Good intentions
Forum Replies Created
-
They ranked them at the end of that section.
“…
In general, the risk of POUR is most significant in spinal anesthetics, followed by epidural anesthetics followed by general anesthetics.[1]
…” -
It’s a hot topic. Here’s a recent paper that suggests that there are many causes.
https://www.ncbi.nlm.nih.gov/books/NBK549844/
Postoperative Urinary Retention
AJ Pomajzl; Larry E. Siref.“…
Anesthesia can pharmacologically impact normal micturition. General, spinal, and regional anesthetics can all lead to POUR by suppressing micturition control and reflexes at both the central nervous system level (pontine micturition center) and the level of the peripheral nervous system by blocking neural transmission in the sacral spinal cord.[2][3]
…” -
How are you doing with your recovery? I pasted your thread link below. Did Dr. Pauli do your surgery?
https://herniatalk.com/forums/topic/pain-after-inguinal-sports-hernia-repair/
-
There is no mention specifically of Dr. Pauli’s specialty at his practice’s web site. Interesting that someone of Medvedev’s level would see him. There must be word-of-mouth, or a professional network that knows something. Worth adding Dr. Pauli to the list of European surgeons to see. The web site is in Dutch.
https://azmonica.be/artsen/steven-pauli/
https://azmonica.be/zorgaanbod/medische-diensten/algemene-heelkunde/specialismen/
“You can contact us for the repair of abdominal wall defects such as inguinal hernias, umbilical hernias, epigastric hernias, incisional hernias, parastomal fractures, and also more complex abdominal wall defects.”
-
Thanks Gullick. I found another paper from the same authors describing the method used, for athletic pubalgia. It shows a suture-based non-mesh repair. It’s an interesting look at the thought processes in 2012. They talk about how mesh was being used at the time but they had some success with the suture-based method.
Dr. Pauli has not published much since then. His practice sites are in a foreign language.
http://www.actaorthopaedica.be/assets/2629/05-Jans_et_al.pdf
Acta Orthop. Belg., 2012, 78, 35-40
Results of surgical treatment of athletes with sportsman’s hernia
Christophe JANS, Nouredin MESSAOuDi, Steven PAuli, Roger P. VAN RiEt, Geert DEClERCq
From Monica Hospital Deurne, Belgium“…
Fig. 1. — Surgical technique : After incision of the external
oblique muscle (O) and retraction of the ductus deferens (D),
the lateral side of the rectus abdominis muscle (R) and conjoint
tendon (C) are sutured to the inguinal ligament (L). Pubic symphysis (S), external inguinal canal (E), femoral nerve (n), artery
(a) and vein (v) are displayed.
…” -
Here is a study that finds no statistically valid difference between several methods and TREPP. But, a person should wonder about the ability to repair any problems that do occur. For example, as seen and described in videos and surgery reports, mesh often sticks to various nerves and arteries, like the inferiors\ epigastric artery, and the material stuck to the mesh must be sacrificed in order to remove the mesh.
The subject of hernia repair should be expanded to include the follow-on effects of problems. Any surgery is damaging but which methods leave the best field to work on if there are problems?
https://link.springer.com/article/10.1007/s10029-020-02291-7
Transrectus sheath pre-peritoneal (TREPP) procedure versus totally extraperitoneal (TEP) procedure and Lichtenstein technique: a propensity-score-matched analysis in Dutch high-volume regional hospitals
Original Article
Open Access
Published: 16 October 2020
volume 25, pages1265–1270 (2021)The paper does contain a surprising weakness, considering especially when it was published. Their definition of pain is very weak and arbitrary. Almost useless.. But the fact that they did the work shows that TREPP is becoming more common.
“…
Outcome measures
Patients were scheduled for regular follow-ups at the outpatient clinic at two–six weeks postoperatively. More visits were scheduled only in case of adverse events. Every outcome that was mentioned in the electronic patient file was noted in the database. For postoperative pain specifically, patients scored a “yes” if they: visited the outpatient clinic after a regular follow-up because of inguinal pain; received pain treatment or had any further pain evaluation (e.g., ultrasonography, MR-imaging, referral to pain specialist).
…” -
Somewhat like the Desarda pure tissue method, its newness means that not many surgeons use it. Of course, that is a good thing overall, the world doesn’t need surgeons jumping on every new method that pops up. But, with the rationale behind it, as the results come in, it might become more popular.
https://link.springer.com/article/10.1007/s10029-021-02554-x
Review
Published: 10 January 2022
Meta-analysis of the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for inguinal hernia
S. Hajibandeh, S. Hajibandeh, L. A. Evans, T. J. Havard, N. N. Naguib & A. H. Helmy
Hernia volume 26, pages989–997 (2022)“…
Conclusions
The best available evidence suggests that TREPP may be a promising technique for elective repair of inguinal hernias as indicated by low risks of recurrence, chronic pain, haematoma, and wound infection. The available evidence is limited to studies from a same country conducted by almost the same research group which may affect generalisability of the findings.
…” -
Here’s another that kind of shows where my thoughts were way back then. Things are actually getting better, there’s more of a focus on quality of life now, but a lot of the old ways still exist. A person can walk in to any of hundreds of hernia repair clinics or hospitals today and be back in 2014, where I started.
-
G’s comment to me in Dc’s post got me to looking for when I joined the forum. It looks like it was a few months before I had mesh removal, in 2017. This might contain my first post, I’m not sure.
My comments, above, in this thread show that I was pretty disappointed in what I had learned since having problems with the mesh implantations and the fight to get the problems solved. Not much has changed since then. Mesh removal is much easier to find on the internet now, it was very difficult even just six years ago. I found Dr. Billing’s name on a forum for runners and a couple of other sites and had to use that sparse information to make a decision. I don’t think that there were any mesh removal videos on YouTube at all. It wasn’t discussed in open like it is today. I guess that’s an improvement.
-
I don’t think that your overall situation is normal so there probably aren’t many people to compare to.
One month after a bilateral hernia repair procedure is really not very long. In your first post you said that you had pain. Now you’re saying that you’re weak and a small effort “puts you out”. Are you saying that things are different now? What does that mean. Is it low energy or pain?
No offense intended but I think that you might be expecting too much too soon. While you were having the pain before surgery you were probably getting weaker overall because you were inactive. Trying to avoid the pain. Maybe you started from a lower base of overall strength.
If you read some of the older Shouldice posts you’ll see that “pulling” is one of the typical feelings after a Shouldice procedure. So that is normal, it’s the nature of the procedure. Apparently it can resolve over time.
Anyway, it doesn’t sound like you are in danger or need another surgery. I’d monitor progress of any kind and keep trying to get stronger. It’s the best that you can do. Good luck.
-
I chose to go ahead with surgery because I thought that it would get me back to my full fitness and ensure that I would be free of hernias in the future. That is the way that laparoscopic mesh implantation is sold, especially Lap TEP. They make it sound like you will be bulletproof after the procedure.
If I had known the truth and the true odds I would have waited and/or chosen a different solution.
The most difficult part of the decision is understanding, really, what the risks are. That is the heart of the travesty. The risks are actively hidden from the patients. The vast majority of surgeons either don’t understand the risks themselves or have convinced themselves that they are insignificant. Or that sacrificing a few patients is okay as long as most of them do well.
-
100 repairs does not tell much. 100 repairs using a variety of methods could mean just a few tissue repairs or just a few mesh repairs. The words from the eminent surgeon are standard boilerplate warnings that all surgeons use for all surgical procedures.
Have you seen the original surgery records? It might be that you have already had a mesh implantation. Prophylactic implantations are a thing, although not so much 12 years ago. But if you did have mesh implanted that adds a complication. You’ll want somebody very experienced.
Ventral hernias are apparently some of the most difficult to repair. Good luck.
-
Did you try any of the recommendations in your other thread?
Be careful when you say “open repair with mesh”. The plug and patch repair is open with mesh. The PHS is open with mesh. There are many types of “open with mesh” repairs.
-
It would be interesting to know if Lichtenstein used his mesh repair on all of his patients. Or if he varied the repair method based on what he found, and/or the type of hernia. It would also be interesting to try to understand how mesh became so popular. Was it a grassroots organic growth? Or something else. How did we get here?
That is the one thing that really shows the inherent bias in the Guidelines. One of the very first statements says that a pure tissue repair should only be used if mesh is not available. Who knows, maybe that’s why inexpensive mosquito netting is used in places that can’t afford the hernia netting made by the big companies.
-
The body adapts to injury. The necrotic tissue gets replaced, the new collagen reforms to stronger collagen, healing happens. The initial tension is worth considering but it’s the results that matter.
In a way you are just following the logical path to the “tension-free” mesh repair concept. Which was/is a good idea to develop, but the prosthetic materials on the market today have new problems. The medical device makers have stopped trying to improve the concept (the revenue stream is very solid, the litigation has been priced in, there is no true device regulation), so here we are – lots of words, but no progress from the mesh suppliers. The meshes are all essentially the same as they were many decades ago.
-
Here is my thread about healing from mesh removal. Probably not really part of the topic that you intended but it does give an idea of how long the body can continue to adjust after surgery. I should update it soon, The last few months have been very good. Over five and half years since removal at the end of 2017.
https://herniatalk.com/forums/topic/healing-from-mesh-removal-surgery/
If the direct link takes people somewhere strange put this in the search box – “Healing from mesh removal surgery”.
-
Still no word at all from EHS/HerniaSurge. Ten chapters being updated in the “International guidelines for groin hernia management”. The group said their work was almost done at the end of 2022. What could be causing the delay?
They should at least tell which ten chapters are outdated. It makes a person wonder about the professionalism of this huge organization. They have roped in many other national hernia repair societies and now they are all left hanging. How can any patient be confident in their surgeon if they say that they are following the Guidelines, which have been defined as outdated?
https://europeanherniasociety.eu/guidelines/international-guidelines-for-groin-hernia-management-2/
“…
The guidelines were developed by The HerniaSurge Group and have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. The guidelines were published in 2018 in the Journal Hernia. Ten chapters are in the process of being updated.
…” -
The web site that I had been using to keep track of litigation seems to be slipping. I found another that seems to be up-to-date.
https://www.millerandzois.com/products-liability/hernia-mesh-case-value/
“…
August 16, 2023: The Bard MDL has been frustratingly quiet in August. The MDL did add 191 new cases last month, increasing the total case count for the 3rd largest MDL in the country to added to 20,126 lawsuits.August 10, 2023: The pivotal 3rd bellwether test trial is on track to begin on October 16, 2023 in the case of Stinson v. C.R. Bard, et al. (2:18-cv-01022). In preparation for that upcoming trial, the MDL Judge recently issued an Order setting last-minute discovery deadlines related to the plaintiff’s post-operative treatment last month. The order gives the parties until August 14, 2023, to complete supplemental fact depositions and until September 27 to finish additional expert depositions. The short time frame of these deadlines suggests that the judge is committed to going to trial in October without further delays.
…” -
Here’s another one. BD’s (Bard) Ventrio ST, used by Dr. Reinhorn of Boston Hernia, in his TREPP procedure.
By the literature it would be an “off-label” usage since it is specified for ventral hernias.
-
Oops, I posted the link below, then saw that it was your thread.
Surgeon recommendation in Oregon or Washington that repairs without mesh?