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quote UhOh!:

Does this have to do with the laparoscopic technique in and of itself, and how such meshes are implanted/affixed, or the fact that the mesh is placed inside the abdominal wall, as opposed to outside of it?

We didn’t see a correlation with type of mesh or type of mesh placement or operative technique.

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We don’t have science yet to back up what I recommend. But BMI 22 is normal and I would not typically consider that a relative contraindication to mesh. Even with low fat percentage.

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Massaging may help reduce this faster and encourage your body to reabsorb any swelling and blood.

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The bulging ridge along the groin incision is referred to as a “healing ridge.” Everyone gets it after an open inguinal hernia repair.

The bruising you describe is unfortunate but can happen in some. It goes away.

It also sounds you have maybe some bleeding into your scrotum. That can happen. It takes much longer to resolve and can be very uncomfortable.

Loss of testicle blood flow is uncommon and likely is not the situation with you.

These are historically all known risks with open repair and some of some of the reasons we have moved to mesh repair with less tension and laparoscopic repair without tension.

No repair is perfect.

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The outcomes from robotic non-mesh inguinal hernia repair are likely not as good as mesh repair or open non-mesh repair. It’s a decision and compromise we make when placing mesh is considered not a good idea at the time. Everything is a balance of risks and benefits. And there are risks with each surgical option. So sometimes the better decision is mesh repair or hybrid mesh repair and not tissue repair.

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It’s considered a tension repair. As far as we know the outcomes are likely to be similar or worse than open repair, but that’s just a hunch. We are studying this next year in a clinical trial. Awaiting funding.

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[USER=”2608″]dog[/USER] it wasn’t possible technically possible before synthetic mesh so most lived with their hernias, no matter how disabling, and could not be offered a repair. People were maimed by other techniques and complications of open tissue hernia repair. Use of the darning technique caused fistula and erosions and chronically draining wounds. Surgeons were harvesting fascia from the thigh to treat abdominal wall hernias. This worked about half the time for the hernia, and the fascia harvesting left a disabling set of complications to the leg, including nerve injury. Deformity was more common. Testicle loss was more common. Scars were enormous.

It wasn’t a rosey picture before mesh.

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We’ve had good results from it for small hernias in low risk patients. We are now studying it in more typical inguinal hernias.

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[USER=”2721″]paco[/USER] great idea. Now have to make it so it’s cost effective. After breast surgery, hernia surgery is the poorest reimbursed field in general surgery.

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If your pain is 3 yrs after the hernia repair, chances are it’s not a nerve issue. May be a hernia recurrence or an abdominal strain. The other questions are best answered by your pain doctor who is doing the injections.

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Thanks for the message. I like to deal with issues scientifically and with an open mind.

I do not support abstinence from mesh repair at this time. That’s technically not possible. We do need better technology and some companies have a mission to develop them.

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Yes. I wrote a Chapter in our book that specifically addresses autoimmune diseases and mesh use.

The book is the SAGES Manual of Groin Pain. You can click on its link on our homepage to buy online.

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It’s been a busy month or so…

Correct, this paper was not intended to be paper about postoperative outcomes, rather of preoperative workup and indications for mesh removal. One goal was to share our experience with the relative incidences of the various indications for mesh removal, with insight into whether specific types of repairs, mesh, techniques, or other clinical factors stand out among them. Also, in doing so, we were shocked to see a trend toward more patients requiring mesh removal after laparoscopic repairs and also more patients showing up with systemic mesh reactions.

We will followup wirh an outcomes paper soon.

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Trying my best to educate. Thanks for sharing.

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Thank you! Comes with a cool video.

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First you need a diagnosis. Sounds like your workup hasn’t been complete yet. Find a hernia specialist you can trust and go through figuring out if it’s the repair, the nerve, inflammation, infection, or the mesh.

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Can be. A block of the nerve may help prove that theory. If the pain goes away with a nerve block then the nerve is typically the culprit.

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I know some of the surgeons there, but sorry, not Dr Nishida.

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Sorry I can’t help you there. Paucity of surgeons in Hawaii.

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Keep doing it!