Good intentions
Forum Replies Created
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Another person on the same forum had open repair with mesh 8 years ago and said he is also very happy with it. Said it was “perfect”. Another weight lifter.
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Somebody on another forum just reported that they were happy with open repair using mesh, after 19 months. Body builder/weight lifter. They would choose the same path if they had to do it again.
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I would ask the surgeon who is planning the exploration what they are looking for and what they will do if they find it. That’s not very clear. Will a second surgery be required or will they fix it right away. If you had laparoscopic implantation for the first repair and you have open surgery for exploration then you will have scarring from both sides. I think that some of the pain from open surgery is from the incisions themselves. You might end adding pain on top of pain. There are laparoscopic methods of exploration.
Also, I keep saying this, but it’s very important to keep track of the details, of your surgery and of what, exactly, causes the pain. If you just tell people that you had a hernia repaired and it hurts that could mean so many different things that nobody can give you good advice. Write all of the details down and keep them in a file. Copy and paste them in to your communications. If people can’t find your old posts then you’re starting from scratch on each new thread.
Good luck.
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quote Orchard212:At the end of March, I had robotic repair of bilateral inguinal hernias with mesh.
The surgery and recovery went fine. Nearly 8 weeks after surgery, while walking, I experienced the same pain that I had prior to surgery on my right side. Since then, the pain has been almost constant while walking and sometimes more pronounced than it was prior to surgery.
My questions are, is it too soon after surgery to consider that my right side hernia was not fixed or has reoccurred? If not, should I see the surgeon about the pain or the sports doctor who originally diagnosed me, or possibly a hernia specialist?
Can you give more detail on the type of mesh used for the repair. There are so many possibilities.
Are you saying that pain goes away when you’re inactive? It’s only there while walking?
You should certainly tell your original surgeon about the problem so that he/she knows, for future reference at least. It’s hard to give advice on which type of doctor you should see, since levels of expertise can vary even within a specialty. A hernia “specialist” could mean high volume or high quality.
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Hello routern7. I just tried to post in your other thread but it came up as “Unapproved”. Hopefully Dr. Towfigh will fix it soon. Good luck. Keep track of what specifically causes your pain. It’s important.
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You’re in a tough spot routern7. After one and a half years the mesh will have much tissue ingrowth and with your activity level will have shrunk to about 60-70% of its original size. It will be stiffer now and won’t conform to the shape of the body around it if it moves. Nothing at all like when it was implanted. So if you did pull some mesh free it will now be like a stiff piece of plastic free to poke and rub on the nerves and tissue around it.
The problem you might have with exploratory surgery is that it will look like healthy tissue, especially since you have reduced your activity level to compensate for the pain. The inflammation will heal up and by the eye it will look like “normal” mesh with healthy tissue surrounding it.
If you can feel the mesh poking you in certain areas as you move and you feel that it is what is causing the nerve irritation and pain, that can be used as a reason for having it removed. But you have to become an expert about your own body and be able to describe it well. If you had been in a car accident and a piece of stiff plastic had penetrated your abdomen it would be an easy decision for a doctor to remove the offending object. It’s just very hard for people to realize that the soft pliable material they implanted has morphed in to a stiff irritating foreign object.
Good luck. Keep track of what actions, specifically, cause the pain, and use very descriptive words for what the pain feels like. It can be difficult but it’s necessary for the doctors to make that decision with you to remove the material, if there is no other recourse. But, as I found, nobody can decide for you.
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quote UhOh!:Not to hijack this thread, but a related question: Is it true that ease of manual reducibility and tendency to spontaneous self-reduce upon lying supine can determine the type (between direct and indirect) and if so, how accurate are these indicators?
I know that my hernia had what seem to be the classic signs of a direct hernia – a peaked bump medial to the groin when standing, that disappears when lying down. I haven’t see a clear explanation of what, exactly, is stretching or tearing and/or why a bump forms there. I assume though that the “tear” extends across or in to the inguinal canal. The image of a round hole is probably incorrect, it’s probably a longitudinal or oblong defect. Some of the omentum and intestine is pressing directly outward, visibly, and some is pressing in to the canal, where the spermatic cord is. While I was trying to live with my hernia, at times my right testicle would get pretty screwed up as the spermatic cord got pinched.
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quote Jeremy B:Good Intentions, thank you for your response.
I am a 37yo male, 170lb thin, 6’2″ diagnosed with a right side inguinal hernia by two local surgeons (both hernia specialists);
Neither of them were able to determine subtype upon examination.I see. You must be early in the hernia development process, with pain and/or pressure but no significant physical signs. There have been a few others on the forum with that problem.
I think that Dr. Kang has a mesh-free solution for direct and indirect hernias. I would imagine that Dr. Brown does also. I think that the open surgical method starts the same way for both so in the end the result might feel the same. I think that repairing a direct hernia soon, before the tissue gets stretched and/or torn, is important. I think that one of the reasons that mesh became popular was because it works well for large defects. If you wait too long on a direct hernia, you might just wait yourself in to mesh, or a high recurrence probability.
Good luck.
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I’ve been under the impression that the physical exam will determine direct versus indirect. Can you give more detail on what your situation is? It’s a bit confusing. It’s sounding like you’ve been diagnosed with a hernia and mesh implantation was suggested as a repair method.
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Three of the site surgeons are from your general area. VA, NY, and MA. I added the link below. Chaunce1234 often posts a list of surgeons that seem to be up to speed on current events. You might search for some of his posts. Good luck.
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Can you give more detail? “Large” can mean many things. Direct or indirect? What kinds of activities do you expect to do afterward? What did the surgeon that you saw recommend? Open, laparoscopic, mesh…?
These are interesting times to have a hernia repaired. So many possible repair methods, and materials, but so little confirmation of superiority of any of them.
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I had a similar experience. The imaging didn’t show anything. Blood tests showed nothing. Urologist said he had never heard of mesh-related problems. Too much dependence on the bureaucracy and not enough plain-old being a doctor.
I know you’re in the wrong part of the country but if you can find somebody who has successfully solved a mesh problem you’ll be better off. It’s just not taught in medical school or residency. Most don’t know what to do about it.
In my case, the mesh inflammation caused several secondary problems. The body’s response to inflammation is more like a shot-gun than a rifle.
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I just came across what looks like an excellent publication on pain management after hernia repair. It might help you with your decision-making. Good luck.
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quote Dwight:Surgeon now wants to get it over with by going in and removing a mesh staple, which he seems certain is the cause.
He is a hernia specialist, seems truly puzzled by this complication and won’t admit ever having had this outcome before.
The doctor says it’s pointless, let’s just go in and remove the staple.
Just to break the problem in to it’s simplest parts. Your surgeon can’t be certain and puzzled at the same time. What he’s offered would be his best guess.
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It seems like the issue might be more about when the “thinning” actually starts causing pain. How much bulge? Does there need to be a “breakthrough” in order to have something to fix? And, of course, how to fix it otherwise. You said that the ultrasound did not show anything. Do you mean that you could see an external bulge but no bulge via ultrasound? That kind of doesn’t make sense.
This seems like another situation where you need to find somebody very experienced. I just mentioned this in another post – don’t be the patient that your doctors are learning from. Since you got the injury from training for an athletic event, seeking help from a surgeon who works on athletes makes sense. Don’t get locked in to what your insurance system allows. You can waste a lot of time trying to work with the typically limited selection of experts available in most insurance plans.
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quote Dwight:Surgeon now wants to get it over with by going in and removing a mesh staple, which he seems certain is the cause. He thinks I’ll never fully heal without this course of action. He is a hernia specialist, seems truly puzzled by this complication and won’t admit ever having had this outcome before. I’m wondering if I should just wait, since I’m seeing slow (but very slow) progress.
Also, my wife is adamant that I need to get an MRI scan. The doctor says it’s pointless, let’s just go in and remove the staple.
If he’s never seen it before then he will go to the books to learn. And the books say that staples or tacks in to sensitive areas are the primary cause of pain. So you have a few contradictions and concerns. If he is an expert then he would not have put the staple in a sensitive spot. So, how did it get there? How can he be cert an that it’s the staple? The guy that made the mistake is going to be back inside. Is that a good idea? If he is an expert and he did everything right, then the staple won’t be the cause.
And if he’s never seen it before then he will be, essentially, experimenting on you. Using you as a learning aid. That’s not a good scenario and can lead to a series of potentially harmful procedures as he tries to understand.
I saw this with the surgeon who implanted my mesh. He was very very reluctant to seek outside help. He tried to make his limited knowledge work, at my expense. I had to implore, via a written letter, that he seek help from someone else and he finally gave in and agreed to do so. But he was still too slow and I found my own solution. I never heard from him again.
On the other hand though, if you go to another surgeon he or she might just assume that the first surgeon made a mistake and also suggest staple removal. I would try to find a very experienced surgeon who will have seen some problems and know how to deal with them.
Your wife has good point. If the staple is in an “incorrect” spot it should show up via imaging.
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I had signs of inflammation in my navel before I had my polypropylene mesh removed. No weeping or open wound but after certain activities you could see reddish fluid building up in the area. Your situation reads like you probably had constant inflammation or an infection around the mesh. You probably tore a section free while moving the couch. Now that it is clearly infected, odds are that it might need removal. Search “mesh salvage” and “infected fields” on the internet and you will find a lot about the topic. Apparently it’s very difficult to kill the infection once it finds a home there. Kevlar is an unusual material for mesh. It has a very fine and small fiber structure which would seem tailor-made to hide infection. Unlike the relatively large and smooth surface of the other polymers.
I hate to be negative but better to be prepared. The good news might be that even if it needs removal and replacement that area is not full of delicate structures like the groin hernias.
I think that I have seen posts on this web site also about umbilical hernias. You might search there for that topic. Pretty sure I’ve seen Dr. Kang post on the topic.
I’m not a doctor, those are just some things I’ve learned about over the past few years. Good luck.
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My understanding of the hernia sac is that the peritoneum layer can actually thin out as it gets extended until it’s almost gone. A surgeon told me that. But, I’m fairly certain that the body will try to maintain that layer of peritoneum so will be working to heal it back to its original function. After mesh removal much of the peritoneum has been disrupted and the intestines are sitting on raw damaged tissue. Eventually new peritoneum grows in, as I understand things. I don’t know if it ever gets back to full coverage but the process continues for years I’m sure. The genetic code persists.
Another interesting fact that I’ve learned is that omentum, which I had thought of as just a gooey material that filled the space around the intestines, is actually a fold of the peritoneum. And it’s fairly active, it can get cancerous. The biology of the “bag” that the guts sit in is actually pretty complex.
The short answer might be that even if a hole was created it probably wouldn’t matter much. Another thought would be that hardness doesn’t really matter if the material can just slide by. If you consider the spermatic cord’s path and how it passes over a very hard area but never seems to get injured it might give another perspective.
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I don’t know much at all about how constant inflammation might affect cancer-prone tissue. I don’t think that any of the possible repair mehtods need fat for support. Fat or omentum or intestine are all potential recurrence sources. Anything slippery AND MOBILEthat can ooze under the mesh is bad.
One thing that might more important is the type of hernia, direct or indirect, and its location. If you read Dr. Kang’s posts in the thread linked below you’ll see how they can be treated differently. Today’s laparoscopic mesh procedures tend to be a one-size-fits-all method, with large area coverage. If your hernias are indirect then a simple tightening of the deep ring would seem like the simplest most appropriate repair method. No need for mesh. If I understand things right, I’m still learning.
Even a direct hernia can be repaired using a minimal amount of mesh, if a tissue repair method is not appropriate for you. I would imagine that a doctor could think that they are doing you a favor by covering all of your abdomen with mesh. So be prepared to hear that. The “state-of-the-art” still assumes that “mesh”, of any kind, is an inert object in the body. It’s what is being taught at the big training clinics, and on the web sites of the medical device makers.
Good luck.
Here is that link – https://www.herniatalk.com/7478-marcy-repair-in-adults-with-inguinal-hernia
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Here is what looks like a long-term success story, although it appears that more work might be needed, after 16 years. In 2002 the mesh was probably one of the “heavy weight” meshes.
A couple of quotes from the post, and the link to the original thread.
“laparoscopic, mesh repair for an inguinal hernia in 2002”
“bilateral laparoscopic mesh repair for inguinal hernias. This is the first time I’ve had a problem.”
https://www.herniatalk.com/7643-hernia-mesh-pain-treatment-steroid-injections