drtowfigh
Forum Replies Created
-
Most patients who have symptoms 1+ years after an otherwise fine hernia repair or recovery have a hernia recurrence as the cause of their symptoms. The next step is accurate imaging to identify the hernia repair and look for recurrences.
If you saw me, I would order an MRI. Every surgeon handles this differently.
Most mesh-related chronic problems start within days to months after surgery and not 1-½ years later. Perhaps this is helpful.
-
I just read the Opinion piece by Dr. Ramshaw. From a surgeon’s perspective, I can totally relate.
Like Dr. Ramshaw, I left the volume-based practice that is imposed on so many of us who are (used to be) employed by an Institution. I used to be the busiest general surgeon faculty in my hospital, and I was being pushed each year to do more and more operations. I had to meet a minimum number of work units; that goal number was random and kept increasing over time. Meanwhile, similar to Dr. Ramshaw, because of my expertise in the field, I was attracting more and more complicated patients that required more of my time and skill.
The current US medical system is not made to meet the needs of complex patients. I left the volume-based system that Dr. Ramshaw describes. Now, as my own boss, I determine how much time I provide to each of my patients and how many operations I perform each day. I focus on quality, not quantity. I do not have a minimum number of work units I must meet each year. No one is punishing me for spending too much time with my patients. I am happier, and I am able to meet the needs of my patients.
Dr. Ramshaw has taken a different route in order to address the burnout that many of us surgeons experience. I know his story and why he has (for now) left clinical practice. The hernia specialty community can be challenging. Patients are in pain, some are suicidal, and they are seeking our help while armed with a lot of preconceived notions and ideas about what they believe is the solution to their problems and needs. Dr. Ramshaw has chosen to use his time and experience to help improve the system. He should not be disparaged for that.
I love what I do, and being my own boss has significantly reduced the burnout. Meanwhile, as have other hernia specialists, I have had death threats, personal attacks and harasssments by phone, email, and on social media. Some surgeons have required police or security involved or have changed jobs and locations to flee potential life-threatening actions.
As a direct result of these attacks and the stress of providing to complex patients with chronic pain (which most surgeons are not exposed to) in addition to the baseline stress of operating on patients and dealing with potential complications (which most surgeons are exposed to), we are losing many talented hernia specialists and at the end, less of us will remain to treat hernia-related complications.
-
We do know that the recurrence rate is higher after tissue repair if using absorbable suture vs non-absorbable suture. All tissue repairs were originally described with non-absorbable suture. If you wish to have a tissue-based hernia repair with absorbable suture, then the higher recurrence risk is the reality of it. And note that once you start recurring from tissue-based repairs, mesh-based repairs become the next reality.
-
Thanks to all who joined in on HerniaTalk LIVE. The Q&A tackled all issues related to obesity and hernias. If you missed it, watch and share via this link: https://youtu.be/rTCDKsxkfgo
-
Depends on what was done. If no reconstruction made of the vas deferens, then can be active, including masturbation and sex immediately or within days.
Each surgeon has their own recommendations.
-
Depends on what was done. If no reconstruction made of the vas deferens, then can be active, including masturbation and sex immediately or within days.
Each surgeon has their own recommendations.
-
We had an amazing hour on HerniaTalk LIVE tonight, tackling the problem of Male Fertility and Hernia Surgery with our Guest Panelist Dr. Justin Houman, urologist and specialist in Male Fertility and Sexual Health.
If you missed it, you can watch and share from my YouTube channel here:
https://youtu.be/2Utj3xXmuxo -
The saying that mesh should be removed in the way it was put in is a simplification of the recommendation and mostly pertains to inguinal mesh. The type of removal is based on many factors. Sounds like, in your situation, the mesh was placed via open incision, but it was found/placed in the intraperitoneal or extraperitoneal space. In that case, a laparoscopic or robotic approach is perfectly fine and in many ways preferred.
As for the # of trocar sites, for robotic, we use 3, sometimes 4 arms of the robot. You will have to trust your surgeon that the choice of number of trocars was a decision made to best serve your needs.
Lastly, as you are learning in medical school (and congratulations!), history is very important in revisional cases. The patient’s history is very important to help determine what exactly is causing their symptoms. Just because you have mesh in doesn’t mean the mesh is cause of your symptoms. There are a wide range of reasons for abdominal pain after your type of repair. It depends on the size of your hernia, the use of sutures or tacks, what the preoperative symptoms were, your own past medical history, and surgical technique.
I recommend you wait a bit. 6 weeks after mesh removal is too early to react. Also, how was your umbilical hernia repaired after the mesh removal? There is healing from that as well.
-
This far out, I would look into recurrence as a possibility. Why was pig (biologic) mesh used? The recurrence rate with biologic mesh is higher than all other mesh types. Alternatively, some pig biologic mesh do stiffen up and get encapsulated.
The next step is usually a CT scan to evaluate the repair.
-
Great!
-
Laparoscopically placed mesh is best removed via lap/robotic method. I strongly advise against considering an open option.
The mesh is always stuck to the epigastric vessels and also in some way stuck to or close to the external iliac vein. Dealing with that is part of the skill of removal.
I recommend seeking consultation with surgeons like us who routinely remove these mesh, understanding the risks of the procedure.
-
– no downsides to taking the supplements around the time of surgery
– I do recommend bromelain and other anti inflammatory supplements to my patients
– zinc, vitamin c have already been shown to augment wound healing. No study has been shown they clinically improve outcomes from hernia repair, ie, hernia recurrence. And this study also doesn’t show much. It only shows one of the 3 collagen markers changed. It has no clinical significance. -
Thanks for sharing your recovery experience, @ajm222. Dr Belyansky is a skilled surgeon. Your experience is what most patients should be experiencing from lap/robotic mesh removal: surgical pain that improves over time, yet resolution of preoperative symptoms.
Just know that though you had built scar tissue from the repair, and that is likely why Your surgeon did not see any hernia after the mesh was removed and thus a re-repair was not necessary. However, this scar tissue may not be adequate for longterm prevention of another hernia. If you have new groin symptoms in the future, you should be evaluated for a hernia recurrence.
-
@chronicpain
Lucas S,
There is no need to travel. There are wonderful surgeon options in Germany: Muschaweck, Conze, Koch.For mesh removal during a Lichtenstein, selective neurectomy may be necessary, as the process of mesh removal itself may cause nerve injury.
I’m not an advocate of laparoscopic triple neurectomy. As @momof4 mentioned, it can denervate the abdominal wall, resulting in potentially irreversible asymmetric bulging.
-
– it’s very possible you have mesh remaining. I commonly see situations where patients were told their mesh was removed and yet there is mesh still left behind
– many of your symptoms are neuropathic (from the nerves). That includes the liquid feeling. Nerve blocks may help address those. -
Great discussion, everyone.
With regard to the rIPT (robotic iliopubic tract) repair, I only recommend it for normal weight (BMI) patients with small inguinal hernias.
-
So many questions! We got through most of them for you. However, we ran out of time again. I hope to return to answer a lot of your questions every couple of months or so. I know how much it means to you all!
If you missed tonight’s HerniaTalk LIVE Q&A, you can watch, like, and share it here: https://youtu.be/LBZGJr_UNKE
-
Thanks to all who participated tonight. We had great questions posed about laparoscopic and robotic surgery pros and cons and options for various hernia repairs.
If you missed it, you can watch and share the whole hour here: https://youtu.be/I28UYkaH9Ao
-
as far as we know, there is no way to modify your collagen status in the groin.
-
The fact that you have a hernia implies there is a lack of mature strong collagen. It’s not a visual or tactile thing.