[Good intentions]

Welcome back ajm. I don’t think that you ever said what type of surgery you ended up getting. Type of mesh, quantity, placement. Could you share that?

Since the lower abdomen and abdominal wall are essentially like a bowl that your intestines sit in, weight gain seems like it would add pressure. So it seems sensible that it would cause more discomfort.

[Good intentions]

quote W.Parker:

Also, I was concerned about the type of mesh that was used…being a veteran they told me there mesh product hasn’t changed in 50years and only concern is with the dissolving mesh type.

Edited – Mesh was introduced about 50 years ago. But, still worrisome, that they think they’re all the same. Makes looking for a solution seem hopeless. Narrow-minded.

Do you know what type of mesh was used, and what procedure? Was it an open mesh implantation? How did you get the hydrocele for the first surgery?

Change will continue over the first few years, with the mesh shrinking, and the tissues around it getting pulled. Good luck, sorry nobody had some advice on your first post. I felt most of the soreness right at the spot of my direct hernia, in the first few months.

[Good intentions]

quote Khernia11:

So you had it done lariscopically when it was implanted and also removed? I saw somewhere here that the way It goes in is the way it must come out? I had mine done open and my first initial consultation from one of the surgeons who do open procedures on the list above said they could likely only get 60 to 90% out. Was that what you heard from your consultations as well?

Also, I was wondering what Were your main reasons why you went through with the removal…was it only pain issues or did you experience other symptoms such as feeling sick, intermittent dizziness spells\off-gate\fatigue or episodes of general malaise and rashes that would come and go? Thanks again for your reply.

I had mine implanted via TEP, but removed via TAPP. I’m not so sure that the procedures need to match for removal. TAPP is essentially like open just from the other side of the abdominal wall so if the mesh is a patch that was placed between the peritoneum and the fascia, it should be accessible via TAPP. But I’m not a doctor. TEP is a very specific procedure, to split the layers apart but leave them intact. I think that TAPP might be the preferred removal method, because they can see all of the abdominal wall, through the peritoneum, before they start removing, and they don’t have to cut through muscle or fascia to get to the mesh, just the peritoneum.

I had mine removed because things were getting worse, not better, and I couldn’t imagine spending the rest of my life like that. I was withdrawing from doing the things that I like to do. Spending all of my time managing my condition. It’s what I imagine people with cancer or colostomies or diabetes have to deal with. After being very healthy for many years I gained much empathy for people with chronic conditions, but I felt obligated to try and get out of it, since I have way too many years left to just wait for death.

I did not have any shooting nerve pain, or dizziness, or malaise, just the mesh hindering any attempts to lead an active life. It was like a prison.

Good luck. I seriously recommend that you don’t make your choice based on convenience or cost, unless you have to. As you can see from even very recent posts, surgeons who have been doing things a certain way for many years will generally just keep doing them that way. They’re not keeping up. Just like people are still getting mesh implanted that will cause them problems two or three or five years from now, there are surgeons who think that leaving 30% of the mesh inside is pretty good.

I had broken out my old German language books and was studying up to make a trip to see Dr. Muschawek in Germany, in parallel with talking to people in the states, while exploring my options. I had even called Dr. Petersen’s office down in Las Vegas and had the details needed to travel down there and have the open procedure done. But after talking to Dr. Billing I chose him, because he was very sincere, confident, and had the experience. Dr. Billing has been removing mesh for about eight years. From what I’ve read, Dr. Towfigh, Dr. Belyansky, and Dr. Billing use similar methods, TAPP, except that the first two might use robotics. Dr. Billing does not. The procedure is very time intensive, so I needed two surgeries, one for each side. I’m still not clear about the need for neurectomies, which might be another difference, and should be discussed.

[Good intentions]

I had the TAPP procedure used to remove the mesh. He got most of it, but like others who have had mesh removed there was a certain area that was too tied up with critical vessels to take the chance. That was on one side, where he left a small patch on the posterior wall. On the other side he thinks that he got all of it. Because of the constant irritation the whole abdominal wall gets scarred up. So, the hernia(s) are gone. After a few years of the body dealing with the scar tissue, they might come back, but there’s no way to predict it.

The recovery is ongoing. Even without the mesh, my lower abdomen is still stiff and flat, but getting more flexible. But, unlike when I had the mesh inside me, it’s a constant upward progression, rather than a slow stair step downward. There’s hope and I feel like I’m making real progress. I just don’t know how far I’ll get. There were some fairly immediate improvements, but getting back to pre-mesh levels might take some time. I’m taking it slow to allow time for tissue stretching and getting used to the new loads.

I’m hesitant to recommend removal in general because I see many different removal procedures being described, from open surgery with triple neurectomy all the way to my procedure, and beyond, using robotics. In my case, it was just a straightforward mesh removal, with no nerves cut, just a very tedious peeling of the mesh from the abdominal wall. But I know that many surgeons cut nerves as a matter of course when they do mesh removal, even the skilled and respected ones. I don’t know how they make that decision.

Ideally, expertise in mesh removal would become a skill that is shared and discussed widely, just like the skills for mesh implantation are. The robotic surgery trend seems to be promising, and seems so suited to mesh removal that mesh removal might yet become accepted as a normal procedure. Maybe then the mesh problems won’t be so quickly discounted.

Good luck. Feel free to ask more questions. I’ve delayed sharing my story because I wasn’t sure if it was going to “stick”. It’s only been 4 months and some days since the second surgery (one side at a time), but things are good so far.

[Good intentions]

Here is the link for Proloop, so that you know what is inside you.

If you look through the past threads, make sure to read Chaunce1234’s posts. He has a good list of surgeons who will remove mesh, if necessary.

http://www.atriummed.com/en/biosurgery/Documents/009966-PROLOOP.pdf

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Here is a link to Atrium’s web site. If I post too many links I might get blocked.

http://www.atriummed.com/en/biosurgery/default.asp

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I suggest that you spend a lot of time searching and reading about hernia repair mesh problems. There are many different forums out there where people describe their own situations. It’s difficult to tell how widespread the problem is, and there is some uniqueness to each person’s problems.

Your Proloop Plug is from Atrium, a company that is an example of how far out things have become in the mesh repair world. Atrium has a variety of “solutions” including, for example, a run-of-the-mill polypropylene mesh which they have coated with Omega-3 fish oil, a food supplement. The FDA has apparently approved this odd material as a bona fide hernia repair material. Not to make you more nervous, but your situation is kind of unique and the company whose product you have is not one of the big ones. The Proloop product is essentially a bundle of polypropylene fibers which are placed in to the hernia defect, apparently to encourage tissue ingrowth, creating a plug of polymer and human tissue. The directions for use are very much like those for a tubeless tire patch. Insert product in to hole, fasten with suture.

If I were you I would find a surgeon who does mesh removal, and also repairs hernias. As you’ve found, many will discount mesh problems with little thought. You need to find one who is broad-minded and experienced. You’ve had the product inside you for over three years. Obviously, to the open-minded doctor, something is changing, it might be the mesh. To the narrow-minded doctor, it can’t be the mesh.

Good luck. Keep researching and reading. Unfortunately, you’ll probably have to make a very impactful decision on your own, based on what you learn. You’re out of the main stream.

I’ll try to post some links to Atrium’s products in following posts.

[Good intentions]

quote SomeGreyBIoke:

Apparently majority of the problems experienced were with the old meshes, newer ones are better tolerated by body

No offense GreyBloke but I think that this is backward. The mesh materials are still about the same, old and new. Polypropylene or polyester, variations of weave and design, sometimes blended with absorbable fibers. And many of the threads you will have seen on this forum are from recent surgeries. I has state-of-the-art Bard Soft Mesh implanted by a state-of-the-art surgeon using the latest methods in late 2014. Then had it all removed three years later. It was almost the worst experience of my life, the three years of realizing that I wasn’t going to get better, and that the experts I had trusted really did not know and/or accept that the problems with the material and/or the procedure were real.

The majority of the surgeons who do this work are trapped in the mess. They really have no choice but to repeat or pass on what the medical device makers tell them.

I had the same general thought, back in 2014, just three and a half years ago, that you’re expressing – that the latest materials must be better. How could they not be, there’s no way that this could be allowed to go on for years? But it’s true – the problem with mesh implantation has been around for at least 10-15 years, probably longer. But they have committed to making it “work” and can’t go back. Don’t get lulled in to trusting the big institutions. Find an individual who can say, honestly, that they have patients who are known to be doing well with what they plan to do. Even then evaluate if they really “know” that to be true. There is a lot of psychological pressure to believe that it works.

This a big problem and these doctors really are stuck with it. They can’t get out from under it. Do them a favor and be very certain that the procedure you choose will deliver the results that you want. Surviving is not enough, you need to be able to live with it. Read the stories about the repetition of “no recurrence” when people go back to their surgeon with discomfort. Recurrence is the measure of success, not quality of life. And realize that the discomfort is constant and never goes away, if you get the wrong material and procedure, whatever that may be. Nobody is tracking results, good or bad.

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There is a new “sticky” at the top of the forum’s main page, about sports hernias.

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Jim82, if you could come back every few months, good or bad, that would be fantastic. Despite the huge number of hernia repairs, it’s very difficult to find any real-life success stories. There’s no way to tell why, if it’s something people don’t want to talk about, or if things are so good that they’ve forgotten they ever had a hernia.

I started a thread to try to collect some, hoping that something positive might show up. If the bad can’t be weeded out, maybe the good can be identified.

https://www.herniatalk.com/6883-successful-good-mesh-stories

[Good intentions]

Dr. Towfigh has written quite a bit about “hidden”, or occult, hernias. You can find a lot on this forum, and on the internet if you search those words and her name. Send her a message or contact her office directly.

Here is some information from her practice’s web site –

https://www.nytimes.com/2011/05/17/health/17brody.html

http://www.beverlyhillsherniacenter.com/hernia-education/types-of-hernias/

[Good intentions]

Here is something that I would add to Chaunce’s advice – get a copy of your medical records. Then write a clear and concise letter describing your situation. Send a copy the records and the letter, in paper form, to whichever surgeons you would like advice from, with phone and email address included.

I found that I could go to an in-person appointment with a clear picture in my head of what I wanted to say but, typically, the surgeon or doctor would, it seemed, not really hear what I was saying. Written words are clear and can not easily be “not heard”. It’s easier for them to read and ponder what you’re saying. Plus they have time to think about how they might respond and if they want to respond. In a clinical setting, the training is to get in, listen, make a diagnosis and a recommendation, then get out. It’s just the way the system works these days.

Good luck. My surgeons have all responded to my written letters. The responses were more productive than the result of the typical 10-15 minute phone or in-person meeting. Make sure the letter is short and to the point though, They will have more time to read, but still be time-constrained.

[Good intentions]

quote LostNPain:

Also, those who have had their meshes removed because of pain-did you find instant relief? Did you have a reoccurrence? Is your level of physical activity diminished due to caution of recurrence?

Is reoccurrence more common after mesh removal if a new mesh is not implanted? Especially with very active people ?

More questions…
For those who have had triple neurectomy, how are you feeling now? Are you happy that you had the procedure ?

I have been presented with options and am unsure which direction to go. It seems like each path is undesirable and I feel stuck.

Mesh removal is a pretty intensive operation, so you end up feeling, physically, somewhat like you did when you had the implantation. So, the relief for me was more mental, in that I was finally rid of the abomination in my abdomen. I had new hope that I might get some or all of my past abilities back. I also had certain problems, related to being a man, that did show immediate benefits, within days. Just removing the inflammation had that effect.

I did not have any recurrence and have not had any signs of one, in 4 1/2 months since. I doubt that I’ll try to set any personal bests for lifting heavy weights, but I have been doing heavy yard work, and just replaced a stove and a dishwasher, by myself. I’m not worried about recurrence. I’m back to just doing things, as I think of them. Not planning my life around the problem.

I also did not have any nerves cut. I don’t understand why that would be done. If it’s determined that the mesh is causing a broad-based inflammation there is no specific nerve that can be cut for that, as I understand things. I’m not a medical doctor but cutting the nerves seems like “insurance” for the surgeon, so that you won’t feel pain anymore. But it also means that you won’t feel pleasure, or just sensation, fomr what those nerves were connected to either. It seems like an extreme measure for a moderate, but persistent problem. I think that many surgeons don’t understand that it’s the persistence of the problem that is the real issue. Not the level. It never goes away. It’s always there and it is always going to get you. Cutting nerves just creates a new type of problem.

Sorry, I wrote another novella. I’m happy that I had my mesh removed. It was a hard decision to make though. I’m glad that I did not have any nerves cut.

I can offer though that TAPP seems to be the best method available today, to remove mesh. Dr. Petersen’s method of splitting people down the middle is just not necessary anymore. I would find a surgeon who uses TAPP and does not cut nerves. And has years of experience. They are out there, you just have to find them.

[Good intentions]

Here is a link to one version of Phasix. It is a fully resorbable mesh. It disappears completely, over a long period of time. Very different from the petroleum-based polymer fiber meshes. Bard says that it is designed for soft tissue repair like hernias, but they say the same thing for the polypropylene meshes.

Frankly, it looks like an experiment. All of the data is preclinical. But the FDA will probably approve its use as substantially equivalent to some past product. And Bard will start selling it. Then everyone will wait and hope.

https://www.crbard.com/davol/product-listing/sp/phasix-st-mesh/

From one perspective, it’s a sign that they are acknowledging problems with the existing products. On the cynical side though, it might just be the start of another ten to 15 year cycle of failure. They are playing both sides, telling people that the synthetic meshes are the “gold standard” but planning to replace the gold standard, all at the same time.

Sorry I can’t be more positive. The same people are behind all of these products.

[Good intentions]

Progrip apparently started out as a Parietex dereivative. There’s a reference to Parietex Progrip in this link. It seems popular with the surgeons.

http://www.medtronic.com/content/dam/covidien/library/us/en/product/hernia-repair/progrip-laparoscopic-self-fixating-mesh-info-sheet.pdf

Some of the surgeons still use the old names for materials, or companies. For example, Johnson and Johnson has separated themselves from mesh by creating Ethicon LLC.

I really hope things work well for you. I’ve heard good things about Progrip. Just a couple of stories, but they were still promising.

[Good intentions]

Parietex is a polyester-based mesh, apparently.

Good luck.

http://products.covidien.com/imageServer.aspx/doc187171.pdf?contentID=15068&contenttype=application/pdf

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Here is that link.

http://www.rimed.org/rimedicaljournal/2016/10/2016-10-31-sports-cohen.pdf

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Here is that link. I just got locked out of another thread though so it might not make it.

http://www.rimed.org

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Parietex is a polyester-based mesh, apparently.

Good luck.

http://products.covidien.com

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“Sports hernias” aren’t really hernias. The proper name of the condition is athletic pubalgia. It’s typically from overuse, not one-time actions. I posted a link in the post after this one, just in case the site locks me out. It doesn’t like links.

The mesh used for hernia repair is not actually made of flexible material. The polypropylene or polyester fibers are not very elastic. They are woven in to a cloth that is flexible on a large scale, by letting loops and knots bend and the fibers slide past each other. After it’s placed in the body and tissue ingrowth occurs, the knots get locked up and the mesh becomes stiff and non-extensible, less flexible than the abdominal wall was before it was implanted. It doesn’t stretch anymore. It actually shrinks. So you might have overstressed the repair site, stretching your abdominal tissue to a level higher than it’s seen, and either pulled an area of mesh free from the surrounding tissue, or torn/stressed some tissue at the edges of the mesh.

Hopefully your body will re-adapt to whatever has happened. But the concept of the mesh repair is that it becomes a permanent part of the abdomen, so trying to help your body adapt to the new damage is about the best you can do. Good luck. Don’t try to treat it like a muscle injury, which will typically respond well to daily activity. I’ve found that waiting a few days for things to settle down completely then ramping back up works better.