[Good intentions]

I have talked, indirectly, to Dr. Meyers, through Marcia Horner. They were very responsive to my communications. If you send an email or letter your questions will probably be addressed. The more detail the better.

[Good intentions]

quote tenreasy:

Is it because of the new power of social media that the horror stories are distorting the actual success rate of mesh?

Numerous professional studies seem to show that somewhere between 10 – 20% of “mesh” hernia repair patients will have chronic pain. I have posted links to several on the forum. These are not internet anecdotes, but actual survey or mesh repair registry data. Somehow, for some reason, the focus is on the 80 – 20% that don’t report pain, as proof that mesh is the best solution. The industry has gone from concern about a 2 to 5% recurrence rate to being okay with a 10 – 20% failure rate, if you define chronic pain as failure. That seems to be the disconnect – chronic pain is not considered a failure. Certain studies suggest that even the recurrence rate is worse with mesh.

The repair industry and device makers have committed much time and money to developing the mesh repair market. The best that you can do is to is to make your surgeon show you that their method does not result in chronic pain. They can stay in touch with their patients via many different means. There is no reason not to know, directly, how their former patients are doing. If they don’t know, or if they waffle or say that they haven’t heard anything bad, then search for a different surgeon. There do seem to be combinations of material and method that give good results. But they are blended together with the bad materials and methods. Which means, in sum, that there are combinations of material and method that are actually much worse than 10-20%.

One of my big mistakes was in not trusting my sense that my surgeon wasn’t telling me something. He actually said to me that he had changed his method from just the previous year, so that the mesh couldn’t move at all. I wanted to believe in him so I assumed that he was fine-tuning an almost perfected technique. In retrospect, I think it meant that he had had problems in the past.

Don’t be afraid to ask your surgeon hard questions. And don’t take “you’ll be fine” as an acceptable answer. Every hernia repair surgeon should be aware of this issue and should be ready with good solid data supporting their method.

[Good intentions]

I have had two laparoscopic surgeries. One was TEP for mesh implantation, the other was TAPP for its explantation.

The tissues and structures in the area of the hernia are tied up with mesh after the first laparoscopic surgery. “Incorporated”. They can’t easily peel them apart anymore like they could during the first surgery. So a second surgery is more difficult, for either method. It’s a matter of choice for the surgeon on which method they feel will give the best results.

You should get more detail on what each doctor plans to do. Sometimes they leave the old mesh in and just put new mesh on top. If you had mesh problems in addition to the recurrence, you might end up with a repaired hernia but still not feeling right.

Good luck.

[Good intentions]

Hello Jen74. I know how difficult it is to stay focused and forge your own path when you have problems like this. But most of the bad stories on the forum are from people who stayed within their own local healthcare system and took the first referral and got the mainstream repair. The mainstream repair for hernia repair today is mesh. Large pieces implanted, to be very certain that there will not be a recurrence. That is the teaching and training that the majority of surgeons receive today, apparently.

So, when you ask your surgeon for a non-mesh repair, they will not know how to get it done. They won’t have the training. And they feel confident that their training in how to use mesh will do the job. Chronic pain avoidance is apparently not a subject in today’s medical schools and residency programs.

So, that leaves going outside of your local healthcare system, to find a specialist. I saw in your other post that you didn’t ask Dr. Towfigh’s office about a consultation. It might be worthwhile to go back and do that. I don’t know if there is a charge or not, but even a small cost could be a valuable investment.

Also, be aware that “exploratory” surgery is not just a look-see. It is real surgery, just with no repair performed. They might dissect a larger space during your excision surgery to get a better look at certain areas. The dissection alone is traumatic to the body. So any imaging work that could help you find a cause before surgery is worth pursuing first. And, there are stories of people having mesh implanted, just in case, even though no defect was found, during exploratory surgery. Neurectomies are performed, because they “might” help. If they don’t find anything they will want to do something, while they’re in there.

At the least, maybe you could ask Dr. Towfigh to consult with whichever general surgeon attends so that that surgeon will know what to look for. It would be a shame to wake up and hear that nothing was found and to have the same pain.

I’ve found that sometimes, when dealing with a front office, that you have to be very specific and direct them in what you are trying to achieve. The majority of their daily work is referrals through the “system”. People calling out of the blue are unusual. Sometimes a well-written letter directly to the doctor works better than a phone call. It will reach different people and will probably get directly to the doctor, unlike a phone call or email.

Good luck.

[Good intentions]

Hello Jen74. Dr. Towfigh might be your best option at this point. Quickest to contact her office directly I think. She offers online, or remote, consultation.

Here is a link from her Twitter account, below. She is the Administrator of this site. You can also send her a message via the site so that she can see your post.

Good luck.

https://twitter.com/Herniadoc

https://www.herniatalk.com/member/935-drtowfigh

Tweets by Herniadoc

[Good intentions]

To your question though – the kettle bell seems more dangerous because at the end of the swing you do generate some abdominal pressure. And the speed of the motion lends itself to a sudden correction, where you might strain to stop the weight. Slow and controlled is the way for hernia management, I think.

[Good intentions]

A direct hernia is not a “muscle tear” as I understand things. It’s not even really a tear. It’s a deformation, or over-stretching, of the fascia directly behind the peritoneum, and in to the inguinal canal. From there the “bubble” of peritoneum and fascia just continues to grow and force its way to places it doesn’t belong via, what is, essentially, hydraulic pressure. The contents of the bubble, whether it’s fat or omentum or intestine, have no significant structure. It’s like a stretchy bag of wet noodles.

Each time you stretch or create the bubble it grows a small amount as the bubble surface, the fascia, passes its yield point. That’s a point of irreversible elongation, or strain. That’s why your hernia has grown slightly even though you’ve avoided abdominal pressure.

If you plan to avoid mesh in the long run, your best option is to find a non-mesh repair while the hernia is small. The original point of mesh was to repair the difficult large hernias I think. Not to be the one-size-fit-all repair that it has become.

Even the stories about self-healing hernias involve years of wearing a truss and avoiding heavy physical activity. I, personally, don’t think that there is a way to become so healthy that the hernia repairs itself. It’s not a muscle injury. The damaged tissue, the fascia, does not have much of a healing mechanism, similar to how a knee ligament will not heal itself if it’s torn. To the body, it’s not really damaged, it’s just stretched out. As far as the body is concerned all of the various surfaces and structures are intact.

[Good intentions]

quote hhernia:

it seems illogical to undergo surgery on such that does not affect my life in anyway. However, I am concerned about the long term and am seeking advice on the best option for myself.

He mentioned severing three nerves as part of the operation to reduce risks of groin pain, is this common? I feel somewhat apprehensive of losing such nerves when I am in no pain atm.

My biggest fear is that by having elective surgery, my life will never be what it used to be all because of a problem that never bothered me. However, I do understand the contrary. Thus, I am left in a pickle with no idea what to do and my thoughts consumed by hernias!

1) How necessary do you feel it is for me to have my hernia repaired, given its size and asymptomatic nature? Is the risk:reward ratio enough to warrant intervention?
2) Is surgery the only option in my case?
3) Without intervention, how would you anticipate my case to develop? (Will the hernia likely increase in size/become painful or could it remain the same)
4) What is the risk of strangulation like for a hernia of a size/nature like mine?
5) If you were me, considering age and circumstances, what would you do?
6) Is there any benefit to undergoing elective surgery early, while the case is still asymptomatic and small?

Take the time, at least, to really understand as much as you can, about your hernia, but more importantly, about the hernia repair field in general. Not all surgeons are the same. There are surgeons who really understand hernias and hernia repair very well, and there are others who are basically reading an instruction manual. The surgeon who wants to do a triple neurectomy from the start should be avoided, I think, since he is taking unnecessary risks with your quality of life. Triple neurectomies are used as an attempt to cure hernia repair pain, not as a preventive measure, from what I’ve seen, and the procedure has its own side effects and risks. I would avoid that surgeon, he doesn’t seem to understand the risk of what he’s suggesting.

Your thought that this could be a life-changing decision is right on target. There is benefit to having it repaired while it is small, if the right option is chosen. The problem is that if you get one of the instruction-manual surgeons you will probably get a one-size-fits-all type of repair, meant for large, medium or small defects. A large piece of mesh to cover the defect and any other possible future defects. And, apparently, even a triple neurectomy, even though there is no pain. That alone seems unconscionable and almost unethical.

Doing things that increase abdominal pressure, like the Valsava maneuver while lifting heavy weight, or making a hard tackle in football (soccer) can cause the hernia to get larger. Playing soccer is what caused mine to grow. So I would avoid those things while studying the possibilities. The fact that your hernia reduces itself is a sign that nothing is being constricted, or in immediate danger. You’ll know more as you read about what it is that is actually being extruded, like fat and omentum.

At age 20 I would make every effort to find the right surgeon and get the right repair. Your body isn’t even finished growing. The wrong repair can affect sexual function directly, as it did in my case, or indirectly, just by constant pain. You can get very messed up. Don’t try to save money or stay close to home. Consider traveling out of country if necessary.

Most of this has been covered on the site, Read through the topics and you’ll see what could go wrong and how to find the right surgeon. Good luck. Don’t be swayed unless your surgeon can prove that they have good results for people like you who are doing what you plan to do.

[Good intentions]

quote muzik:

Thanks for the reply. Did you see a specialist or were you able to go to a local surgeon to do the surgery? Did they seem confident in their abilities? How long has it been since you’ve had your removal?

I traveled out of my insurance network to see Dr. Peter Billing of Eviva in Shoreline WA. He is known for removing mesh but does many other things besides hernia work. I’ve been impressed with his practice from the beginning. It’s been about 9 months since I had two 6×6 pieces of Bard Soft Mesh removed. Of course, they weren’t 6 x 6 anymore they were very shrunken and stiff. My problem was not infection but just constant irritation due to the nature of the mesh.

Dr. Billing also did not repair any hernias while he was removing the mesh. So far I’ve not had any signs of recurrence, but the recovery process is long and slow. I had the mesh implants for three years so the surrounding tissue had thickened and distorted and it’s taking time to reform to its new environment. It’s all been forward and promising since removal though. I don’t regret it.

Good luck.

[Good intentions]

I wrote a long reply but got “green-screened” as unapproved. I am doing very well after mesh removal, so don’t give up hope. Your surgeon seems to be thinking in extreme measures, which may not be necessary.

I also sent a message to Dr. Towfigh so hopefully she will have some comments.

Here is Dr. Towfigh’s recent tweet about plug removal. Good luck.

https://twitter.com/Herniadoc/status/1021561699290116097

What do you see?

This is a medium size Perfix #plug #mesh that has balled up, aka #meshoma . It was causing chronic groin & nerve #pain due to erosion into the spermatic cord, so I excised it. He is now #pain free!🙏🏻#meshcomplication #hernia #chronicpain #itsnotjustahernia pic.twitter.com/EgnLh0ULXR

— Dr. Shirin Towfigh (@Herniadoc) July 24, 2018

[Good intentions]

I had similar depression when my mesh implant wasn’t working. But now, ~9 months after having it removed, I feel like I’ll be back to at least 80-90% of where I was before the hernia. So there is hope, if you find the right surgeon.

If you had a simple direct hernia, which is what that system is used for, then I don’t think that there is a need for a biologic mesh. Your current surgeon seems to be thinking in extreme measures. Even the UHSM system is on the extreme end of hernia repair, used for large hernias in people who will be stressing the area after repair, I believe. It’s a lot of “repair” for a small simple hernia. I don’t see the absorbable polymer in the description though. Maybe you got the “Comfort Plug” which does use the PLA.

Dr. Towfigh just removed a plug system that was causing pain. And she has published on infected fields. So, hopefully she’ll have a recommendation for a local surgeon. Dr. Peter Billing removed my mesh, he is in Shoreline WA.

Here is Dr. Towfigh’s recent tweet about the plug removal –

https://twitter.com/Herniadoc/status/1021561699290116097

And here is the Ethicon product page –

https://www.ethicon.com/na/specialties-procedures/hernia-surgery/lap-inguinal

https://www.ethicon.com/na/products/hernia-mesh-and-fixation/hernia-mesh/ultrapro-hernia-system

https://www.ethicon.com/na/products/hernia-mesh-and-fixation/hernia-mesh/ultrapro-comfort-plug-partially-absorbable-hernia-repair-device

What do you see?

This is a medium size Perfix #plug #mesh that has balled up, aka #meshoma . It was causing chronic groin & nerve #pain due to erosion into the spermatic cord, so I excised it. He is now #pain free!🙏🏻#meshcomplication #hernia #chronicpain #itsnotjustahernia pic.twitter.com/EgnLh0ULXR

— Dr. Shirin Towfigh (@Herniadoc) July 24, 2018

[Good intentions]

Hello muzik. This sounds like a terrible experience. I can appreciate gong back to the original surgeon, since they should know what might have gone wrong, and they also need to know that their work has gone wrong, but from the details of your story it seems like you should find a new surgeon. Implanting the mesh and understanding the problems with mesh are not necessarily connected.

There are simple, quick, blood tests that can be performed to determine if infection is present. Unfortunately, as I understand things, infected mesh is very very difficult to clear up, or “salvage” as they say. Regardless, your mesh does not seem to be “incorporated” in to the surrounding tissue as it is supposed to do. I’d say that you do need an expert in both infected fields and in mesh removal. Dr. Towfigh has that expertise and probably knows of others who do also.

Can you give your general location? Somebody can recommend a surgeon with the knowledge that you need.

Also, if you haven’t done so yet, you should get a copy of your medical records. There are several versions of “Ultrapro” some with a polymer that degrades and is absorbed and others without, plus different physical forms like the plug. They probably have different types of problems.

Good luck. Post your location soon so that people will see it.

[Good intentions]

If you know people who do what you plan to do and they have had a good repair consider using their surgeon. It doesn’t seem to be mesh per se that is the problem. It’s how it is used, and/or the type of mesh. For whatever reason, perhaps protecting fellow surgeons or protecting device makers or protecting their own practices, nobody seems able to distinguish the good from the bad, or they do know and just aren’t telling anyone else. So the good gets tarnished by the bad. What the industry and the surgical profession need are a few people brave enough to speak out and be specific. Identify the bad devices, identify the improper usage.

The recent comment on Dr. Towfigh’s tweet about the Bard Perfix plug is a good example (Momof4 mentioned the tweet in another topic). But it’s only one and it’s not very specific. It’s by Dr. Yuri Novitsky, who seems to feel that mesh can work, but plugs are bad. We need more of this, much more, and much deeper. The professional societies should be promoting this type of sharing and discussion, and they should be modifying their guidelines to include these types of things. Without the professionals who know speaking up the chronic pain problem will just continue. As things stand today it seems like a big circle of “not my responsibility”, with the patients paying the price of this abdication.

https://twitter.com/Herniadoc/status/1021561699290116097

https://www.crbard.com/Davol/en-US/products/PerFix-Plug

https://www.columbiadoctors.org/yuri-w-novitsky-md#about-yuri-novitsky

Good luck mackerel.

What do you see?

This is a medium size Perfix #plug #mesh that has balled up, aka #meshoma . It was causing chronic groin & nerve #pain due to erosion into the spermatic cord, so I excised it. He is now #pain free!🙏🏻#meshcomplication #hernia #chronicpain #itsnotjustahernia pic.twitter.com/EgnLh0ULXR

— Dr. Shirin Towfigh (@Herniadoc) July 24, 2018

[Good intentions]

I hope that you are reading the other topics on the site and considering each. If you decide that you need to stay in a certain area or need to act within a certain amount of time, here is a link to a recent topic, about a surgeon in your area. A message to smurph71904, the author, might get the surgeon’s name if he does not want to publicize it. It’s only been 3 1/2 months for him but a discussion with his surgeon might help you.

The plugs and the 3D products can take time to shrink and crinkle up. Even the flat products can fold over. So months of time is not really long enough to make a well-informed decision but the surgeon might have more information. His early results look promising.

He mentions Geogia pollen in the first post – https://www.herniatalk.com/7096-open-inguinal-hernia-repair-monday

[Good intentions]

I really don’t know. There is so much variation within each technique that,without tracking long-term results, nobody can say. There is TEP versus TAPP, the surgeon can use a small piece or a large piece of mesh, a 3D material or flat, lightweight versus normal weight, they can leave it unfixed or they can go crazy with tacks, they can place the mesh high or low or to the sides.

Many of the same issues are present in open repair. Different types of mesh, device designs, placement, fixation, etc. That’s why I think that it’s best to make the surgeon verify that what they do is proven. Otherwise you’re just their latest effort to get it right.

Without high quality oversight from regulatory agencies or good guidance from professional organizations, it’s just a crowd of individuals working on separate puzzles with a huge selection of puzzle pieces. You can’t trust just a material or a method. Find a person who had a successful repair and get that exact repair from the same surgeon. Or find a surgeon who has known history of good repairs. But I wouldn’t simplify it down to open versus lap, or assume that certain medical device will always give good results.

[Good intentions]

That is great news. Can you give more detail on the type of open repair? Was mesh used? Do you know the type and/or brand?

Can you give the surgeon’s name? I don’t think that they mind, if people are saying good things about them. We need to know who the good ones are.

Good luck. I hope things keep working for you.

[Good intentions]

It is still being taught that mesh itself can cause no harm. That’s why surgeons are so nonchalant about implanting it. The disconnect between what the few long-term studies have shown and what the prevailing thinking is astounding and disturbing.

Can you give more detail in the type of hernia, indirect or direct, and the reason that your first doctor diagnosed a hernia. Did you go to the first doctor for pain, or was it found during a general physical exam?

Not too long ago “watchful waiting” was the recommendation for small and/or asymptomatic hernias. It’s surprising that your latest surgeon went directly to recommending surgery using mesh. Did she discuss any other options? If not, she’s not even following general guidelines, as I understand them. I would be wary. Most surgeons do not tell you that they “want” to repair your hernia either. They discuss the possibilities and let you decide.

If it is small and not extremely painful or dangerous you should certainly take the time to learn about the options, and the long-term risks. The results of the operation with mesh are meant to be permanent, good or bad. There are very few “we’ll try again” options if there are problems.

[Good intentions]

I had similar problems with sitting for extended periods, but only when sitting in an office type chair in front of this computer screen. So I switched the chair to an upright back wooden dining table chair and that made a big difference. I might never use that office chair again, it seemed to create pressure in certain areas due to its design.

I also have found that going for short runs, 1 or 2 miles, has a positive effect. I think that there are probably pockets of scar tissue left behind that have poor circulation, after the trauma of the mesh and its removal. On the other hand, I found that hiking or walking over uneven ground or hills for extended periods makes me more sore, overall, across the lower abdomen. A different type of muscle usage I assume.

I had been waiting until I felt like I had found a steady base, physically, to speak from before giving any advice or thoughts on healing from mesh removal. I’m in pretty good shape now but still spend a lot of time taking care of the area that was damaged. It’s still a huge part of my life. Good luck.

AGF, sorry for taking over your topic. I hope that your questions got answered. To Jeremy B’s point, don’t too hard try to stick in your insurance plan’s coverage area. It will limit your choices. Any extra cost will level out over the many years you have ahead of you.

[Good intentions]

Thank you for posting that Baris. It sounds like you’ve been through the wringer.

It’s a shame that these professionals can’t get together and discuss the pros and cons of what they do without criticizing the other methods, and guarding their own. All of the methods seem to have horror stories attached, and all seem to have inherent flaws. But they all seem to have some positive stories too. If they could just share the knowledge with a combined effort to determine the best method for the individual patient, everyone would be better off.

Here is a link to a thread I started about good mesh stories. The last one I posted, #30, is one of those positive stories. Keep it and the surgeon he used in mind if the Shouldice technique doesn’t stick. It’s a mesh-based procedure but the person had very good results. I wish we knew why. I’m not promoting mesh by any means, just offering a “known-good” repair’s surgeon. Good luck.

https://www.herniatalk.com/6883-successful-good-mesh-stories/page2

[Good intentions]

quote Jnomesh:

Hey good intentions. Did you happen to do any type of body work that helped you post mesh removal-like myofascial release or ART etc?

jnomesh I have not done any program type rehabilitation work. It’s all been just me and what I’ve been able to learn, plus my experience from past injuries. I started with the knowledge that pretty much all of my lower abdominal wall had been torn apart and put back together, and went from there. I avoided strenuous activities until I was confident that the entry points for TAP surgery should have been healed and strong then slowly increased levels and duration of activity, with long periods in between to let healing happen. I think that that’s important, to let things settle down before exercising again. The swelling and soreness takes much longer to diminish than for a normal injury. If I had a daily physical job I would probably be suffering.

I had talked to a physical therapist when I was having mesh problems, and looked around the internet, and found that there are really no physical therapy programs designed for mesh implantation or mesh removal. We’re all pretty much on our own.

At this point in time, about 8 months post mesh removal, I’m just expanding the envelope, both for level and duration, and keeping track of cause and effect via a daily log. My experience from past injuries was helpful in that I know that the body will keep working to get right, even years after an injury. So my time-frame might be longer than most, as long as I’m making progress I’ll stick with my program. So far it’s been a steady slow climb up a long and slippery slope.