Good intentions
Forum Replies Created
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Can you give more information, like your general location, how far you are able to travel, and the type of repair that you had? There is good advice available here but there is no general recommendation that can be made. The more detail the better.
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Hello katie. I don’t think that the “top” removal surgeons have been defined. There really aren’t that many who you could say specialize in it. And they all seem to do it differently. Some use an open technique. Some use TAPP laparoscopy. Some are using robotics. Some do a triple neurectomoy as a matter of course. And the methods used depend on the individual patient’s situation, I believe, for some surgeons. Others do it one way every time, like Dr. Petersen in Las Vegas.
I think that Chaunce1234 has put a list together in past posts. And several of us have made individual recommendations. I think that you’ll find them if you search the forum posts.
I am about nine months out from mine and still feeling the effects of the mesh and the removal. The mesh really made a mess of my abdomen while it was in there and it’s still adjusting. I can’t tell where it’s going to end up.
Good luck. Ask lots of questions.
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quote Jen74:Well my GI doctor said everything came back normal. Well I went to get a copy of the report and the CD today and was reading the report and on the impression it says: “No intra-abnormality to explain etiology of patients symptoms of lower left pelvic/abdominal pain. No evidence of appendicitis or diverticulitis”. Well I started reading over the whole report and in the section where it talks about the Body wall it states that there is a small umbilical hernia!
Your doctor probably just read the summary, like many of us do, and the doctor reading the image was only looking for what he’s been trained to look for specific to how your symptoms were reported to him. Lower left pelvic/abdominal pain. The umbilical hernia was just a side observation.
Good luck.
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To be clear, I do research for a living, but not in the medical field.
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Yes, the design could have made sense, with more care taken to control the other variables. But as it stands, they have overlooked the knit pattern, and, possibly, other factors, like partially absorbable components that seem to be used in several Ultrapro products. Ultrapro is a brand name that Ethicon uses for many different devices. One more way that cause and effect are blurred, making it very difficult to determine which products are good, and which are bad. It’s not even clear which Ultrapro product that they are evaluating. I copied the Ultrapro product page link below.
One interesting fact, is that even though Bard offers a lightweight version of their “gold standard” mesh, they couldn’t find, apparently, enough surgeons that used it, even though they found enough that used the “heavy” mesh. It would have been very obvious that Bard Mesh and Bard Soft Mesh should be the subjects of the study, from the beginning. Makes me think that they compromised to Ultrapro lightweight, or vice versa to Bard heavy, when they couldn’t find the proper devices for a good study.
I do this type of work for a living so these things stand out to me when I see them. The concept is a good idea, poorly planned, but well-executed. Much talent and expertise was wasted to produce a nice paper that doesn’t really show anything, except for the collection of more general data showing that “mesh” causes significant pain and discomfort, even for open surgeries using the Lichtenstein method. That finding has value alone, I think.
https://www.ethicon.com/na/products/hernia-mesh-and-fixation/hernia-mesh/ultrapro-hernia-system
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I came across another long-term success story. Open “mesh” repair in 1985, relaying his story in 2005. Twenty years, and an active athlete. Stories like this are probably what have led other surgeons to think that any mesh anywhere is okay.
https://www.hillrunner.com/jim2/id93.html
The surgeon, Dr. William Howard, has, unfortunately, died fairly recently. His story is worth reading.
http://www.baltimoresun.com/news/obituaries/bs-md-ob-william-howard-20160111-story.html
His Sports Medicine Clinic is still there though. Might be a good starting point for people in that area.
https://www.medstarunionmemorial.org/our-services/sports-medicine/
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One week is still early. You could probably do with more walking. I did a lot more walking than 15 minutes at a time after my mesh implantation via TEP laparoscopy. Probably one to three hours a day, easily. The majority of the swelling was gone after about one week, but I was still sore. Walking and staying active gets the fluids moving to where the body can absorb them.
Good luck.
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Thank you for the correction Dr. Kang. I know very little about the anatomy of the groin. I should have learned more about tissue repairs in general before making that post. Most of my thinking has been about mesh and how it’s used since that’s how my direct hernia was repaired, before I had it removed.
Thank you for staying in touch with the forum and good luck with your efforts. I look forward to your posts.
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I can’t add anything very specific to why “pure” tissue repairs fail, but I have realized that one of the difficulties with hernia repair is that the tissue that fails is not normally injured so does not have a robust healing mechanism. It is very like an ACL tear of the knee, which can only be repaired well by replacing it entirely. That’s why, I think, they call mesh a prosthetic. It’s an aponeurosis replacement. The pure tissue repairs are attempts to tie a “ligament” back together. It doesn’t work well.
The aponeurosis is essentially a wide flat ligament, at the ends of the abdominal muscles. I supplied the Wikipedia link below. Each suture point in the ligament is a new hole that can elongate and tear. That’s why Shouldice uses so many, to spread the load across many holes. There are some basic engineering principles involved. It is a lot like darning a sock or a pair of Levis. More sutures are better. To avoid that, many of the multitude of repair techniques involve moving tissue that heals, over, to take the place of the failed aponeurosis, which will, essentially, never really “heal”. As I understand things.
Just another way to look at things. The more I learn the more complicated things seem. I can understand the attempts to simplify that have led to this huge mesh problem.
https://en.wikipedia.org/wiki/Aponeurosis
UhOh!’s recent topic and link is very relevant to this topic.
https://www.herniatalk.com/8458-guarnieri-technique-and-hernia-center
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Sorry that you’re not getting any responses. The northeast and the southeast seem to have options but the middle is sparse. Chaunce1234 keeps the best list of surgeons with specific skills, if you want to search his past posts. Your situation is not one of the more common ones because you have a recurrence, and it’s very early. It might be that you didn’t actually have a hernia or that the cause of your pain is not the hernia that was repaired.
I’ve copied your original post here for reference, below. I think that a hernia specialist would know more than the “common” (no offense intended) surgeon because of the unusual nature of your recurrence, so soon. While you’re searching, make sure to get a copy of your medical records. Having them yourself can save a lot of waiting, for the “system” to get records transferred. Especially if you are working outside of your local network. Since you have images, or even without, Dr. Towfigh might be able to do a remote consultation. She has specific expertise in women’s issues, which others might not have, and she is a hernia specialist. Sometimes you have to contact the imaging facility to get your images, outside of the office that requested them.
https://www.herniatalk.com/8431-early-recurrent-inguinal-hernia
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I haven’t got to the technique description yet but that “Online Book” under the Doctor heading is an excellent overall review of all of the repair techniques. Thanks for sharing that. It’s very high level and full of references and illustrations.
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I am pasting the link to your other topic here, for reference. The Vincera Institute seems more focused on athletic pubalgia, or sports hernia. Certainly worth talking to but your situation doesn’t seem like their normal type of problem.
Good luck.
https://www.herniatalk.com/7977-need-help-2nd-hernia-repair-gone-bad
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quote EHF97:How does this happen so soon after original repair? I was advised to proceed with surgery on the original hernia as it was irreducible. The “new” hernia is five times the size of the original and is also irreducible. The CT showed a 5mm wall defect. Should I request to be referred to a hernia specialist? What is the timeframe I should expect to undergo surgery again? Will the second operation be more complex?
A hernia specialist seems like the way to go at this point. Your situation is not simple.
I would try to step outside of your insurance/medical system to see what your options are. By this I mean choose your next surgeon yourself. If you stay in the system you might or might not get a good surgeon. Many times referrals are chosen by somebody in the office just getting on to their computer and picking the first name they find, or somebody they know, or somebody within driving distance.
Post your general location and somebody can suggest someone. Many practices do not require referrals.
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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.
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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.
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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.
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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.
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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.
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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.
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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.