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Forum Replies Created
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[QUOTE=Good intentions;n8909]How have things been before the symptoms in April? Looks like you got about two years out of the first repair. Were they a good two years?
I’ve mentioned that some surgeons seem to just lay more mesh on top of old mesh when fixing a recurrence but Dr. Towfigh replied that that was not how it’s supposed to be done. You should get more details on what, exactly, these surgeons are planning. If the original mesh failed, some or all of it will need to be moved or removed.
As far as having the other side done, prophylactic mesh placement, to prevent a hernia that has not occurred, is not medically advised, as I understand things. But, reality suggests that many surgeons do so. Surgery can always have complications so that seems like an unnecessary risk.
Also, it’s unclear if there are differences between the types of mesh. Your “new” mesh might be more problematic than the old mesh, as far as chronic pain. And, open surgery could mean the use of a “plug” which seems to cause many problems. If they don’t plan to remove any of the old mesh, they’ll probably use a plug to fill the new failure point. Some surgeons feel that plugs are “evil”. See the Tweet below.
Besides all of that, it doesn’t seem that anyone has even guessed at the cause for the failure. They’re just going to perform a different procedure without understanding why the first procedure failed. If you’re inherently at risk of failure because of weak tissue, you’ll probably have another.
Personally, I would avoid all three of those surgeons. You’re on the beginning of what could be a long trail of failures and problems. Find a real expert, with verified successes, not someone who has just performed a large number of procedures. Good luck.
I would totally agree
Dr. Shirin Towfigh would be a great choice along with few others we mention here all the time….Personally i was lucky to find this forum and trusting doctor ..and was smart enough to cancel my mesh surgery after reading these horror stories….i made my choice of doctors for no mesh surgery ..you can find it here..https://www.herniatalk.com/8654-dog-made-his-final-doctor-choice As active member of this forum i see that unfortunately so many people getting themselves in all kind of problems and just after that starting to do a research:{
Remember ! Every revision surgery will not be as good as it could original one .People please be careful i read this forum… Smart people learning by others mistakes …When it comes to your health… don’t learn by your own mistake. From the bottom of my heart ! -
quote Chaunce1234:Shouldice has a much longer track record of success compared to Desarda repair, which is relatively new. I am not sure if there have been enough long term studies on Desarda repair, but it certainly seems promising. There is always the Bassini and Mcvay repair as no-mesh options as well.
Ultimately you have to do what you’re comfortable with, and with a surgeon you trust.
It is increasingly difficult to find no-mesh hernia surgeons in the USA however, so you may need to travel.
I totally agree ..however i would consider Desarda first…with surgeon you can trust.
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quote John Fortem:I read an interesting article yesterday regarding chronic post operative inguinal pain (CPIP). You may want to read it.
https://www.degruyter.com/view/j/iss…-2017-0017.xml
Two of the predictors for chronic pain appear to be pre-operative and post-operative inguinal pain. Females also seem to be more predisposed to chronic pain. It contains a lot of interesting discussions about chronic pain. It was published in 2017, so it’s very recent, and it is a systematic overview.
The question of whether or not the use of a mesh can reduce the risk of chronic pain compared to suture repair is inconclusive.
“The use of mesh seems to reduce the risk of CPIP compared to suture repair. Many trials have investigated the question whether lightweight meshes (LWM) may reduce the risk of CPIP. The interpretation of these studies is difficult due to the large variety of mesh materials and mesh properties such as weight, pore size, tensile strength, weaving pattern, and elasticity.”
The conclusion states:
“The avoidance of chronic pain is a primary concern in inguinal hernia repair and may be considered the most important clinical outcome. This problem preceded modern mesh-based techniques; however, as recurrence rates have decreased, pain has become the more prevalent and important complication. Understanding the causative mechanisms and risk factors of inguinodynia help to prevent, diagnose, and treat this condition. Groin pain, especially in the absence of a bulge, often needs interdisciplinary diagnostics and no operation. Detailed diagnostics, meticulous operative technique with profound knowledge of the anatomy, proper nerve identification and handling, optimization of prosthetic materials, and careful fixation are of utmost importance. Further research on how to avoid CPIP and explore the effectiveness of treating it is necessary.”
This is interesting. Because when you read the statements of mesh promoters, they will all almost unanimously say that meshes have helped reduce recurrence rates down to practically zero. I agree with this author though that recurrence should not be the primary clinical outcome measure, while chronic pain should.
The author is Dr. Reinpold of Hernia Centre Hamburg-Wilhelmsburg. He does hernia surgeries both with and without the use meshes. You can read more about this doctor and the center here:
https://www.leading-medicine-guide.com/en/Specialist-Hernia-Surgery-Hamburg-Dr-Reinpold
Of course ..It is German Doctor.. The are the best!
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quote Jnomesh:Consider dr. William brown in San Fran. He also specializes in non mesh repairs. It is also possible it is a Seroma-which is swelling donto fluid collecting where the hernia once was. It’s is usually soft and can be similar in appearance to a hernia
Shouldice repair is very complex..recovery is difficult … Dr. Chen correct about overstretching …..better alternative
Desarda M. P. method …..dr. William brown in San Fran..worth to visit..he is expert in this kind of situations -
quote Chaunce1234:[USER=”2019″]drkang[/USER] Thanks again for the response, and I understand what you are saying. From a patients perspective, I can hope you present your method and results as I think you have a lot of value to add to the international surgical community and to future patients.
Chaunce1234 i do understand what you understand LOL
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Totally agree with everyone ..every revision surgery care more risk than original…i would go to one of very top doctors we recommend remove mesh ..fix everything old way..and never touch it again…my humble opinion only.
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quote John Fortem:I agree on the previous statement that “initial hernia repair and fixing a failed repair are two distinct specialties”.
I have read about several cases where the surgeon gladly repairs a hernia with a mesh, but when the patient presents with complications, the surgeon agrees that the mesh is the reason for the complications and that the mesh needs to be removed. But they don’t easily agree to attempt to remove the mesh themselves, and send the patient off to see another surgeon who specializes in mesh removals.
Depending on where you live in the world, you may have to travel to another state, country or even a different continent to have the mesh removed. Just because the original surgeon doesn’t dare to attempt to remove the mesh, because of the added risks with that procedure alone. But they are all scalpel-happy to have the mesh implanted without reason or questioning…
Great Business ..one inserted it…Second remove it ..You see every one has job! Well …Will you trust surgeon who created mess in the first place to undo it? I wouldn’t
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quote Good intentions:I just came across this video from 2011 and the first 1:30 minutes are very interesting. Business versus medicine. Device makers “selling” mesh. Doctors not allowed to talk publicly about specific products.
https://www.youtube.com/watch?v=yptGL14t298
Once business has invested time and money in to building a market, they will work very hard to keep it. The mesh market is a growing profitable market. North America is, apparently, the largest.
https://www.google.com/search?ei=9sOrW-nnHqu90PEP3p2zuAo&q=global+hernia+repair+market&oq=global+hernia+repair+market&gs_l=psy-ab.3..0i22i30.506108.519790..520867…0.0..1.150.7194.40j31……6….1..gws-wiz.CQc3CLrcf-8
https://www.marketsandmarkets.com/PressReleases/hernia-mesh-devices.asp
In 2018, North America is projected to account for the largest market share
The global hernia repair market is segmented into four major regions, namely, North America, Europe, the Asia Pacific, and the Rest of the World (RoW). In 2018, North America is estimated to account for the largest market for hernia mesh devices. The large share of North America in this market can be attributed to the strong demand for and adoption of hernia repair in the US, presence of a large pool of hernia patients, and an efficient and favorable healthcare system are supporting the growth of the hernia repair market in North America.
The major players in the hernia repair market profiled in this report are Covidien ( Part of Medtronic) (Ireland), Ethicon (Part of Johnson & Johnson) (US), B. Braun (Germany), C.R. Bard (Part of Becton Dickinson) (US), W. L. Gore (US), LifeCell (Part of Allergan) (Ireland), Maquet (Part of Getinge) (Sweden), Cook Medical (US), Integra (US), DIPROMED (Italy), FEG (Germany), Cousin Biotech (France), Herniamesh (Italy), Aspide Medical (France), TransEasy Medical (China), and Via Surgical (Israel).
WOW! Unbelievable !
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quote John Fortem:Should I require that I have my hernia surgery recorded on a video camera?
I will most likely be paying for my surgery straight out of my wallet. I might as well require that it has to be recorded. I can think of a few good benefits for me. One being documentation, for whatever reason. Two being hard evidence should I ever need to take the surgeon to court. Three, I don’t trust anyone, least of all a person I only heard or read about over the Internet and met for a 15 minute consultation. My life experience has taught me to not put too much trust in other people. If I could – which I obviously cannot – I would rather do the surgery myself. If you want something done right you better do it yourself. That has always been my motto. But not this time around…
Am I asking too much? What would it take for a surgeon in a private clinic to record the operation? Why do I feel like I have to bribe him to do this for me? Shouldn’t video recording be part of the procedure in 21 century?
JUST LOVE IT ! But possibly good luck with that ! Dr drtowfigh Would you allow it ? :}
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quote drtowfigh:I’m sorry to say that that statement is no longer true. The famous brains of Mayo have mostly retired.
In our experience, we treat and cure a lot of patients who have sought help at the Mayo and were unable to get the help they need. One patient even lived there for a month!
Their Hernia and Abdominal Wall expertise is not strong.
drtowfigh Thank you! Yes Agree !
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quote John Fortem:All valid arguments. But in Shouldice, they use a steel wire for suturing. Unless it’s a modified Shouldice technique with absorbable wire.
I didn’t hear about modified Shouldice technique with absorbable wire?
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I would truly fallow advice of 2 prior comments.
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Dr. Grischkan.Is a great choice !
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quote tenreasy:I’ll let one the doctors chime in, but urinary retention after surgery is a risk which is caused by the general anesthesia. Could happen in any surgery where you receive general anesthesia. Plus the fact that I am 57 yr old male with not the greatest prostate. It is a risk you will have to consider.
One thing I will say is that I am glad I had the procedure done locally so that my wife could help. Travelling by myself from Chicago to somewhere like Florida really did not sound appealing. If everything goes ok then fine; but still the thought of outpatient surgery and then going to a hotel to recuperate by myself did not seem attractive. Just my 2 cents.
Well, sometimes you can do it under local sedation.. .or prostate must be advised by doctor to be treated before surgery or used different type of general anesthesia or if doctor see that can happen with you ! ..Sorry it is not about you..It is about our medical system that is totally out of any common sense and control >>> Doctors use general methods like robots themselves … Philosophy is clear “ONE tool fits al” l without considering our special circumstances and after they get way with everything ..They are Breaking main low ..”.Don t harm!!!
If i conduct my business that way i would be out of business ..like a lot of You! ! . People come to me with problem pets from all over USA.. .Yes ! CANT fix every case…some of it driven by genetics or just too far gone :{ i am not Jesus or God .but i can make it better all the time …just the question is…to what degree ? That depends not just of me ..SO.. i let people straight FORWARDLY know about risk and limits, even if some CLIENTS have a hard time to hear it.. ..That is my principles!
I tell them what i can do for min result .. and ask if it is OK ? .and trying for max of course.
By contrast i remember when i meet doctor here in Newport beach ca ..He was telling me how mesh surgery is simple and easy..and side effect less then 1 PERCENT ..just was POLITE AND SMILING { Southerner California style;:}}} whole time….
After that HE TOLD ME THAT that pain possible can happen..HE HAS NO control ..no one know why pain CAN HAPPEN million reasons for that ….so he was preparing me ..so i will possibly have bad reaction or something unknown
Well I believe that the only one thing doctors must blame their own negligence and poor training. -
quote drtowfigh:It means different things to different people. The classic “darning” is using suture to recreate a hernia mesh effect. It is also possible that they just means suture repair.
thank you! i ENJOINING YOUR POSTS drtowfigh
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drtowfigh thank YOU! also professor Desarda WOULD LOVE TO COMMUNICATE WITH YOU personally and become contributor ! please feel free to e/mail him.. desarda@gmail.com> many great DOCTORS already DID!
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quote Good intentions:I hope you won’t be offended Dr. Towfigh, but your comment really affected me when I saw it. So I wrote this…
Hello Dr. Towfigh. I’m sure that you agree, as a doctor and a scientist, that the issue of chronic pain is not one of whether or not laparoscopic techniques are “better” than open techniques, but one of whether pure tissue repairs are better than the new mesh repairs, and/or whether there are certain mesh materials and methods that are the cause of the high levels of chronic pain.
As you know, to do good scientific work, and to make good decisions, good meaningful numbers are needed. Is a 10% chronic pain rate really better than a 15% chronic pain, for example, if a method exists that gives a 2% chronic pain rate? It seems that the commitment and investment in laparoscopic training, and/or open repair with mesh, is dominating the market and the discussion, leading people to compare which of two “bad” methods are best, instead of perfecting these new methods so that true claims of superiority can be made..
Defining things in terms of better or worse is just not going to produce true progress in stopping the growth of the chronic pain problem.
As someone who has been harmed by today’s “best” method of TEP implantation of lightweight mesh by a highly trained, experienced surgeon, and whose problems were found to derive solely from the mesh, no errors in technique, I feel obligated to make this point. No effort has been made by anyone involved in my situation, a perfectly healthy male in excellent shape, a perfect “candidate” for TEP mesh repair, to understand why this optimum method did not work. Chronic pain is, today, accepted as normal, with pain medication used as the solution to the problem.
If prospective patients keep getting assurances that these undefined materials and methods are “better” than others but without knowing the true risk, in usable numbers, then it will be impossible to improve the situation. People need to be aware that there is still significant risk of very debilitating chronic pain. Lucky46 is an example of how bad things can get.
Sorry to be so blunt but comforting words aren’t going to help anybody. They just perpetuate a bad situation.
Good luck tenreasy. I hope that your recovery goes well and that your long-term outcome is one of the good ones. I assume that my words in my previous post, #3, just sounded like the rant of a weak-willed person and you decided to go with what the surgeon told you would work? Can you give more details on the materials used and how it was placed? The possible combinations of materials and methods, using mesh, is really incredible, and adds to the lack of focus and progress. The situation cannot reasonably be described in simple terms of mesh, laparsoscopic or open, I think.
The problem is ..that no one cares about your pain.. Private medical system driven just by One think by Profit. …. they will convince us about everything and of course that risk of chronic pain is reality with any operation, regardless of technique…{.well to me it is hard to believe} … if person had no pain before and has pain after ..it means doctors didn’t do meticulous work { plan and execute} with greatest detail how headlining tissues and nerves and pick most safest techniques ..possibly not most profitable.. .. Everyone can have PAIN …..it is really sorry statement almost kind of excusing mistakes doctors makes that they will never admit,,,, of course :}
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quote drkang:If your hernia bullges eaily by cough or with a Valsalva on lying positon. yes it is very likely a direct type.
You are the BEST!
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quote tenreasy:I have lingua hernia on the left side. Noticed it about a 4 months ago as a bulge. My general doctor said I have a hernia and recommended that I do nothing. I am 6’1″, 57 yr old, 165 lbs. No other health issues. Good health. Recently it is bothering me if I walk for a long time. Gets bigger and some discomfort. Frequent gurgling sounds. Saw Dr. Mark Toyama in Chicago and he would do a laproscopic mesh repair using polypropelene material. I am freaked out by reading the horror stories of mesh complications. But it seems like all of the surgeons use mesh. Is it because of the new power of social media that the horror stories are distorting the actual success rate of mesh? I am confused. My other option seems like to see Dr. Tomas in Florida to do the Desarda technique.
I would Run to him or to one more great doctor i like a lot in Florida ..- Dr Jonathan Yunis in Sarasota, FL :}
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quote tenreasy:Except for the minor problem where I could not urinate after the surgery (it resolved the following day) everything went fine. . So far so good.
WOW!!!! How Humble we are to accept such treatment..where cure is worse the disease..NOT acceptable side effect ..i would not call it minor..it gives these doctors incentives to those doctors make excuses for everything.. Dr drkang Could that happend with you ..if you would do this surgery….Why this could happend .i would made the fur fly…!