DrEarle
Forum Replies Created
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Agree with the statement all hernia repairs have a risk of chronic pain. The risk is very low, but that will not predict the outcome for an individual.
Without complications, there are no specific limitations of activity after hernia repair.Hope this helps!
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I agree with everything Dr. Szotek said. I used to be a Medical Officer for the FDA working in the group that regulates robotic assisted surgical devices.and my opinion is there are two ways to look at surgical approaches – minimally invasive or not. For example, sometimes it a less invasive to use a traditional open technique, like when repairing a small belly button hernia. The robotic device company d only a tool that helps us provide a minimally invasive technique when it might not otherwise be possible. Mesh removal after laparoscopic groin hernia repair is one of those operations that the robotic device can be very helpful for the surgeon, but make no mistake, there is nothing magic about the tool. Remember each case is unique.
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The problem with anonymous surveys is there is no connection to what the patient had done. There are also rules about this with regards to human subjects research. there are also rules however with regards to quality improvement, which are generally exempt from HIPAA, but because of a general misunderstanding of this, rarely used if even possible. A single/integrated medical record is the answer to accurate outcomes data for hernia repair, and indeed all of health care. “Medicare for all” is doomed to fail. Current payment system doesn’t have accurate outcomes data.
Not sure what Rand Paul is worried about. Seems like there is some sort of agenda there. I don’t know what, but something doesn’t quite add up.
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Damien – The cavernous nerves are not anatomically related to your hernia repair and mesh placement. Further, if the hernia repair was 9 years ago, and you have been fine the entire time, it seems less likely for the repair to tbe the culprit, even if some scar tissue was torn/stretched. Therefore, it is not logical the two could be related. Having said that, the human body is quite complex, and there is no good test to see pain. The groin is complex, with lots of muscles from the abdomen and leg attaching to the pelvis in that location. Further, there could have been a torn tendon or aponeurosis (like a tendon, but a large flat one that covers the surface of the muscle) as the cause of the pain, and with constant use during normal activity, these can be notoriously slow to heal, and even require operative exploration for diagnosis. I have seen this once during a reoperation for groin pain after open hernia repair, and repairing the torn aponeurosis mostly resolved the pain, but not completely. Finally, erectile dysfunction (ED) also has multiple causes. If that is the main concern currently, I would suggest seeing a urologist who specializes in ED, and looking for more common causes of this. Since we’re in this forum, my opinion would be that mesh removal would have a low probability of solving the ED problem. The chances aren’t zero however, but I would look in to more common causes first. Hope this helps! DE
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Jeremy B – Thanks for the posts and update. Glad you are feeling better. Your concern about a recurrence once the sutures absorb is reasonable, but there’s nothing to do about it. Absorbable sutures do not equal certain recurrence however. It’s usually best to continue on with your life, and worry about it only if a problem arises. Best – DE
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Actually, even getting data from billing databases using ICD and CPT codes is very difficult. And it’s impossible to get good data. A single.integrated medical record would allow us to get good, real world data. I respectfully disagree with the notion that medical device manufacturers dictate surgical procedures. That is generally the last thing in a surgeon’s mind when seeing a patient. And mesh choices are often dictated by hospital administrators, without, and even ignoring surgeon input. I have seen this first hand. Finally, the sutures are made out of material very similar to mesh, and I have seen plenty long term problems from suture repair in my career. Not as many as mesh, but that’s because the numbers for suture repair are lower. If 90% of groin hernias were repaired with permanent sutures, we would certainly see more problems from this. Some technique related, some anatomic related, some infection related, some related to foreign body reaction to the suture material, and some related to recurrence. And that is exactly why we need long term outcome data. By the way, I know a surgeon that had their inguinal hernia repaired at Shouldice, and ultimately had a good long term outcome, but the experience there was terrible, and there has never been a follow-up survey or contact of any kind from Shouldice. I am not advocating for or against Shouldice Clinic, but anyone claiming near perfection simply is not telling the truth. From their website: “Our 99% lifetime success rate for repairing primary inguinal hernias sets the gold standard.” This type of statement is no better than a mesh company saying the same thing about mesh repair. Nobody is perfect, but we could all be honest.
By the way, this is a very good discussion, and I appreciate you all taking the time to respond.
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Good intentions – Excellent comment regarding outcomes data. You stated there are “few metrics, despite close to one million surgeries per year”. Hernia repair, like health care in general, is complex. Not complicated, but complex. Therefore, by definition we cannot control it, but we can manage it. But we can only manage it if we have real world feedback (data) from the output of the system, in this case hernia repair outcomes. Only then can we get some really smart people to analyze the data, and gradually improve our application of hernia repair methods to those most likely to benefit. This can be accomplished. However, we need a single medical record (not single payer) to do it. The PPACA required electronic records, but inadvertently created a multi-billion dollar industry who’s own interests are well above those of the public. Not only would this allow continuous practice improvement, it would allow the type of post-market surveillance of hernia mesh (along with all other devices and drugs) we so desperately need.
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Michael – Any update on your condition? Best – DE
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There’s always more than one side of a story. Here’s an interesting perspective of the Shouldice Clinic from a Canadian Surgeon.
“this blog comes from my own professional opinion as a general surgeon/hernia fixer and defender of evidence based medicine and socialized healthcare, discussions with many patients who have gone or are considering going to the Shouldice clinic, going to a talk some years back given by a surgeon who worked there, and the Shouldice clinic website.”
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4 years of hip/groin pain. Help!
Thanks for the update, and best of luck.
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Chronic Pain After Inguinal Hernia Repair (Boston)
Michael – I am transitioning in to private practice, and currently doing some locum tenens work (temp work) in MA. My current office number is 978 630-6130 (Heywood Hospital in Gardner, MA), and my number starting in October will be 978 452-5050 (Lowell Surgical Associates). Sounds like you may need your mesh removed. As has been said on this thread, there are potential problems with this, but it may be the lesser of two evils. There are options for hernia repair in the future as well if that is needed. While no surgeon can predict the future, I can definitely tell you that I will listen to you, not dismiss your complaints, try my best, and keep your interest in mind as the focal point. I’m confident we can come up with a plan. All the Best – David Earle
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Finding no-mesh inguinal hernia surgeons on west coast?
I am not aware of any good data to suggest there is even an increased risk of a problem, let alone a given subtype of disease. None of the polymers used evoke an immune response, but all evoke a foreign body response of variable, and unpredictable intensity. Some of the coated mesh products however can have contents in the coating that could cause an immune response in rare circumstances.
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4 years of hip/groin pain. Help!
In San Diego, I would suggest Garth Jacobsen or Santiago Horgan at UCSD.
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Umbilical hernia question
Can you expand on your opinion that there is an increased risk of mesh related pain during pregnancy? This is not something I have seen. In fact, I have seen pregnant women with pain from their umbilical hernia, but never from mesh. I have a couple women that have had more than one pregnancy after mesh repair of umbilical hernia without problems. Have you had negative experiences with this?
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4 weeks post op inguinal hernia surgery
Ah yes. The infamous autocorrect. Yes, intended to say “reoperating”. Agree that Belyansky is a good choice. Pain in your feet could be a spinal problem. Sciatica? Best of luck. DE
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4 weeks post op inguinal hernia surgery
Brad – While I agree with Dr. Goldstein’s points, something is definitely wrong here. You are not following the anticipated, or typical course after an inguinal hernia repair. Having said that, conservative, non-operative treatment is likely the most appropriate thing to do. Reiterating at 3 weeks would be very difficult, and possibly dangerous. Given all that, you are more likely than not to resolve your pain without further operation. May need to give it 6-12 weeks. Do you know what type repair you had? Open vs lap. Mesh vs no mesh. What type of mesh?
Hope this helps! -
Need guidance
I agree with Dr. Goldstein. Keep in mind, the watchful waiting data we have applies only to men. We don’t know if it is the same for women, and many surgeons consider women to be at higher risk of needing emergency surgery comparatively. The overall risk is still probably in favor of not requiring emergency surgery, but it’s just an educated guess. Let your symptoms guide you, and go with your gut. Pun intended. Hope this helps!
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Physiomesh Recall… Should I be concerned?
Simpson – Why are you concerned about this mesh? This could help me answer your question. DE
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Weight training with *possible* inguinal hernia
I have no idea how to answer that. Listen to your body, and use common sense. While you may not know the medical terminology, most people know if something is seriously wrong.
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Weight training with *possible* inguinal hernia
I am saying that coughing probably puts more strain than weight lifting. If it hurts the groin, don’t do it. If it doesn’t, go ahead. Very unlikely to do “more damage” following that rule of thumb. DE