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Auto immune disease and mesh rejection

Sandiego,

My inclination to your question is: YES!

We have no proof that patients with autoimmune disorders have a different reaction to mesh than others. However, in my experience, I have anecdotally noticed that patients with lupus, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome have had a prolonged and abnormally high inflammatory response (aka pain) to mesh implantation. Removal of the mesh has resolved their flare up.

I systematically do not place mesh in such patients. If they need mesh, I choose a Biologics tissue with low inflammatory potential (but higher risk for recurrence). There are also hybrid meshes coming to the market that have very little synthetic mesh.

I wish to have an opportunity to study this patient population. To date, no blood tests are abnormal among them to help predict this mesh reaction.

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Please Help!

This is great news.
If your pain improves with PT, that’s great.
If you feel that PT actually hurts, then see Dr Ramaswamy again as you may have an occult inguinal hernia.

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Chronic pain that will not go away

Dear TJ from Texas:

Some thoughts comments and questions for follow up:

– mesh can tear off its repair and it can also tear in half (though that is less common)

– nausea can be a sign of hernia occurrence

– it is certainly not expected that every single hernia repair you have be torn or tear off. We have to figure out why this happens so that it is not repeated with the next repair. So here are key questions to have answered prior to the next operation:
1. We’re all of these open style repairs (ie, a scar in the groin)? If so, did anyone talk to you about performing your repair laparoscopically? That is usually the go-to technique when open has failed.
2. What types of mesh were used and of what size? Do you know the surgical technique or the brand of the mesh used? These should either be noted in your operation report or elsewhere in your surgical chart. Lightweight mesh is more likely to fail than heavier weight mesh. Small size mesh is more likely to fail than larger size mesh (3×6 inches or larger).
3. What risk factors do you have which make you prone to hernia recurrence? Any of the following: constipation, chronic cough or asthma or bronchitis, nicotine use of any form, overweight or obese, family history of hernias, immune suppression or healing problems such as with use of steroids, collagen disorders, diabetes, other medical problems such as cirrhosis?

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is this hernia

Hmmmm.
Hernias don’t move. But intestines do. Perhaps you have a problem related to the intestines?
Have you had surgery before? Is there nausea or bloating associated with this? Any weight loss? Change in bowel movements?

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Are my symptoms from a hernia?

Is she better now?

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Are my symptoms from a hernia?

Did you figure out what was causing your pain?

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Need help in diagnosing hidden hernia

Hi there
Did you see Dr Brunt? We discussed your situation when Dr Brunt and I saw each other at a conference back in May.

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Chronic Hernia Pain – Where to turn now?

Hi
Were you able to get the care you needed? Please provide an update so we can all learn from your experience.
Thanks.

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Desperate for Diagnosis-Diaphragmatic Hernia-9 mo.

Hi
Have you had any change or improvement of your symptoms or new tests to figure out what is going on?
Read about para duodenal hernia and see if your symptoms are similar. Diaphragmatic hernia is likely not the cause of your symptoms. Is there nausea or vomiting involved? Have you had surgery before? Is there associated bloating?

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Lower abdominal tenderness

Infrequently, I have patients with pain that radiates from their groin up to and toward their belly button.

Is the pain still there? Did you find a cause for it?

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hernia specialist in New Hampshire

Hi there.
Did you end up having a hernia and a repair to follow?
Curious to know how you’re doing.

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Please Help!

Hi there.
Any update as to how you’re doing?

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Multiple Surgeries – SECOND OPINION

Hi there.
Any update regarding your situation.
An open exploration to confirm no hernia recurrence is not a bad idea. If there is fat in the canal or a recurrence, the open repair should fix it. If the mesh is bulging into the defect and mimicking hernia symptoms, then an open anterior approach can also address that problem. We see that more often in large build Patient’s or with large/wide hernia defects.
Lastly, there are thee causes for groin pain. This includes hip and back problems.

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Mesh Removal

Please call my office and let them know you reached out via HerniaTalk.

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Painful ejaculate post open hernia repair

Your surgery involves mesh placement and suturing onto the pelvis muscles. Strong contractions of any kind early after surgery, such as with orgasm or certain exercises, may cause pain and even stress the repair in rare cases. Also, the mesh is typically adjacent to or wrapped around the spermatic cord, which includes the vas deferens, which carries sperm from the testicle to the prostate. There are nerves along this. Any extra tension or pressure in this area, which includes orgasm, may be perceived as painful because the area of the cord is already swollen from the recent repair, as evidenced by the swollen scrotum.
Perhaps reduce any stressors on the repair until the area is less swollen, which can be gauged by the scrital and incisional swelling.

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Inguinal hernia recurrence

Definitely would use mesh for a recurrence. That is pretty much the gold standard.

When repairing a hernia in open fashion after a recurrence from a laparoscopic repair, you are basically performing an anterior repair after failure of a posterior repair. That is the standard approach and what is recommended for most patients. Therefore, an open anterior mesh repair should be chosen. Mesh repairs with the plug and patch or the Prolene Hernia System involve a posterior dissection as part of the anterior approach and that can be tricky. I would not recommend complicating the situation in that manner. A simple anterior onlay mesh repair (à la Lichtenstein technique) is probably your best and safest bet.

Once again, it is your surgeon’s discretion. A lot of the decision making is based on the type of recurrence, what is happening with the laparoscopic mesh, what your body habitus is and other risk factors.

Check the AHS website for surgeons skilled in revisional surgery in Arkansas and nearby. There are plenty that you can tap into I’m sure. http://Www.americanherniasociety.org. Tennessee is a great next door state for hernia specialists.

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Graves disease and Hernia connection?

There is no known direct relationship between Grave’s disease or other acquired hypothyroidism and hernia formation.

Patients with hypothyroidism may be constipated. Straining for constipation is a risk factor for developing hernias.

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Spigelian hernia?

Abdominal wall hernias and groin hernias can cause back pain. When they are fixed, the back pain can go away if it was due to the hernia.

A Spigelian hernia is a very specific type of hernia. Most general surgeons are knowledgeable about what it is, though they may not readily diagnose it as it is a rare type of hernia. At Kaiser in San Diego, seek consultation with Dr Jaclyn Parker. She is a general surgeon with excellent laparoscopic and hernia experience that trained with us prior to moving to San Diego.

Films, including MRIs, can be misread, especially for hernias. It is important to see all the images and in high definition in order correctly identify the findings you mention.

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Possible Hidden Hernia?

On the AHS website (www.americanherniasociety.org) you can just click on your state and a full list will show you member surgeons.

In San Francisco, Try Dr Hobart Harris. He is a senior surgeon and should be able to help diagnose and treat an obturator hernia. Let him know you were referred by HerniaTalk.com. I’m also happy to see you down in Los Angeles.

I have not seen reports of hernia after trans-obturator tape sling.

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Mesh Removal

Laparoscopically placed mesh can be removed off the transversus abdominis. Some muscle will be injured as part of the removal, as the muscle has grown into the mesh. Surgeon technique and surgical technique can help reduce the injury. It is usually not a major problem. There is minimal muscle tissue that is removed with the mesh and it typically does not affect abdominal wall strength.

I recommend that laparoscopically-placed mesh be removed laparoscopically. To do so via an open laparotomy, in my opinion, is causing too much extra damage and instability to the abdominal wall, cutting through the abdomen full thickness to get to the mesh. The recovery is also much longer. That said, there are not that many surgeons who routinely perform mesh removal laparoscopically. Mesh removal itself has risks of vessel (external iliac artery/vein), bladder, spermatic cord, and nerve (genitofemoral or lateral femorocutaneous) injury regardless of technique.

I have switched to performing all of these with robotic assistance, and have found the results to be much better, with less injury.