[Good intentions]

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.

[Good intentions]

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.

[Good intentions]

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.

[Good intentions]

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.

[Good intentions]

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.

[Good intentions]

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

[Good intentions]

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

[Good intentions]

Good luck dand. 14 years is a long time to live with a hernia.

Posting your surgeon’s name again to add to the list of experienced hernia repair surgeons who use robotic methods. Also, another Progrip story. I hope you’ll post again as time goes on.

Stephen Pereira MD at Hackensack NJ

[Good intentions]

I don’t really know where Wikipedia information comes from. But the Inguinal Hernia Surgery page is very well referenced. And seems to fit my own general impression, from the numerous articles I’ve read.

But, even so, there is little distinction between the brands and types of synthetic mesh, except for lightweight versus normal weight. Still, it’s very well written, and was updated on May 18, 2018. Much more useful than the SAGES page.

https://en.wikipedia.org/wiki/Inguinal_hernia_surgery

[Good intentions]

I assume that you meant Brian Jacob, not J Brian? They have the experience. I’m surprised though that they would make a blanket statement like that. Maybe they don’t know of or don’t believe the stories.

Still not clear what you me by “lifting”. Are you talking about gym lifting? Weight work? This is not a body building or weight lifting site where “lifting” would mean squats or dead lifts or similar. No offense. I’m guessing that that is what you mean, but you might mean something totally different. The type of lift, even if it is in the gym, might be a clue.

Also, the “area” where the mesh is is pretty large for laparoscopic surgery . Typically about 4×5″ at least after they trim 6×6″ pieces to fit the space. That’s just one side. If you had bilateral repair then you have twice that. So pain “where the mesh is” covers a lot of area. That would mean that all of your lower abdomen is in intense pain.

Sorry to keep picking on your posts. There’s just not much there to think about.

[Good intentions]

It sounds like the expected “foreign body reaction”. You’ve had the peritoneum peeled off of the abdominal wall and pieces of mesh inserted in between. It takes time for your body to cope with the foreign material and cover all of the mesh fibers.

Do you know what brand of mesh was used?

Since you are only 4 weeks after surgery you’ll just have to wait and hope. It’s still very early. Good luck.

[Good intentions]

quote routern7:

I saw many doctors and they say no way it is the mesh. They said mesh complications should start directly after surgery and that heavy lifting will never cause mesh to fold or move or cause this kind of pain especially after 1.5 years from surgery.

I did have tenderness after surgery but it was not blocking my life.

Mesh problems are like a nightmare to surgeons that implant mesh and they seem to have a psychological block to dealing with them. The responses that you got are what they are typically taught in medical school or residency. The fact that you had tenderness and discomfort right after surgery, is, by definition, a complication. They are ignoring that fact. If you are just seeing general practice physicians they will go to the current references to learn about mesh problems and that is what they will read.

Can you describe what you mean by “heavy lifting”? It’s very vague.

Also, post a general location. State, city, metro area.

Good luck.

[Good intentions]

Hello msp. Just wanted to let you know that I did actually post a long reply to you but it got flagged as spam. It’s out there somewhere, I hope that Dr. Towfigh will release it.

The gist of the post was about keeping a log of what works and what doesn’t. And possibly ramping up activities to see how much is too much. Since you’ve been dealing with it for three years you might feel like you are familiar with it, but I’ve found that some actions can cause a delayed response. The correlation shows up as you look back on what you’ve been doing.

Good luck.

[Good intentions]

quote emckenna:

I am an endurance triathlete who recently underwent two hip labrum repairs and FAI (left hip in Sept 2017 and right hip in Nov 2017). I had great recovery for both until February 2018 when I began experiencing left pubic bone pain and lateral/outer hip pain. Shorty thereafter, the pain turned from muscular/skeletal pain (which was painful yet tolerable) to include nerve pain. At this point, everything seemed to spiral.

Since February, I have been unable to partake in all physical activities and require assistance for routine activities such as lift pots and pans too cook, carrying a light suitcase, etc. After months of trying to understand it, I think it is nerve pain.

In terms of test and diagnosis – I have seen several orthopedic hip specialists and surgeons as well as general surgeons, a rheumatoid specialist (who confirmed no rheumatoid issues), and pain management specialists. I have had two pelvic MRIs (one that included a few images of my upper abdomen), a left hip MRI, a lower lumbar MRI, and a CT scan (with my left and right hips read). I have also had multiple nerve blocks into my hip joint, psoas, genitofemoral nerve and ilioinguinal nerve. All have provided some relief but not full.

My MRIs show possibility of a very small re-tear of my left labrum or perhaps just abnormalities from the original surgery –

I have been diagnosed by a general surgeon with a likely hidden inguinal hernia. I have received mixed diagnosis on athletic pubalgia/sports hernia and/or perhaps mild chronic detachment of the rectus abdominus-adductor plate at the lateral edges.

I lived and was very active with labrum tears for years and so I am relatively confident my pain is not coming from a possible small retear. I do however have some swelling, numbness, and burning/tingling feeling (with certain movements) in my lateral/front hip and upper/outer thigh though which is perplexing

Hello emckenna. I don’t have any direct advice but I did have some questions while reading your post, that others might have also. I broke your post in to pieces to try to make it more clear.

Your last surgery was about 6 months ago? You “recovered” then were okay for about 2 – 3 months. Then started having pain which has lasted about 2 – 3 months. So, it’s been a relatively short time since surgery.

How long did you wait before going back to full effort activities? Your “recovery” time. Did you feel like you were completely healed up or were you training around the healing process?

Did the pain in February come on “overnight” or did it slowly build as you ramped up activity level? Are you taking full rest and recovery breaks or are you testing things as soon as you can? Maybe you need to take more rest and start from a lower base. I know that athletes hate to lose their fitness and will often try to shorten recovery times.

Did you talk to the surgeon who did the original surgeries?

I’m not a doctor but I think that swelling is caused by some sort of physical damage. I’m not sure that nerve irritation alone will cause swelling. So, the swelling seems to show that some sort of physical damage is occurring. Even if nerve irritation alone will cause swelling, it seems like the physical manifestation of the pain is a good area to focus on.

Good luck. I’m trying to work back to higher fitness myself, and figuring out what is happening in the surgery area is very difficult.

[Good intentions]

I have read good things about Dr. Ramshaw. There are some posts that mention him on this site. He is certainly worth contacting, I think.

I just got my medical records today, from my mesh removal procedures at the end of 2017. I asked for them just to be sure I understood what had been done. There are some comments in the post-operative reports that might be of interest to you, but probably won’t make things more clear. Dr. Billing reported that both sides of my abdominal wall, where the mesh was, looked “normal” after inserting the tools and taking a look. In other words, there was no obvious sign of a problem. But we already knew that it needed to come out, based on my description of my symptoms, so he removed one side, the worst side, as planned. So, I think that’s why it’s best to find someone who has experience removing mesh or knows of cases where mesh has been removed. They know the symptoms, and, as in my case, sometimes the symptoms are all there is to work with. If just an exploratory look had been planned, nothing significant would have been seen. I don’t have any regrets about having the mesh removed, but my symptoms were obviously tied to the mesh.

Also, one thing that struck me about reading my own correspondence with Dr. Billing, which is included in my records, is that I really did put a lot in to describing my symptoms and the activities that preceded them. I think that that helps everybody involved in making the right decision. The words on the page are all that most of the people involved will have to examine, from the insurance company people who have to approve payment, to the surgeons themselves when studying the case later. Things will also become more clear to you as you try to describe them.

Good luck.

[Good intentions]

Have you read the Sports Hernia thread? There might be some clues there.

Hernia pain is, in essence, nerve pain, as nerves get stretched and damaged in the area of the tissue damage. Since you’ve had all of that surgery in the area and probably have lots of scar tissue pulling in unusual ways, even if you had a hernia, and had it repaired, it might not solve your pain problem directly. Just a perspective.

Have you tried varying or expanding your activities to see if anything helps? I have had short times, days long, of persistent pain after mesh removal that would not diminish with rest. I decided, based on the research like that of Dr. Bendavid, that the scar tissue might just need to be moved around to get fluids flowing and help with moving irritants out. Nerves are growing in to areas of low blood flow, the scar tissue. So I went for a solid 2 mile run. And it worked, the pain went away and I got back on the path of recovery. It’s counterintuitive but it’s part of my routine now. Certain types of pain are a sign that I need to do more.

I also found, back when I was trying to make the mesh work, that lifting weights had a similar effect. The increased abdominal pressure, and straining to lift, seemed to stretch and move things to where they felt better. It wasn’t the range of motion it was the activation of the muscles, I think.

In short, I’m suggesting that maybe you try to stress the problem areas, in a controlled fashion. Go beyond walking or stretching, maybe do something more extreme. Ideally, you’d have a professional physical therapist help you, but I don’t think that the problem is amenable to the common therapies. It’s a risk of more pain, but if you don’t overdo it you should at least be able to get back to where you are now.

I also just suggested this in somebody else’s thread – keep a log of your activities and how you feel. It looks like you already do, but make sure that you track the time between also. I’ve found that some actions have a delayed effect, and you can miss the correlation if you don’t keep track.

[Good intentions]

In broad terms, the statement is saying that all mesh products are the same. There are many many alternative designs, but somehow the “expert” witnesses were not able to make that clear.

The irony is that Bard markets its “alternative” design, the 3D shape, explicitly. 3D Max is the alternative, feasible design for flat mesh.

It’s one of the barriers to understanding why one out of six people will probably have chronic pain from mesh repair. Bard put a lot of time, money, and effort in to developing 3D Max as a “better”, different, product. Without understanding why these failures occur they just allow them to continue happening. Letting the courts classify all mesh products in to one broad category is not helping anyone, except Bard.

p.s. I don’t mean to seem argumentative. I’m just stating what I see. It’s a missed opportunity. Bard has a financial obligation to their shareholders to win these cases. But if they lose, the obligation turns to making a making a better product to avoid similar losses, which requires understanding the failures. It’s the great strength and weakness of our free market economy. Money drives progress.

[Good intentions]

There are many things that you can strain down there that will cause pain. Have you read the “Sports Hernia” thread on the front page? They usually show pain during activity, not so much at rest.

Good luck. You’ll probably need to monitor it over time. I’ve found that keeping a simple log or diary of activities can help show what causes pain and how long it persists. It forces you to review what you’ve done during the day, and makes things more clear.

[Good intentions]

My situation was very different from yours. It was very clear that the mesh was the problem since the pain, soreness, discomfort and side effects covered everywhere the mesh was in contact, and surrounding areas, from the first few weeks after implantation, never ending.

As far as exploratory, the first surgery was for removal of one side’s mesh, it was that bad and we knew it was going to come out, and the look at the other side was just to plan the second surgery. It was one month to the second surgery, but normally they would wait six weeks. I asked to have it moved up to four weeks.

When I was initially planning to have my hernia repaired I searched for surgeons that had experience working with athletic people. It was surprisingly difficult to find any that were close to my location, and known for that type of work. But you might have better luck. With the large number of people that have hernia repair you would think that there must be a surgeon who has seen your type of problem. One who repairs construction workers, for example, maybe.

I found that my whole lower abdomen would swell and be painful like you’re describing, when I had the mesh. I often left my pants unbuttoned and used a belt. Does the pain subside at all over time, if you stop all activities? I could go through a cycle of feeling “okay” by not doing anything but could not go back to being active without starting the whole process of pain and soreness over again.

This thread, linked after, might help you. Dr. William Brown, in CA, has lots of experience. It might be a good starting point for recovery even if it ends in mesh removal. Since you caused some new damage, it might be that you just need help in getting it healed. https://www.herniatalk.com/7643-hern…oid-injections

Dr. Billing in Shoreline, WA is also very good at assessing these types of problems for what they are, he has been removing mesh for over eight years. I mentioned telling people your general location earlier, if you want specific recommendations.

[Good intentions]

Your problem seems difficult to tie directly to the mesh, since it happened during a specific action. Mesh problems generally seem to build up over time, from what I’ve read, or show up immediately after implantation. You’re saying that you weren’t disabled for about 1 1/2 years, then suddenly, in one action, injured yourself.

Was it one lift of a heavy weight or a period of heavy lifting, like a training session? If it was one lift you might have damaged something else. Of course, since you know what the discomfort felt like originally, you would know if it is more like an amplification of the mesh-based discomfort.

A good surgeon will just do what is appropriate, even if it means closing you back up with no action taken. I think that TAPP is the method that would be recommended. My surgeon looked at the left side while he was removing the right, then used the same entry point to remove the left in a second surgery, so it can be done. I had TEP originally for bilateral implantation. Some surgeons will just go ahead and remove the mesh though, as I understand things. Recovering from mesh removal is a whole new experience, it takes time.

I would make sure that your description of what happened is very accurate and let your surgeon help decide if it might be the mesh. Unless you’re positive. Find a surgeon who knows about the other types of injuries that might have happened.