[David M]

I continue to be amazed at the open-minded ness and thoroughness with which Watchful approaches his post surgery and the sharing of his journey.

[David M]

Ajm, your description of how the internal mesh felt is very cautionary. It does make sense to me that you would feel this tightness, as the mesh has a structure that doesnt remodel like human tissue might and even is known for shrinking. Did you have polypropylene or polyester mesh?

[David M]

@ Good Intentions, could you weigh in on something that I may have read from you about how your peritoneum, the mesh, and the muscle were all fused together? Is this always the case, or was this something specific to your case ( or do I have that wrong altogether)? Also, can you give any better understanding of why you had it removed? Was there sharp pain? Was there just general discomfort? Were the negatives constant or only on certain activities?

[David M]

Chuck, I would prefer tissue repair and, secondarily, open mesh, but I’m not sure if I’m a candidate for either. So, I’m trying to get as realistic of a picture as I can for for lap mesh, as well, in case that turns out to actually be what I need most. Cant you envision, even given the negatives for some, that it might be the best option for others?

[David M]

Good post, ajm. I looked back to be for sure and read that you have had your lap mesh removed. Can you give more detail on why? What was the feeling or negative effects that led to removal?

I have a baseball sized direct that I have to have something done soon. It feels obvious that it’s intestines that are pushing out. While it’s reducible and it doesn’t really hurt, any problems with coughing that come up are making me more and more worried about how safe it is for the intestines to be popping that hard.

Given the nature of my hernia, I wonder if open or tissue will hold and think my best repair option – perhaps my only practical repair option – is lap.What do you think you would do in my case?

[David M]

With regard to the above comment about there always being inflammation, I realize that there will certainly be an initial round of inflammation as the mesh is incorporated, but my question pertains to whether this inflammation ever passes, or if the body continues to attack the foreign substance?

And would the inflammation maybe be worse inside the abdominal cavity as opposed to the inguinal canal?

[David M]

Thanks for the response. I may have already asked you that, now that I hear the answer. A hen sized egg doesn’t sound all that big to me, but it does give something of encouragement for tissue repair for those with hernias of that size.

[David M]

Mike M, How big was your direct hernia? Tennis ball? Baseball? Golf ball? Somewhere in between?

Does anyone remember who else that Dr Kang treated had a direct hernia?

[David M]

Also Good Intentions, just how big was the direct hernia that you wish you would have watched? At what point do you think you would have eventually had it fixed?

[David M]

William Bryant, I’ve wondered the same thing about Dr Kang and his success with Direct Hernias. Most of the people on this board who have visited him seem to have had indirect, and given that his surgeries are different for each, it’s not really much help to know that they had a good outcome.

Chuck, for a long time, I have batted around tissue repair vs open vs lap. I’m about undecided as ive always been. Lap surgery was originally lowest on my list, but it has moved up recently, all the problems notwithstanding. One of the cliche-ish sounding reasons for advising lap is the bicycle patch analogy, that a patch is stronger on the inside of a tube than the outside. While I think that sounds too pat, ive come to think that maybe given a large size direct that it actually does seem more likely to prevent the hernia from pushing through. Any thoughts on this? Also, can you quit so dramatic about your life being over? People cope, and we know you will,too!

[David M]

Here’s a randomized trial they did on hippos comparing progrip vs sutures. Surgery time was nine minutes faster with the progrip,

https://www.researchgate.net/publication/314225749_The_HIPPO_Trial_a_Randomized_Double-blind_Trial_Comparing_Self-gripping_Parietex_Progrip_Mesh_and_Sutured_Parietex_Mesh_in_Lichtenstein_Hernioplasty_A_Long-term_Follow-up_Study

Frankly, hippos would be my last choice to test mesh on. ¯\_(?)_/¯

[David M]

I looked this up and the meta analyses that I read all came to the conclusion that the pain and recurrence levels were about the same. The advantage for progrip was in the quicker operating time. I think we’re talking a few minutes there,though. Here’s one link:

https://pubmed.ncbi.nlm.nih.gov/29029881/

[David M]

Thanks for the clarification!

[David M]

I’m puzzling over what is meant by “no study has shown that the absorption is inconsequential.” Are you referring to possible consequences due to the products of the chemical breakdown of the mesh?

[David M]

Cpk, in your original post you mentioned that you had had absorbable mesh recommended by a surgeon at some point. Do you remember which absorbable mesh?

Also, we probably need to separate Kang repairs done for direct vs indirect in our list of people here who have used Dr Kang, as his technique would be different for each. You havent possible sorted that out in your research while reading the people here?

[David M]

Sounds like you had a really excellent experience. Do you remember the name of Dr Kang’s book and whether it can be purchased on Amazon or elsewhere online?

[David M]

I havent had my hernia surgery yet. Ive always had various intestinal stuff that’s come and gone. It’s very possible that the stomach problems were as a result of the change in my diet that corresponded to the pvcs. Specifically, I thought maybe the pvcs were a result of drinking too much caffeine. They probably werent, but I switched off coffee and changed to soft drinks (dr pepper)which i didnt normally drink. I realize these also have caffeine, but not as much, and I was only drinking about 20 to 30 ounces a day.

So,the stomach problems might have been something from that. At any rate, presently both problems have cleared to a large degree.

I would try to get myself one of the oximeters with the heartbeat graphs and watch the graph when the heart palpitations are happening. Possibly the intestinal bloating is not the root cause. Those oximeters are maybe 30 dollars.

[David M]

Random suggestion, probably wrong, but if youre having palpitations and shortness of breath, what makes you think your heart is ok? I recently had to wear a heart monitor because I noticed my heart felt funny and watching my heart beat on an oximeter, I could see that I was getting a missed heartbeat on a regular basis. Mostly this was due to a premature ventricular contraction, which is something that can affect people with otherwise normal hearts.

When this happens, the ventricle fires early before it fills with blood. It’s not necessarily dangerous unless it happens a lot. When it’s acting up, though,there is some shortness of breath and a sort of feeling like you’re riding a bicycle with the brake on. Now, mine has cleared up a lot, but when it was occuring regularly, I was also having a lot of intestinal problems. Perhaps this was just a coincidence.

[David M]

Yes, the five year follow up in this study was completed. Sort of. The biggest problem is that there were fewer than half of the initial people in the study who they were able to follow up. Plus, for the layman, and probably even for the doctors, there is a ton of ambiguity. There were 20 recurrences, but some how they came up with a figure of 22% recurrence, even though there was a small amount of people who they were able to follow up.

At any rate, although this type of mesh seems interesting and possibly promising, it’s hard to see whether this is available for more normal hernias.

https://journals.lww.com/journalacs/Fulltext/2022/12000/Long_Term,_Prospective,_Multicenter_Study_of.11.aspx

[David M]

The three year follow up linked above was published online in Dec of 2020 and in a journal the following month. So the 5 year follow up should be out or out shortly, it would seem.