Good intentions
Forum Replies Created
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Your questions are very specific.
The last one though, isn’t really specific to hernia repair. It’s just pros and cons of anesthesia type. General is more risky, as I understand things, but necessary for laparasocopy. It’s not necessary for open though, so it isn’t used, just for general risk reduction.
The first question is actually two questions combined. Self-gripping mesh vs non-gripping mesh, and polyester mesh vs polypropylene mesh. It can’t really be answered directly.
Good luck.
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Thank you Momo. My comment about the engineer was more about how 60 minutes asked him to comment on a very complex science problem, the potential degradation of polypropylene in the body, when that is not an area that a plastics engineer would have expertise. Then they made it worse by oversimplifying it down to “oxygen eats plastic”, which is,of course, a gross oversimplification. But that’s how TV shows work, they need a catch phrase. The plastics expert should have said “that’s not my area of expertise”. His comments about identifying that the material was counterfeit were on target though. But plastic has been used in the body for many years, for a multitude of purposes.
It’s actually a big problem with much of what’s happening in the overall mesh travesty. People are oversimplifying, when they should be defining the fine details.
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Thank you Khernia, for bringing that to everyone’s attention. I actually got texts from family members when it came on, to watch it.
It was much better than I thought it might be. Very on-target, with the corporate greed and criminality, and the incompetence of the FDA. There are weak points, though, for example, having an engineer portrayed as an expert in polymer science. But, still, the story is clear. An unproven product, and counterfeit materials, pushed to market, to make money, at the expense of patients. People from Boston Scientific should go to jail.
One major shame of the whole situation, assuming the origin of the idea for this mesh is Lichtenstein’s work, is that Lichtenstein’s original work actually had value, and still does. The concept is valid and proven, but it has been exploited to where the good, and the potential good, is far overshadowed by the damage being done by the device makers’ devious methods to get market share.
Here is another link to the story for anyone that missed it. https://www.cbsnews.com/news/boston-scientific-gynecological-mesh-the-medical-device-that-has-100000-women-suing/
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Professor Sheen, aka Herniator, is in Manchester. He was on the site just a few days ago. [USER=”2016″]Herniator[/USER]
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Any tissue damage will cause some “free” fluid. Bleeding or just the body’s response to damage, I think. I have watched free fluid from large bruises travel down my leg. “Peritoneal fluid” seems like an odd term to use. It implies another hernia or a breach of the peritoneum. I’m not a doctor.
It looks like they’re just saying that they saw some fluid that shouldn’t be there but it’s not clear where it came from.
“anterior to the common femoral vessels at the prior hernia repair” means the fluid was in front of the femoral vessels. The mesh is placed behind the femoral vessels, so that means the fluid was between the mesh and the abdominal wall. Which implies that the mesh might have torn free from the abdominal wall and there is a damaged spot. Again, I’m not a doctor of medicine, but in view of how the mesh is supposed to work, the simple fix would be to get it to reattach itself. But, in the big picture, if that is the case, the question is “why did it break free?”
Anyway, it’s good to collect lots of information before making a decision. Good luck.
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Here’s a very good video description of the two basic types of inguinal hernia. I’ve noticed that most descriptions of hernia generally stop with showing the abdominal contents just starting to poke through the superficial ring. With the indirect it’s obvious that everything ends up in the scrotum.
But I haven’t seen a good description of where the direct material ends up. Where does it go after it gets free, which way? After it passes through the external oblique, it must be either under the fat layer or between the skin and the fat layer. Or maybe it’s bluntly dissecting its own pathway directly through the fat layer. In my case, it felt like the material was being pushed medially, toward the center. The initial bulge was peaked and distinct but eventually, as I tried to live with it, it grew to be broad and shapeless. After the hernia repair, when the swelling went down, I could see what looked like the shape of a deflated balloon under my skin. This area would get irritated and swollen with activity, then shrink with rest. Eventually it ended up as a small solid lump under my skin. I would probably make an interesting autopsy case for any students studying hernia repair. Hopefully far in the future, studying the ancient techniques that didn’t work.
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quote inguinalpete:a coviden progrip self-fixating mesh was placed in me using TEP. …
Since having the mesh put in I have continuous discomfort and pain from the hip bone to the lower groin. I am extremely limited in my physical activities. The area is very tight and has a prominent scar tissue ridge a couple inches long.
The only thing that makes it feel better is a couple months of rest, however after a rest period if I even do very light exercise the symptoms return again along with swelling of the area. I don’t know if a muscle or the conjoint tendon is straining or its due to the scar tissue. Any input would be greatly appreciated.I reread your first post and realized that I had been distracted by the other details. It’s very reasonable to assign the tightness to the mesh. All parties that deal with mesh will agree that the mesh shrinks as tissue ingrowth occurs. The ridge, as I mentioned, could be inflammation of tissue in that area. Not like a “scar ridge” from open surgery, just swelling from internal irritation. I still get swelling in the spot where, I believe, that the last patch of mesh could not be removed because it’s all tied up with critical parts. It’s in the area of my original direct hernia. It’s very firm and feels like a tendon, but I really don’t know what it is. But it is real, and visible from the outside. I have realized also, that the wall of the abdomen, the muscles and the fascia, that separate the intestines from the outside world, is actually quite thin. So any swelling will be noticeable. The mesh is not as deeply buried as you would imagine.
The cycling of pain with rest and activity is also similar to what I experienced. Really, stepping back and just considering the mesh and your symptoms, without the Bassini repair and the torn stitches, your problem looks like a typical mesh reaction.
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This is the Dr. Brown I mentioned, and it’s also the type of story that does not exist for the common hernia, and a mesh repair. Sometimes I wonder if some of these players don’t actually have real hernias. Regardless, the pros only go to certain places. If you can’t afford the travel and expense they might at least be able to refer you to someone in your insurance network.
https://www.sportshernia.com/dr-will…r-adam-moffat/
Edit – just realized that the story was written by Dr. Brown, for his web site. Still, Adam Moffat is a pro.
Edit 2 – it gets more interesting. Apparently, his sports hernia was an inguinal hernia. If you have contacts, he might be a good source of information for you.
https://www.transfermarkt.co.uk/adam…/spieler/36764
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You might have seen some of my posts about my situation, if you’ve browsed the site. I was a very active soccer player myself, in the amateur leagues, in very good shape, probably of above average skill level, and bilateral implantation of mesh destroyed me for soccer. I was able to get back to the field very quickly, without losing much fitness but it was impossible to play at a high level AND have a life besides playing. I told my surgeon that if I was a farm animal and only needed to work and eat, that the surgery might have been appropriate for me. But life could not be enjoyed at anywhere near the level before I had the mesh implanted. The mesh was a constant irritation, causing swelling and discomfort, reducing my aerobic capacity, and eventually getting stiff and board-like. I was happier with the hernia. It was a slow three year downward spiral until I had the mesh removed. I knew I needed to have it out at two years, I was thinking about it at under one year. I wasted a lot of time trying to live with it.
If you look up Dr. Muschawek in Germany, and Dr. William Meyers of the Vincera Institute, and contact them, I am sure that they will tell you to avoid any mesh implantation, if you have any plans to have a professional career. Dr. William Brown is also known for working on athletes. They all work with athletes and they all see what mesh does to them. They all understand athletic pubalgia (sports hernia) also. They all have answered my email messages. Travel to someone who knows and has proven success with athletes. Do not try to work within your insurance system, or find somebody close, or try to save a few weeks or months, do whatever it takes to find an experienced hernia repair surgeon who repairs athletes. If they can’t look you in the eye and say that they have repaired a professional athletes hernia, one like yours, don’t let them fix yours. Your choice will affect more than your career, it will affect the rest of your life. Many surgeons do not really know what happens to their patients beyond the first few months after surgery.
And I can’t emphasize strongly enough how impossible it is to “work through” the effects of the mesh on your body. It’s not like an injury that will respond to a plan of physical therapy or nutrition or just working harder. The harder you work to get your body to accept the mesh the worse the response is. You can’t gut it out, or out-smart it, or take painkillers to cover it up. It’s like a living thing in your gut that you have to take care of.
My surgeon was top-notch, well-respected, and knew that I was a very active soccer player but he either didn’t know about how athletes have problems with mesh or he thought that his skill level would make a difference. There is a meme out there that the most important thing to look for in a hernia repair with mesh is the surgeon’s skill level. But there is also evidence that it is the material itself that causes the problem. So no matter how good your surgeon is, it won’t matter. I have looked far and wide for a success story about a professional athlete who was happy with a mesh implantation and have not found a single one.
Your story, except for the professional part, mirrors how my ordeal started. Having bilateral laparoscopic implantation of mesh was the worst decision of my life.
Good luck. Don’t convince yourself to “take the plunge” or “roll the dice”. The odds are stacked very much against a true athlete.
p.s. the hernia repair surgeons that use it really believe in it. That’s why you have to be extra careful. They just don’t know.
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quote Pete:I am faced with making a decision about mesh removal now and leaving me exposed to future hernias as only stitches would be used to sew me back up apparently.
After mesh removal you will be essentially starting over as far as hernia recurrence, as I understand things.
And there is a wide range of mesh removal possibilities also, from open surgery, entering the abdomen from different points, to TAPP laparosocopy using robotics. The TAPP procedures enter from small incisions in areas that are not hernia prone, so the risk of hernia really only comes from the removal of the mesh reinforcement and the skill of the surgeon in leaving a smooth surface behind, with even stress distribution. That’s my guess, from an engineering perspective.
It’s probably hard to recall the memory from back when you had the original hernia, but it might help your decision if you consider mesh removal as starting over, with hernias, as the worst case. Then you can have them fixed via different methods. It might be that the hernias don’t recur and you’ll settle at some new acceptable condition.
Good luck. Talk to the surgeons that use TAPP and have experience in mesh removal and things will be clearer. Dr. Billing, Dr. Belyansky, and Dr. Towfigh, for example. You might be assuming that things will be worse than they need to be.
As far as pain, my thought had been that the pain and other problems were coming from general tissue irritation and inflammation, from the mesh, as your body moves and causes it to bend and stretch. As Dr. Bendavid proposed in his paper about SIN. It isn’t a few nerves that can be neutralized, everywhere that has mesh is affected, as the body tries to re-innervate the damaged tissue, growing new nerves in to the scar tissue around the mesh. Then the mesh redamages it as you try to live your life. It’s a cycle of fix and destroy. That’s one source of pain. The other is from the constant shrinkage around the mesh as body goes through it’s normal healing process. My abdomen flattened out and stayed tight like there was a battle going on. Stretching it via exercise caused damage, which caused a healing response, which caused more shrinkage. At times it felt like I had a plastic picnic plate inside my lower abdomen.
Here is a link to Dr. Bendavid’s paper – http://file.scirp.org/pdf/IJCM_2014072117033945.pdf
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quote nonPalpableHernia:Otherwise, I’d go straight for surgery and get past this asap.
My question is, has anyone managed discomfort of a small hidden/occult hernia with exercise. Looking to making it easier to work until it is palpable and ready for surgery.
Thanks!
Be careful. Take your time and read up on what you might be getting in to. I thought something similar, about getting my direct hernia fixed, so that I could move on with my life. It had the opposite effect, consuming my life for three years, still affecting it today, after mesh removal. I was very healthy, and should have been a great candidate to show how advanced the state of the art in hernia repair was. It sounded so easy.
Read through the threads on the site. Things are not as simple as many surgeons will lead you to believe. The true numbers are undefined, almost hidden. Don’t trust what you’re told, verify that it is true.
If you’re an active person, you could have athletic pubalgia, aka “sports hernia”, which, apparently, can lead to a real hernia. There is a sticky at the top of the first page about it. Treatment for it might not involve mesh.
And your symptoms of soreness and discomfort after sitting are some of the problems that I had after my hernia repair. The focus of hernia repair today is on the mechanics of the defect. Patching the hole. Not the comfort or life quality of the patient. That’s probably why they want to wait until there is a visible defect. Then they can show that they “fixed” something. My cynical view.
Good luck.
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I have not heard back from the person I contacted one week ago, Post #2 above. Hopefully he’s just having too much fun to reply.
I did remember one other person who had a successful hernia repair. It was done in 2006, an open repair with mesh, eight years before mine. He is actually the one who recommended the surgeon who did the bilateral TEP implantation of Bard Soft Mesh. So, even in his mind, as a general surgeon, he thought of TEP and open surgery as giving similar results.
So that’s one more successful open surgery with mesh. He was very active and athletic when I knew him and really believed that I would be better off after the TEP mesh implantation.
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Thanks Feuermann. Yours sounds like it’s one level up from your dad’s. I think that they use it for a more robust repair, for larger direct hernias. But it covers a small area so most of your abdomen will be unaffected, unlike the common TEP procedure,which opens a up a very large space. Good luck, and I hope you’ll come back every few months to update.
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A woman just posted about her imaging work showing hernias, then finding out that there were none when she had surgery. See her post titled “Bilateral hernia repairs”. I don’t know anything about your pain problem, but a misdiagnosis of hernias, plus your pain, could lead you to choose unnecessary surgery. Be careful.
You can message Dr. Towfigh to make sure she sees your post, and/or to give her more details. [USER=”935″]drtowfigh[/USER] Good luck.
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Hello Marty. I have heard of somebody who had whole body physical effects after mesh implantation for a hernia repair. He lived with it for many years, and eventually had the mesh removed, and is doing much better, as far as the constant feeling of being ill that he had with the mesh. He had been sick from the moment he woke up from the surgery, and knew that the mesh was causing it. But, like in your friend’s case, the doctors looked for every alternative cause that they could think of.
You haven’t asked a specific question so maybe you’re just gathering information. Your friend probably has the best idea of if the mesh should be removed. One of the hard parts of choosing to have mesh removed is the fact that you’re essentially alone. Most or all of the experts will recommend against it, for reasons that they probably don’t even understand.
Post a general location and people can advise of a local surgeon who knows the symptoms of mesh reactions. He needs to find an open-minded surgeon who will evaluate his conditions objectively.
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I would go see Dr. William Meyers at the Vincera Institute. He works on athletes.
It sounds like you got on to the “one size fits all hernia repair for the masses” conveyor belt. Within the last few years there is even a tendency for prophylactic mesh implantation, “while they’re in there”, although they can always find a reason. I don’t know if they can actually tell that the wall of the inguinal canal is weak if they don’t see a defect. They’d have to poke at it and do it by feel. Very suspicious, it looks like they got in there, found nothing, and thought you would want some value for your time. Good intentions at work. Or just didn’t want to close you back up and tell you that they did nothing. Many hernia mesh implantation surgeons don’t really seem to know how an athlete’s body works, so they probably didn’t even consider that aspect.
Dr. Meyers can probably tell you what was or is really wrong. Whether or not he’ll remove mesh is unknown. He might, I think, if he thinks it will help and if he can get it out before it gets covered with scar tissue. “Incorporated” in to the body is the popular term. Once it gets incorporated, with tissue ingrowth, things get more difficult.
Send your medical records (get a copy soon) to the Vincera Institute, with a letter, and they will at least get back to you with an opinion, I’m sure. They did for me. I would do it very soon.
Sorry if it seems that I’m confirming worst fears. That’s just what it looks like based on what you wrote. No hernias found but they implanted mesh anyway. And athletes are known to have problems with mesh. Those are the basic facts. Good luck.
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Thanks for adding. Do you have any details on your dad’s surgery? Type of mesh, type of hernia, how long it took him to recover? And any details on your own, the same questions.
One of the major difficulties in learning anything at all about what the cause of the problem might be for those of us that had problems, is that ALL mesh gets grouped together. Even though there are many many different types of mesh, currently and over the years since it was introduced.
Did you have the same surgeon perform your surgery? Did he use the same material and method? Somebody recently had a hernia repair at a VA hospital and, apparently, they are doing the same thing that they’ve been doing for many years. So, it might be that we just need to unwind some of this “progress” and go back to what was working.
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My direct hernia progressed sideways, toward the center, after it broke through. It was a bit higher than the pubic bone though. I have not seen much written about where the material that pushes through the abdominal wall actually goes, with a direct hernia. With an indirect hernia, it ends up in the scrotum. But the direct hernia material goes wherever the weakest point lets it go, I believe, once it pushes through the fascia. There is a defect, material gets pushed through, and the sac continues to grow as pressure “bluntly” dissects a bigger cavity. My surgeon described pulling a large amount of material back through the defect, and I had what looked like a deflated balloon shape under my skin after hernia repair.
So, in my uneducated view about how hernias work, it seems like you could have hernia sac material in that area.
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Sharon Bachman looks like an interesting surgeon also. “Hernia geek”. Not clear where she’s based. MO or VA, or both.
https://www.google.com/search?client=opera&hs=K7n&ei=npHqWpHlIeSU0gLt-7_oAg&q=Sharon+L.+Bachman&oq=Sharon+L.+Bachman&gs_l=psy-ab.3..0i30k1l2.57905.59272.0.60544.3.3.0.0.0.0.67.171.3.3.0….0…1.1.64.psy-ab..0.3.171…0i7i30k1.0.ejKjQ0KTtXE
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Thank you for that link Chaunce1234. Andrew Wright looks like an interesting person. I can’t tell if he’s chosen a side. Of course, it’s best to be open-minded. Some interesting comments on the Twitter feed though.
Here is Andrew Wright’s bio from the University of Washington. Also a link to another Twitter feed that says Andrew Wright is “tackling the tough topic of Conflict of Interest and surgical research. “We all have implicit bias.”” I think that the thought can be applied to just general practice. Who is “running the show” and what are their motives?
https://www.uwmedicine.org/bios/andrew-wright
https://twitter.com/JohnRomanelli2/status/985213199476637696
@andrewswright tackling the tough topic of Conflict of Interest and surgical research. "We all have implicit bias." #SAGES2018 #WCES pic.twitter.com/1w1c4cjP81
— John Romanelli (@JohnRomanelli2) April 14, 2018