Good intentions
Forum Replies Created
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You’ve had a bilateral hernia scheduled before learning much about them? Five days?
Time is really not on your side. People often postpone their surgeries. You should postpone yours until you are sure of what you want to do.What type of hernias, how were they diagnosed, and what type of procedure? Good luck.
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The final program looks pretty good. Packed with ads, plus the topics look interesting. And it is searchable, unlike the SAGES program documents. At least AHS is transparent and easy to access. The conflicts within seem enormous though. Many of the ads are about mesh. It’s everywhere. Strattice, Tela Bio, Phasix, all within the first ten pages. The full list of “partners” fills a page. Mostly bronze with one silver and one gold.
The Program document is also packed with abstracts. Better download before they make it members only. I haven’t gone though the whole thing, it’s 277 pages.
https://custom.cvent.com/9D6126EEBC1B404DA11E747D5B4411CE/files/955da81f74bd4068b0c320dd2aba1bdb.pdf
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What type of surgery did you have in India for the varicocele, what type of hernia do you have now, and what type of surgery is planned for November 1? You might not even be a candidate for a Shouldice procedure. There are many types of hernias and many types of repair.
Good luck.
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It would be interesting to find out what methods the surgeon who took over Dr. Brown’s practice uses. You’d think that he might have been aligned with Dr. Brown’s thought process but maybe it was just a financial decision.
The web site still contains the old non-mesh descriptions. Dr. Nguyen might be worth contacting.
https://www.sportshernia.com/no-mesh-hernia-repair/
But, it might be that he just left the old stuff there and will recommend a lap procedure. Lap = mesh. Hard to imagine that he would go back to pure tissue after spending his education time on the latest lap procedures.
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Dr. Meyers and the Vincera Institute is well-known in the world of runners, and professional sports in general.
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Thanks Jack2021, those are some good references. It’s interesting that just a day of rest and a small amount of ibuprofen and things got back to normal. I was getting worried, again.
I had had a thought in the past, over the years, that cycles or number of steps seemed to bring on soreness and odd sensations, more than exertion. Kind of counterintuitive for hernia concerns but that’s what my memory and notes seem to show. Luckily, for me, my range seems to be lengthening, with more miles allowed before I have to take a day off. Actually, I think that I had moved on from monitoring distance travelled (I had been keeping a log) and was being more spontaneous and hiking and walking farther. I think that I had just hit the new limit recently.
One of your references described the motor function of one of the nerves in actuating the abdominal muscles. I wonder if that plays a part in the fact that my abdomen between the navel and about halfway to the pubic bone feels like a stiff plastic bowl.
I did a quick Google and another interesting very recent paper popped up. It describes the ilioinguinal nerve as following the spermatic cord. So, it sees what the cord sees, as far as irritation from internal abrasion or poor environment. It seems to fit what I was feeling with spermatic cord irritation.
It’s an interesting topic, especially considering what seems to be a trend toward prophylactic neurectomy. Besides just the broad effects of disturbing so much of the network during laparoscopic mesh implantation. Unintended consequences.
https://www.ncbi.nlm.nih.gov/books/NBK556034/
Anatomy, Anterolateral Abdominal Wall Nerves
Aurimas Kudzinskas; Bruno Cunha.“Introduction
The anterolateral abdominal wall is a layered structure composed of skin, fascia, muscles, extraperitoneal fat, and peritoneum that extends from the thorax to the pelvis and bounds the abdominal cavity and its associated organs.[1] It plays an important role in the movement of the torso, stabilization of the spine, retention of a physical barrier, and increase and maintenance of intra-abdominal pressure.[2][3] Numerous nerves traverse the anterolateral abdominal wall to serve regions of the abdominal wall, pelvis, and perineum. A variety of pathologies have the potential to impact the anterolateral abdominal wall nerves, including trauma, neoplasm, and infection. Any clinical involvement of these nerves may result in pain, loss of sensation, or motor deficits and reduce an individual’s quality of life.
…The ilioinguinal nerve travels within the neurovascular plane between the transversus abdominis and internal oblique muscles until it reaches the superficial inguinal ring. At the superficial inguinal ring, the ilioinguinal nerve pierces the internal oblique muscle enters the inguinal canal, and travels along the spermatic cord (in males) or the round ligament (in females). The ilioinguinal nerve innervates the skin overlying the inguinal ligament, medial thigh, mons pubis, scrotum, root of the penis, and labia majora. It also contributes to the motor innervation of the inferior portions of the transversus abdominis, external oblique, and internal oblique muscles.
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Thanks Watchful. After taking a day off and resting, and taking one ibuprofren/Advil, the right groin pain has disappeared and other minor discomforts have crept in. I think I’ve just been overdoing it. I also think that my whole pelvic area is unbalanced after the multi-year process of mesh, mesh pain, mesh removal, mesh removal pain, etc. It’s a twisty road back.
FAI and osteitis pubis symptoms seem to fit in a minor way. Which are both kind of mystery conditions, like occult hernias and athletics pubalgia. Once the area gets screwed up I think it’s hard to get it back in to shape.
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All of the issues raised here can be answered by your surgeon. If you don’t trust your surgeon enough to believe that they won’t hand you off to an assistant then you should probably find a different surgeon. Of course, most people don’t ask too many questions or they get evasive answers when they do.
Thinking back to my initial mesh implantation I should have paid more attention to my own misgivings about the surgeon as a person. He was too smooth in his demeanor, and did some things that made me wonder, like showing me a piece of mesh while saying it was not the type that he would be using but it was close. But I wanted to believe in a professional. I had already passed on a different surgeon in the same clinic because he seemed so unenthused about what he did.
So, this question really seems to boil down to trust. If your surgeon tells you he’s feel great at the end of a day of ten hernia repairs, within a week of 50 repairs, do you believe him/her? Conversely if your surgeon says that they only do two to three surgeries a day because any more is too many, do you believe that the third one is just as good as the first?
You can go round and round. But, back to the original point – experience leads to expertise. I’m not talking about fatigue. Or trust, or large scale hernia repair mills. Just the benefits of performing many surgeries on a regular basis. Would you rather have a Marcy repair by Dr. Kang or a Marcy repair by somebody who’s only done ten over the course of a year?
I have mentioned in the past that Dr. Billing said that trying to remove all of the mesh inside me, two sides, in one go was too much. Because he would get fatigued. So, he apparently knew his limits and didn’t try to exceed them.
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How would a person seeking a surgeon evaluate the “fatigue factor”? The multi-persona person seems to go by gut feel. Can somebody suggest a number to use, some sort of break-point? Should a surgeon’s age be considered? Older people fatigue more easily.
The last statement in the post above, funnily enough, seems to have been written under the duress of fatigue (no offense, it really is kind of funny and it was late). The original topic isn’t about learning while fatigued. It’s not even really about fatigue. It’s about the experience gained by doing many surgeries of the same type.
Of course, my first post brings Dr. Kang to mind since that’s what the multi-persona person has implied in his/her posts. But it could also be applied to Desarda (Tomas) or any of the high volume lap mesh surgeons or any of the Shouldice Hospital surgeons. How many surgeries per week or day or month is too many? How old is too old?
Hearing a number and feeling like “that’s too many, they must be tired at the end of the day” doesn’t seem like a very precise way to choose.
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Stumbled across an article that seems relevant.
https://pubmed.ncbi.nlm.nih.gov/11711938/
Plast Reconstr Surg
. 2001 Nov;108(6):1618-23. doi: 10.1097/00006534-200111000-00029.
Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain
M Rab 1, J Ebmer And, A L Dellon -
Thanks David M. The take-away from your point seems to be “get an early surgery time”. Not sure that the “tired at the end of the day” really applies to the point I was making. I was talking about experience leading to precise knowledge.
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All of your questions have been addressed in great detail over just the past year or two on the forum. Not exaggerating. If you don’t get many specific responses it might be because of that.
I just looked up an old email from somebody very much like you, in that they had had a mesh repair in the past that had only given them very minor problems, for 13 years. Then he got a hernia on the other side and the repair had a completely different outcome, eventually leading to mesh removal 17 years later. It’s unclear why, but I think that it illustrates the fact that you can’t simplify the situation down to just mesh versus pure tissue. And age might be a factor.
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.Dr. Gilbert has retired apparently, but he might still be out there. He might be worth talking to, since he has a whole history of patients like you behind him.
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Here is the latest on the Bard MDL. A case starts in about five weeks. It’s interesting that the Bryan v. C.R. Bard Inc. case is actually about transvaginal mesh. So the legal profession sees the mesh design and/or the material itself (polypropylene) as the source of the problems. As a materials person myself, I think that it’s probably more product design than material. But, broadly, the products as they exist today are not good enough. The medical device makers need to start considering the cost of damages versus the cost of research. It might be time to make a new investment in future products instead of coasting on what used to be easy 510(k) money.
From the link in the post above –
“September 1, 2023: After a very long wait, it looks like the next bellwether test trial in the Bard hernia mesh MDL is finally going to happen. In a new Case Management Order issued yesterday, the MDL Judge confirmed that trial in the case of Stinson v. Davol, Inc., et al. (18-cv-1022) will begin on October 16, 2023. A fourth bellwether trial will be scheduled for early 2024 in the case of Bryan v. C.R. Bard Inc., et al. (18-cv-1440).”
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We’re a week in to September, 2/3 of the way through the year, and still not a peep about the update to the Guidelines. I wonder if the people involved have become aware of their liabilities in promoting this document. The mesh lawsuits that looked like they were about to have a global settlement, so that business could continue as usual, have been delayed and a similar single mesh lawsuit had a huge settlement, in the millions of dollars. It would be awkward to promote the use of a product with 100’s of millions or billions of dollars worth of legal costs associated to it. And there’s no reason to expect the constant stream of new lawsuits to diminish. The products and procedures are essentially the same.
It’s unclear what the real reason is for the delay. Silence after exuberance usually comes from a realization that things aren’t as they seemed.
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I’m still not clear on how that matters. PeterC continued to have pain after the first surgeon(s) worked on him. Dr. Brown tried to help. Why does it matter if he removed a piece of mesh? It should also be pointed out that PeterC said that the mesh had no tissue ingrowth but then said it was pulled out with bloody tissue attached to it.
Sorry, but I don’t see the point that you’re trying to make. You’re just showing other parts of PeterC’s story. They don’t seem connected.
And, why do you show up as two separate screen names? Do you have two accounts on the forum? Doesn’t really matter, it just confuses things.
How is your recovery coming along? You were going to post an update.
The mesh that was removed sounds like a Gore Medical PTFE product. The kind that Dr. Grischkan uses for his “modified Shouldice” procedure.
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No offense intended Guygolo but I don’t know what you mean. Are you saying that in the beginning he had the same problem on both sides but he had a neurectomy and mesh placed on only one side? I don’t understand. Why would that be done?
My point was that Dr. Brown did not ruin a perfect body. Previous work had been done and Dr. Brown was trying to help with a pre-existing problem. This wasn’t a simple hernia repair. The other doctors had apparently given up or had no ideas to move forward with. Damage had been done before Dr. Brown got involved.
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The full story should be told. PeterC’s problems started with a prior operation, that included a neurectomy and a mesh implant. Dr. Brown attempted to help him resolve his problem with high intensity chronic pain at rest after exercise, after these procedures did not work. He tried to help improve his quality of life. PeterC’s story is an example of why many surgeons don’t want to get involved with mesh problems. The attempts to help often don’t work, and the person that attempts to help gets blamed.
PeterC had apparently been dealing with groin pain for a while even before he had any procedures done. So, there was pre-existing pain, a neurectomy, a mesh implant, and the pain continued. Dr. Brown got involved in the middle/end of a long trail of problems. Do the people that came before bear some responsibility? Where are they now? Should they also be avoided?
PeterC’s story is also an example of how chronic pain affects a person’s thinking. It really is mentally debilitating.
https://herniatalk.com/forums/topic/my-experience-with-dr-browns-sports-hernia-surgery-pt-2/
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Before going in to Dr. Brown, I had had only one procedure to remove a part of my illioinguinal nerve, accessed through the external oblique aponeurosis on the right. They left a solid small local
mesh (not perforated) there in the opening of the external oblique aponeurosis that closed/healed over it. The rest of my abdominal muscles (internal oblique, transverse,rectus etc) were not touched whatsoever. They thought
I had pain due to entrapped illioginal nerve and that anything else would heal over time. The first surgery lasted 40 minutes total. Right away I knew that it wasn’t my issue
because the next day my pain was still there and my gait was still a little off on the right side.I went on to dance for 2 years after that surgery – in that condition hoping I would heal naturally. For the most part I had almost no pain during high-intensity exercise but high chronic pain at rest/after to the point where
it became difficult to have quality of life.
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Yunis and Tomas are Florida.
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The suture material matters. Absorbable apparently has more recurrences.
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Do you know the details of the Shouldice repair? 2 layer, 4 layer, modified, etc. Stainless steel, Prolene, or absorbable sutures? Apparently you did not have it done in Canada.
There might be some clues there. If the repair is splitting open somewhere (dehiscence) it might be that permanent sutures could get it back to where it should be if they weren’t used, or something like a Lichtenstein. Of course, that would depend on where the problem is exactly. If the sutures are holding and the tissue is failing again that would probably require a different focus.
But if it is a suture line opening, if the split is pulled back together the pain should resolve, since you only have pain during movement. The neurectomy would be insurance. In your case, since you didn’t have pain before the dehiscence, and you don’t have pain when relaxed, nerves growing back should not cause a problem. It’s the straining of existing nerves that is the problem. Remove the strain and the pain should resolve, seems rational.
These are just ideas. You know more about what causes the pain. It is definitely a difficult decision when there are so many different opinions, from beginning to end.