Good intentions
Forum Replies Created
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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
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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
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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.
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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.
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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.
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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.
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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.
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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.