree with that statement.

Unfortunately there are fewer and fewer surgeons who are able or willing to perform a pure tissue repair, so I am not sure where these suggestions of offering pure tissue repairs to interested patients will be implemented.

It is curious to me that this particular subject seems to defy all laws of supply and demand. You’d think given the large number of consumers (patients) interested in pure tissue repairs, that the market would respond and there would be a significant supply of surgeons growing to meet that demand for non-mesh repairs, but that does not appear to be happening.

[Chaunce1234]

quote Jnomesh:

The article mentions that there are over 300 types of meshes!!!
It boggles me how surgeons can quote reoccurences
percentages with mesh or pain percentages with
mesh so neatly when there are 300 different types.
How can mesh be so easily generalized form one to another to quote
these percentages and stats?
Just seems so obviously wrong and unethical.
No brainer every mesh implanted should
ne tracked and monitored.

I can’t help but think that having over 300 different types of mesh is a result of over-engineering, and perhaps there are other incentives related to patents and pricing as well.

Regardless they all need to be tracked on implant and, if relevant, on removal too. Opacity in healthcare outcomes is not a good thing.