Forum Replies Created

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  • drtowfigh

    Moderator
    November 30, 2019 at 6:38 am in reply to: Need advise – infected hernia mesh with hernia recurrence

    Sorry to hear your problems.
    1. not clear why you had biologic mesh (porcine bladder) used for your hernia repair. Biologic mesh absorbs and do the hernia can recur. It is not considered standard for hernia repairs.
    2. Sounds like the biologic mesh failed. It balled up. You had a lot of seromas which is common with biologic mesh. That’s why drains are used.
    3. with a mesh infection, all of the implant must be removed in it’s entirety, especially when balled up.

    I agree with 2nd opinion. And you definitely need mesh. But not pure biologic mesh. I would use a hybrid mesh such as Ovitex Permanent or a lightweight synthetic mesh if it can be placed under muscle to reduce risk of mesh infection

    – what was the Swiss cheese hernia from in the first place? Ie, what prior surgery caused it?

    – what bacteria grew from the infection?

  • drtowfigh

    Moderator
    November 26, 2019 at 1:40 am in reply to: Incisional Hernia – post wound infection from an open appendectomy

    Good question. Very hard to know. Online reviews are not necessarily accurate for surgeons. Other healthcare providers may have some insight if they work with them. This forum is also very reliable.

  • drtowfigh

    Moderator
    November 25, 2019 at 10:43 pm in reply to: Incisional Hernia – post wound infection from an open appendectomy

    The type of repair is best chosen based on the size and location of the hernia, your own risk factors, and the skills of the surgeon.

    There is no one best repair.

    Pick a surgeon who can do all options and go through pros and cons of each.

  • drtowfigh

    Moderator
    November 25, 2019 at 10:33 pm in reply to: Post Hernia Repair Nerve Pain

    Done thanks

  • drtowfigh

    Moderator
    November 9, 2019 at 7:42 pm in reply to: Types of mesh and their manufacturers

    [USER=”2029″]Good intentions[/USER] thanks for all the informative posts. Very nicely done. You make this a better forum because of your participation.

  • drtowfigh

    Moderator
    November 9, 2019 at 6:47 pm in reply to: Umbilical hernia post-op questions.

    A little tugging at the repair, especially within the first year, may be normal. If it’s not affecting your ability to perform normal daily activities, then usually not necessary to worry. If any more concerns. I would seek an examination by your surgeon.

  • Allow me to provide some background and context to this.

    The surgeon being interviewed is well known and respected for her hernia research, which is mostly based on population databases. She is a resident in training. She’s reporting on what data was presented based on her population based research. As you know, the Danish and Swedish hernia databases provide us with robust and longterm patient data that we really don’t have anywhere else.

    Note that these databases are government based and objective. They are not influenced by industry or company sponsors.

    Most data show superiority in outcome for umbilical hernias when mesh is used, no matter the size of the umbilical hernia. It also shows laparoscopic to provide better outcomes than open, again regardless of the size of the hernia. Outcomes are mostly based on her i recurrence, but also include pain and infection risks , etc.

    But that’s not the full story. My belief and that of some others is that we are overusing mesh. That is, the benefit of mesh placement is not as high for smaller umbilical hernias. It is more beneficial for larger hernias.

    My analogy to this is driving a car (aka using mesh) Vs walking (aka nonmesh repair). Driving somewhere will always be faster than walking there. But there are risks with Driving (Ie, mesh), such as pollution, car accident, cost of gas. And when needing to visit a neighbor a few houses away (Ie, small umbilical hernia), the Lee really is no need to drive there. Walking (Ie, non mesh repair) is just as good and without the risks of driving, though driving will still be faster to get to your destination.

    [USER=”2580″]DrBrown[/USER] I agree with him because we need to add some logic in interpreting the data. This is one of the problems of database research. It doesn’t account for tailoring to the needs of the individual patient.

    Again with the driving analogy: for some people (eg, broken leg, wheelchair-bound) (Ie, patient with high risk factors for recurrence, such as smoker, obese, chronic cough), perhaps the drive for 1 block away (ie, small umbilical hernia) is still better than walking (ie suture only repair).

  • drtowfigh

    Moderator
    October 25, 2019 at 1:58 pm in reply to: small subcentimeter bilateral inguinal lymph nodes in MRI

    – the lymph nodes are normal and not part of the problem. No need to operate on those
    – MRIs are often misreported for hernias so I read my own in addition to the radiologic report. Ie, just because the report said you don’t have a hernia doesn’t necessarily mean you don’t.
    -Any core exercise is perfectly safe.

  • drtowfigh

    Moderator
    October 21, 2019 at 3:01 am in reply to: No mesh

    Dr Koch is an excellent surgeon.
    you can search this site for posts about him.

  • drtowfigh

    Moderator
    October 21, 2019 at 2:53 am in reply to: When Surgery Is Dangerous

    So did you have hernia repairs already and they recurred?

    in my patients with mast cell activation, i offer tissue repair or use of hybrid mesh by TelaBio.

  • drtowfigh

    Moderator
    October 21, 2019 at 2:50 am in reply to: Post Hernia Repair Nerve Pain

    Agree with Dr Brown.
    no need to wait to get the nerve blocks.
    do not contemplate any surgical intervention for at least 3 months

  • drtowfigh

    Moderator
    October 21, 2019 at 2:46 am in reply to: In-Depth Sports Hernia Guide [Infographic]

    [USER=”2817″]columb.if[/USER] not sure i would repair both if wish a non-mesh repair. Determine which is the cause of pain and focus on that.

    foe example: Any tissue hernia repair will add tension to external oblique tear repair and make that fail.

  • drtowfigh

    Moderator
    October 21, 2019 at 2:44 am in reply to: post neurectomies

    I suspect that the open approach to the laparoscopic mesh repair may have disrupted the mesh repair.

  • drtowfigh

    Moderator
    October 21, 2019 at 2:40 am in reply to: Mesh migration question

    Not possible.

  • drtowfigh

    Moderator
    October 21, 2019 at 2:40 am in reply to: Genital position long after surgery

    Scar tissue from the hernia repair can cause a rise in the level of the testicle. Mesh removal is not necessary not recommended. In extreme situations (yours does not sound like one), release of the scar tissue can help lower the testicle to a more normal position.

    Penile positioning should not be related to any hernia repair.

  • drtowfigh

    Moderator
    October 17, 2019 at 3:06 pm in reply to: My IH Repair by Dr. Kang

    [USER=”2804″]pinto[/USER] I can see your incision attachment.

  • drtowfigh

    Moderator
    October 12, 2019 at 5:03 pm in reply to: How to instruct the radiologist to look for occult hernia in the MRI?

    1.5 T is fine for most people.

  • drtowfigh

    Moderator
    October 9, 2019 at 4:05 pm in reply to: My IH Repair by Dr. Kang

    [USER=”2804″]pinto[/USER] message me regarding any issues re posts and posting pic. I will try to repair.

  • drtowfigh

    Moderator
    October 7, 2019 at 5:37 pm in reply to: How to instruct the radiologist to look for occult hernia in the MRI?

    As far as I know, Beverly Tower Wilshire does not have our protocol. You can share it with them. Beverly Hills Imaging does have our protocol, just a few streets away. As does Mink and Cedars-Sinai.

    See our protocol, attached, and you can show it to them to see if they will follow it.

    #MRI #MRIProtocol


    Attachments:

  • drtowfigh

    Moderator
    October 6, 2019 at 9:27 pm in reply to: Incisional hernia

    A small incisional hernia should not be giving you any nausea or distressing urinary symptoms. Hard to know your specific situation.

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