Good intentions
Forum Replies Created
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Do any of these five people tell you that you should have got a mesh repair? That would be the true test. Not “I feel fine”.
My experience over life has been that people, men especially, want to tell people when they made a good decision. And downplay their poor decisions. It’s just how we are. I get the impression that these five people aren’t telling you the whole story. The surgeon has inherent bias.
How long have they had the repairs? That is another part of the long equation. And what do they do? How old are they? etc.
Just for fun – by your numbers there is a 20% chance of neurectomy after a mesh repair. 33.3% after Lichtenstein. Ha ha.
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I am bumping this thread just to keep it alive. I didn’t intend for it to happen but Matt posted about his successful mesh removal in #33314 above. Which, considring the way things are going in the repair field, could be an active Topic.
Again, I hate to pile on. If anybody knows somebody who feels good enough about their mesh implant to get on the Forum and tell people about it, along with any extra details like the surgeon, method, and materials, please convince them to sign on just for at least one post. There should be hundreds of thousands of patients out there, there have to be a few that can give people, surgeons and patients both, hope.
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Here is another really interesting video from Dr. Jacobs. Biologic meshes have been a hot topic off and on over the years. The premise has been that the collagen of the biologic mesh gets slowly replaced by the human body’s collagen until, eventually, the two are indistinguishable. It is a nice dream and worth attempting. But this video by Dr. Jacobs shows a biologic mesh that was explanted after 1 1/2 years and shows no sign of absorption or even of tissue infiltration/incorporation. It peels off just like it probably looked when it was implanted. If you look back through the literature you’ll find that this is actually not uncommon with biologics. The new biologics were supposed to fix this problem.
Something to be aware of if a surgeon wants to use the latest biologic mesh for your hernia repair. It might actually be a good thing, the ability to just peel the mesh out if there are problems. In the first video in the post above you can see that the main problem is getting the veins and nerves peeled off of the mesh without damaging them.
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Thanks for posting that William Bryant it is very interesting. I clicked through to the FDA links and see that the FDA has updated their “Surgical Mesh Used for Hernia Repair” page as of 7/13/23. They have finally removed the disingenuous focus on the recalled mesh as the cause of mesh problems.
https://www.fda.gov/medical-devices/implants-and-prosthetics/surgical-mesh-used-hernia-repair
But, overall, they do not appear to be planning to take any action to make things better. All that they are doing in their other report is reporting the state of the situation, ending their “Surgical Mesh for Hernia Repair: FDA Activities” report with a weak statement implying that the 3.8% impact on quality of life is acceptable and not worthy of action. Even though the bulk of their report describes how widely varied and of poor quality the data is. Basically, the data is of such poor quality that they can’t tell what is going on so they will do nothing. Unfortunately, in America today, that is typical of a government bureaucracy. Leaving the impetus for action up to the consumer, and the litigation, and whatever moral obligations the medical device company executives feel.
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The definition of chronic pain in the studies varied, which resulted in a wide range of incidence (0.3-68%). However, the incidence resulting in significant impact on quality of life does not exceed 3.8%.Although barrier coated and hybrid meshes were involved in the majority of adverse events reported to the FDA, the literature did not report a significant difference in barrier coated and hybrid meshes compared with other hernia meshes.
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I went back to the beginning of the forum to get a sampling of hernia repair stories and came across this one that is interesting. A bilateral pure tissue repair lasted 38 years. From about age 22 to age 60. He had a recurrence and got some mesh repairs. By the evidence he did have a recurrence. But a 38 year run is pretty good.
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Thanks for posting that William I probably would have missed it. Besides the terrible behavior of the surgeon, the fact that everyone around him was afraid to report it is the most concerning. The parallel with hernia repair is remarkable. I am certain that PA’s and nurses and anesthesiologists and imaging specialists are all aware of the hernia repair mesh problem. They are all actually present as the initial reports are made and along for the ride as the delay and deflecting occurs, sometimes leading to treatment including pain treatment and mesh removal. But they have bills to pay and lives to lead so they stay quiet.
I remember days after the mesh implantation I got a call from a nurse at the ambulatory surgery center asking me “how’s the mesh?” in an aggressive irritated tone. I was so shocked that I could barely comprehend what she meant and had to ask her to repeat the question, and ask if there was something wrong with it. She said “how is it, how is the mesh doing”” and I replied that it had only been a few days, “how would I know?” I then called my surgeon to ask what was going on and he was kind of flustered and said it was nothing and he would deal with it. It’s always been in the back of my mind that something wasn’t quite right about the surgery, but the surgery notes said that everything went according to plan. A perfect implantation.
Also shocking that the brain surgery story happened in Scotland where they banned transvaginal mesh, or tried to, because of the numerous problems. So on one side you have proactive actions and on the other you have inaction. All in the same system.
https://www.parliament.scot/~/media/committ/552
They fell back on the “removal will return the patient to normal” fallacy.
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Ms Todd said the Scottish Government has made “significant progress” on transvaginal mesh as she said “everything is being done” in negotiating contracts to assist those with mesh implant removals. The Minister said she hopes to update parliament on the negotiations soon.Ms Todd said: “We’ve established a national service for the management of mesh complications and women have options with regard to their treatment which can be undertaken in Scotland, elsewhere in the UK and also with an independent provider if desired.”
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Here is the Topic I created about healing from mesh removal. It’s been a long slow process for me. Over five years and I’m finally feeling like I’m at a stable 90% of where I was before mesh implantation. You’ll find posts from a year or two ago where I said something similar but this time feels more solid. Of course, the worry now is that if things have been changing could I have a recurrence? I’m not going to worry too much about it, I’m just going to enjoy these moments of good health while I can.
Good luck herniacomps. I kind of hate to wish for it, because things shouldn’t be this way, but I hope that you get a huge settlement. And I hope that all of the other people after you get huge settlements. So that, finally, the financial aspects of selling bad products drives them from the market.
https://herniatalk.com/forums/topic/healing-from-mesh-removal-surgery/
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Thanks for the reply Dr. Towfigh. I’m just trying to keep track of, and understand, what is going on in the field of hernia repair. Progress seems to have stalled dramatically.
If the goal is to learn about ASIA/Mesh Implant Illness then a description in the introduction of the survey would be appropriate. I see though that you have now added “Pain” as a category. So, kind of getting a mixed message.
Anyway, good luck with the project.
“9. What were your symptoms?
Bloating
Brain fog
Change in taste
Chronic fatigue
Concentration problems
Dental problems
Feeling hot
Hair loss
Headaches
Hearing changes (e.g., ringing in the ear)
Itchiness
Joint pain
Joint swelling
Memory loss
Nausea
Pain
Rashes
Sleeping problems
Sweating abnormally
Tingling in fingertips or toes
Visual changes (e.g., blurry vision)
Weakness
Other (please specify)”
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Hello Dr. Towfigh. I started your survey and it kind of reminded me of a sociology class I took years ago where we had to develop our own survey as a project.
I notice what could be a flaw that confounds or negates some results. If a person answers “No” to question #5 – “Did you have a reaction to the implant?” then they should not be able to answer any more questions. Because they did not have a “reaction” to describe. On the SurveryMonkey site the patient is allowed to continue to answer questions even after selecting No.
Also, as I noted in a topic I created, why is there no category of pain or discomfort as a “reaction” symptom. It makes the whole survey seem odd, like one where a company could say “no patients reported chronic pain or discomfort”. Because there was no way to report it. Chronic pain has been identified as the number one problem confronting hernia surgeons and patients. How can it be excluded from a survey about implant experiences?
Could you give more detail about the purpose of the survey?
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I mis-wrote above. Dr. Towfigh said “best seller”, not most popular.
Sorry SN, I know that you’re trying to find a clear path forward. Keep working at it, something will make sense to you eventually. Her comment seems strong enough to at least knock one option off your list. Some small help.
https://herniatalk.com/forums/topic/big-picture-litigation-perfix-plug/#post-33897
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Yup, agree that plug meshes should be off the market and the main reason they aren’t being pulled is because it would look like they are admitting it is a poor design. Also, plug mesh still seems to be among the best sellers, if you can believe it.
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Dr. Towfigh said that the plug is the most used repair method in the world. Apparently it is very easy and fast to do.
Here is a paper from 2014 by one of the participants in the HerniaSurge mission, the Guidelines. He reports some details about three open methods; Lichtenstein, plug-and-patch, and the Prolene Hernia System (PHS). Four years later the plug was the only mesh product that the Group did not give a firm recommendation to. Ten chapters are under revision in the Guidelines. There might be something useful in the new version of the Guidelines, if you can wait.
Sorry, this probably does not help your decision-making. But it is the reality of the situation. 2014 is when I had the laparoscopic TEP procedure to repair my unilateral hernia. It’s easy to see why the surgeon chose it, it is highly recommended. But the results for me were terrible.
https://www.frontiersin.org/articles/10.3389/fsurg.2014.00020/full
MINI REVIEW article
Front. Surg., 20 June 2014
Sec. Visceral Surgery
Volume 1 – 2014 | https://doi.org/10.3389/fsurg.2014.00020
Tailored approach in inguinal hernia repair – decision tree based on the guidelines
imageFerdinand Köckerling* and imageChristine Schug-Pass
Department of Surgery, Centre for Minimally Invasive Surgery, Vivantes Hospital Berlin, Academic Teaching Hospital of Charité Medical School, Berlin, Germany“The endoscopic procedures TEP and TAPP and the open techniques Lichtenstein, Plug and Patch, and PHS currently represent the gold standard in inguinal hernia repair recommended in the guidelines of the European Hernia Society, the International Endohernia Society, and the European Association of Endoscopic Surgery. Eighty-two percent of experienced hernia surgeons use the “tailored approach,” the differentiated use of the several inguinal hernia repair techniques depending on the findings of the patient, trying to minimize the risks.
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To be clear, I posted this mainly as a discussion point about the fact that pure tissue techniques are still a major area of study. The work itself in this paper is obviously of little value except that it reintroduces an old technique to the community of hernia repair surgeons, and shows that some surgeons have not accepted the view that mesh is the best starting point for hernia repair.
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Six weeks is not very long. One month ago would be two weeks after the surgery, correct? That is right at the edge of the usual time for being released for activity after surgery.
Do you know what the “sports hernia repair” method was? Mesh is not typically recommended for athletic pubalgia (aka sports hernia). Was it a sports hernia repair or did the surgeon just call the problem a sport-based hernia? Good luck.
There are many possible causes, but no simple solutions. Since it’s so early your best bet might be to avoid running for a while until the pain resolves then try to slowly work your way back in to it.
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Rejuvenating this Topic from the past. There is a link to a bodybuilding forum that has a long thread about hernia repair in it, in one of the posts above. Some of the bodybuilders report good results. Overall, sometimes I think that activities that are high in repetitive exertions, like running or playing sports, cause more problems than extreme exertions at low repetition, like weight training. I was way out on the high repetition and extreme effort end of the activity scale.
I haven’t read back through this thread but there might something of value in it.
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Two fairly young men (in their 30’s) just posted on the forum looking for advice on hernia repair. They both sound like active people, one mentioned deadlifts, a weightlifting term. So, a node on their decision tree might be “will I be able to exercise like I used to?”. That might then lead to defining the degree of exercise. High intensity track work versus weightlifting only, for example. If it’s high intensity track work or running, they might look to Muschaweck’s work on soccer players or Dai Greene’s story to help decide on a method or a surgeon.
Of course, the stories linked below are stories of problems. I created a Topic quite a while ago looking for good mesh stories. If somebody has found a story of a professional athlete who got a mesh repair, or any repair for an inguinal hernia and regained their health and abilities, please post it. There might be materials and methods that actually work. In an ideal world, the good would rise up and the bad would be allowed to fade away.
https://herniatalk.com/forums/topic/pro-soccer-player-ruined-by-hernia-mesh/
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Generally, for hernia repair, seeing a hernia specialist is recommended. Hernia repair is not simple surgery, although many doctors make it sound easy. You don’t want to get the wrong surgeon for hernia repair. The results are permanent.
There is a Topic on the forum about hernia repair in Germany. It might be worth reading.
https://herniatalk.com/forums/topic/can-we-mention-the-germans/
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If you just want to get the surgery method of the day by the most capable surgeon in that technique, then Jacob, Dalkin, or Novitsky are good candidates. Sbayi has expertise in the Shouldice method. Podolsky publishes about robotics so he might be doing a TAPP mesh repair. Actually Jacob, Novitsky and Dalkin might be also.
You said that once you choose you’ll be locked in. So, you kind of have to decide what matters most to you, the repair method itself or the surgeon’s knowledge of a certain type of repair method.
At your age you certainly have a lot of life ahead of you. Whatever you choose, the results will be with you for the rest of it. Doctors can think about the 85 patients that they helped (as far as they know) and ignore the 15 that they hurt (those are mesh repair numbers). It’s just the reality of their lives. Try not to be one of the 15.
You’re doing the right thing by researching options first. Things just aren’t very clear at this time. Even the “International Guidelines” of hernia repair are being revised, and they seem to be having difficulty deciding what should be in the updated document.
There really is a lot on the forum. Not much has changed in the last 15 years, except for the advent of robotic surgery. It’s the latest new thing. The materials and methods are all about the same. So the odds are too.
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To be clear, in my post above I was combining recurrence and pain, as “problems”. Both are bad, and even the experts aren’t sure how to avoid either. The factors involved in controlling the problems are still unclear.
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Spend some time reading posts on the forum. This is not a typical “what’s best?” forum. Is your hernia direct or indirect? The description sounds indirect. Why do you want surgery? Is there pain, or does it hinder your activities? Hernia surgery is very risky, both in the probability of problems (10 – 20% chance [guesstimate] of recurrence or some sort of pain) and the difficulty of fixing those problems if they occur. Surgery involves permanent changes.
Spend some time educating yourself. Don’t be in a hurry to get “fixed”.
A typical surgeon will tell you that the “vast majority” of patients don’t have problems. That doesn’t tell you the whole story. There are many references to professional publications on the site. Read a few and learn the real numbers. Good luck.
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It is a topic of study in Japan. Here are some links. I assume that “rescue analgesics” might be a term for “pain-killer”.
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=japan+inguinal+hernia+mesh&btnG=
https://link.springer.com/article/10.1007/s00595-012-0153-5
https://journals.sagepub.com/doi/abs/10.1177/17504589211054371