[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.

[Good intentions]

There are many different types of open repair. Plugs, patches, two layer systems, and variations of each of them. “Mesh” is not enough to go on.

I post this advice often – ask your surgeon if they have verified that their method will work for you through communication with former patients. There is no reason that they should not know that, it just takes a letter, or an email, or a survey after a year or more of time has passed. The medical device makers do not have long-term data for their products, only very short time frame animal study results. Animals can not describe their pain.

[Good intentions]

Most hernia repair patients do not get a “pain pump”. So that is unusual. Since you were originally diagnosed with a groin strain, and the pain is associated with activity, it might be that the hernia was not the actual cause of the pain. I had a direct hernia that was only painful “after” strenuous activity but not during. And the pain resolved after a few days to a week. I only had it repaired so that I could, supposedly, get back to my high level of activity.

Consider the possibility that the pain is actually from something like a “sports hernia”. Athletic pubalgia. There is a “sticky” about it on the forum’s front page. Here is the link – https://www.herniatalk.com/6882-in-depth-sports-hernia-guide-infographic

There are doctors who specialize in the condition, like Dr. William Brown, Dr. Muschaweck, and Dr. William Meyers. Good luck.

[Good intentions]

quote Dave Graham:

I suppose at some point you h ave to assume the surgeon knows what he or she is doing.

Put your effort in to verifying that what your surgeon is planning for you will actually work for you. Otherwise you’re in the 1 of 6 category, generally. Like Russian roulette. 10 – 16% chance of chronic pain.

Many surgeons are expert at getting the mesh implanted. It’s the long-term results that are undefined. My surgeon had the best of credentials. But lost track of his patients after he was done so, as I found out later when I had problems, he could not say if past patients were doing well or poorly. Only that the surgery went well.

Ask your surgeon if they know, based on communication with past patients, that their methods work for your planned activities. If they don’t, then the risk is higher for you.

Good luck.

[Good intentions]

Hello Baris. Can you tell more about your situation? The type of hernia and what made it fail? I saw your other post and replied but it is Unapproved at this time.

I was very athletic also but had a laparoscopic mesh repair. The mesh was worse than the hernia, it made athletic activity impossible without side effects.

Any details would be appreciated. Good luck at Shouldice.

[Good intentions]

quote Baris:

I believe its something he does quite common as he knew i was involved in high level sports at the time and still used absorbable.

Hi Baris. Could you give more detail on your situation? Your story sounds very interesting, in many ways. I think that the “holy grail” of hernia repair is one method that works for everyone. What type of sport, and did you gain the 35 lbs afterward, or does Shouldice just like very skinny people? Was your sport a high frequency sports like running, or a high intensity sport like weight-lifting? Or a combination of both like soccer (football)?

I was very athletic, mainly soccer, before my hernia repair with mesh and I found out why very few, if any, professional athletes get repairs with mesh. The mesh is a constant irritant to the surrounding tissue, which cannot handle the stresses and strains of continuous high level activity, with mesh. Since the mesh is gone I am slowly working my back to a higher level. All of my personal data, three and a half year’s worth, points to the mesh as the main cause, with the extensive unnecessary dissection as a secondary cause. It’s incredible how much healthy tissue was damaged to insert mesh in to areas that had no problem.

It would be great if you could tell more. Dr. Mucschaweck is known for working on athletes and her association with Biohernia is important.

[Good intentions]

Type of mesh does make a difference. But what, exactly, the long term effects are is unclear. Most of the literature provided by the device makers focuses on the immediate feel of the material before and/or during implantation, Soft or Flex or Grip, and various other qualities, many to make implantation easier. It’s one of the great failings of the industry, that they have all of these different types of mesh, used on a regular basis, but there is no verifiable long-term data available to use for correlating problems or benefits to the mesh type. The new meshes are approved based on similarities to past meshes, meshes with, ironically, the very problems that the new mesh is supposed to improve.

Many surgeons do not get to choose the mesh that they use either.

Bard is a medical device maker. A brand. They have many different types of mesh products. Bard Mesh, Bard Soft Mesh, Bard 3D Max, etc. Here are three links, one showing how some surgeons just rely on their purchasing departments, another showing Bard’s product portfolio, and an different device maker’s products..

Click “cancel” in the print window that shows up and you can read the article – https://www.generalsurgerynews.com/Article/PrintArticle?articleID=34826

Here is Bard’s hernia repair portfolio – https://www.crbard.com/Davol/product-search?pg=1&devicetype=hernia+repair+%26+fixation

Here is another device maker’s, Medtronic – http://www.medtronic.com/covidien/en-us/products/hernia-repair/mesh-products.html

[Good intentions]

Hello Chaunce. Great idea to start a topic for this. I think that Dr. Koch is the Holland-based surgeon in this partnership, along with Belgium. Dr. Muschaweck apparently handles the UK and Germany. Ireland is either. And there is a separate “International” link.

Looks like this person, Nahom Welldeiesus, started the partnership, after his/her own hernia repair in 2015. It’s on the About Us page. It looks like the three of them are the business, and both surgeons can be contacted through the Biohernia site.

Also note that they reference three methods – Shouldice, Desarda, and Muschaweck. And mesh removal.

Here is an excerpt that I translated from their Holland page, using Google translate. The web site is a bit clunky, it’s new of course. Click the “how does it work” from the info link.

“Kom voor een kennismaking met onze chirurg, Dr. Andreas Koch, langs op één van onze maandelijkse spreekuren.”

“Come for an introduction to our surgeon, Dr. Andreas Koch, along on one of our monthly office hours.”