drtowfigh
Forum Replies Created
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The reality is we don’t know the real truth about anything. We know what’s been reported in peer reviewed literature from various population studies. Their results may or may not apply to an individual patient.
Most of us believe that lightweight mesh has less overall foreign body, and therefore less inflammation, and so it should result in less mesh-related pain. One major study disproved that. In fact there was more pain with lightweight mesh. Not sure why.
The (Parietex) ProGrip anatomical mesh is an excellent choice and in our experience has had the least amount of mesh-related complications.
Similarly: thin patients. I feel that thin patients, especially women, do worse than normal weight or obese patients. Your BMI is 23. That’s normal and not really ”thin.” So I would not necessarily be that worried about you falling into the category at risk for mesh-related reaction.
Again, we are dealing with likelihood’s and odds. We cannot predict the situation for each individual patient. Yet
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There are a limited number of reasons why you would have pain after laparoscopic surgery. It’s often easier to figure out than the open procedure, as there are less nerves there and the mesh is often not sewn in.
Please return to see your surgeon. A good examination and maybe imaging will help figure this out.
[USER=”1916″]Chaunce1234[/USER] of course is always right on in what is posted
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If you’ve had so many adhesion problems, it seems your body may be more active than average in making adhesions. So, you should consider looking into that again. It’s a cycle that keeps repeating itself often. There are anti adhesion barriers which can be used. Not sure if your surgeon has done so before.
it’s uncommon to have mesh-related problems that occur 1.5 years later. Usually troubles begin early—within the same year. So, I would look into other problems, such as hernia recurrence. A specialist in hernias can do the full workup for you.
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[USER=”1218″]Beenthere[/USER] just to clarify: the AHSQC is a quality collaborative. It’s sole purpose is to help surgeons gather their outcomes data from hernia surgery. Let’s encourage that more surgeons sign up to use this service.
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We don’t know enough about systemic reactions seen as a reaction to mesh implantations. What we do know is
a) it’s rare and
b) no blood test has been shown to be diagnostic or consistently shown to be suggestive of such a syndrome. -
[USER=”2707″]fidel18[/USER] if you have an insurance with a limited network, the law is that they must cover medically necessary care for you. If they cannot provide that care by surgeons within your network, then the insurance must approve coverage for care to be provided by a surgeon outside your network. The surgeon must also agree to accept that referral.
Indications for non-mesh tissue repair includes allergy to the mesh product itself, risk of reaction or chronic pain if mesh is implanted (Eg, very thin, autoimmune disorder, fibromyalgia, chronic pain, CVID, mast cell reaction syndrome).
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There is a lot written about how to prevent hernia-related problems. Try the Search option in the drop down menu here and look for key words such as “prevention.”
in short, activities such as exercise are protective. Things to prevent include smoking, weight gain, chronic cough, constipation.
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The spermatic cord itself does not expand.
As with almost all tissue in the body, except bone and ligament, there is a stretch capacity.
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Thanks for your insightful question.
The hernia sac has has no structural integrity to it. It stretches, hence the increase in hernia size with time. It is anti-adhesive in its property. So it doesn’t immediately attach itself to anything. Because it’s not inflammatory or adhesive, it can cause fluid collections. The paper reports fluid seeping out of wounds in 5%, so perhaps that is why.
We prefer not to cut out the hernia sac as part of the hernia repair. First, it’s unnecessary most of the time. There is some thought that cutting the peritoneum (Hernia sac) can contribute to the acute hernia pain.
Just to clarify, the cited paper shows a typical tissue repair with onlay of peritoneum. It is not using the peritoneum as any support or patch.
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This requires examination by your surgeon. It may or may not be a recurrence. Most likely it’s not.
Curiously: why did you have it done open and not laparoscopic?
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Thanks for your post.
Please use the Search option on this site (drop down side menu) to seek out recommendations in ”Boston.” I recommend you consider traveling to see Dr Brian Jacob in NY, Dr Gina Adrales in Baltimore or Dr SHARON Bachman in Virginia.
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Dr Guarnieri’s technique is among many tissue repair options. It hasn’t caught on in US. Some in Europe use it. It’s mostly historic. There are no major advantages between that and the others.
Dr Nicolo is retired. As far as I’m aware, his role is mostly historic and as a translator.
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responded on separate post.
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There are various possible reasons for a bulging mass in the groin when standing, and one that resolves eventually when lying flat. Your surgeon should be able to figure it out for you:
– communicating hydrocele
– varicocele
– recurrence -
[USER=”2662″]John Fortem[/USER] There is nothing nefarious here. The talks preceding the panel discussion are posted separately. It is the only meeting that openly posts all the surgical talks after their meeting for all non-members to view as well. Follow them on YouTube if you are interested. https://www.youtube.com/channel/UCV1x1G84AHRBOO4ysqa8Y8Q
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It’s very good to do research on these topics. We have a very large number of non-physician contributors on this site who do an excellent job at commenting and educating those that post here.
I am here to help provide some clinical relevance to the discussions.
– The Bleeding Edge discussed the higher risk of suture failure when sewing the vaginal cuff robotically than with open/laparoscopically with the robot. This was a learning-curve issue for the surgeons and not related to the robot itself.
– It is a very extreme comment to make that “there are an enormous number of deaths that have not been reported.” Deaths are tracked at all levels of medical and surgical care and analyzed from all different aspects. In surgery, we have mandatory meetings weekly to discuss complications and death, called “Morbidity and Mortality conference.”
– It is unfair to assume anything that we use in life is a perfect product. Cars are not perfect. Surgical instruments are not perfect. The goal is to constantly improve with the goal of improving outcomes. The patents you mentioned are looking at improving the current graspers to allow varying strengths of grip within one grasper, as opposed to the current situation where there are various graspers, each with its own grip strength. The product is supposed to be be out this month or next month for surgeons to use.
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Happy to help if you wish to see me.
Briefly:
– open mesh plug repairs are best removed via open technique.
– you have to double check to make sure your pain is from the plug itself and/or mesh and/or nerve. Once the diagnosis of the cause of your pain is pinned down, then the appropriate approach and options can be discussed. -
[USER=”2662″]John Fortem[/USER] In general, we recommend no manipulation of the nerves at all during hernia surgery, unless there is an obvious entrapment or scarring or involvement with the hernia.
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Sometimes it is worth traveling for the right operation.
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Inflammatiion should resolve in the first 6 weeks for most patients. If there are situations, such as an underlying inflammatory or autoimmune disorder, this may be prolonged.