Good intentions
Forum Replies Created
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Here are the basics, at the bottom. It’s interesting that he does not see an indirect hernia when the peritoneum is closed, on first viewing, but after he opens it up and removes the mesh he apparently sees an indirect hernia. Not sure how that works, maybe it means that the internal ring is enlarged.
The left side went smoothly so I haven’t included the Procedure notes. The mesh that came out was smaller than what went in, but I think that he meant inches, not cm, in his description. I have the pictures and they are next to what looks like a 6 inch ruler for scale and they are about 2 x 5 inches. The piece started as 6 x 6.
I had been exercising more after the right side had been removed so that might have caused some of the edema. I had been considering leaving the left side in (still trying to believe that the mesh implantation alone wasn’t the problem, that maybe a mistake had been made and the left would be okay) but after exercising, the left side was now the worst side, compared to what had been the worst, the right side.
Any typos are mine. I had to retype from an image of his notes.
Right side, where the original direct hernia was.
“Findings: The right groin was densely adherent to surrounding tissues. I was able to remove about 90% of the mesh. I left some mesh laying over the iliac vessels and near the spermatic cord. The left side looked normal and not explored. The colon and small bowel were normal.
Procedure:
…The left groin was examined and looked normal with no hernia. The right groin looked normal too, but we agreed to explore the right groin because of his pain and to remove the mesh. I dissected the mesh off the anterior and lateral wall of the groin. It was densely adherent to the tissues, more than expected. I then went medially and dissected the mesh down to Cooper’s ligament. I removed the mesh in this area. I dissected up to the cord and freed as much as I felt comfortable doing. The cord structures and major vessels going into the groin were carefully protected and I left some mesh there. The spermatic cord and vessels were dissected of the mesh. The epigastric artery was adherent to the mesh and I was not able to preserve it. I ligated it with ligaclips. The excised mesh was removed through the 12mm trocar in three pieces. There was an indirect inguinal hernia but it was small. The area was irrigated. There was no evidence of intestinal injury.
…”Left side:
“Findings: The tissue was edematous. Essentially, all of the mesh was removed from the left groin. He has a small indirect inguinal hernia. This was not repaired. The dissection was tedious due to the inflammation and the contraction of the mesh to the tissues of the abdominal wall. A 2×5 cm piece was removed.”
Herminius, let me know if you’d like me or others to start new Topics instead of adding to yours.
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Thanks Herminius. My inferior epigastric artery couldn’t be saved either. I suppose that the lack of blood supply to the areas it supplied could have caused some of my longer term healing soreness. The body’s other supply lines will grow in to provide new supply over time, as I understand things. Something to be aware of if you have some pain. It should resolve, although I can’t find much about it on the old internet. Lots about where it goes and how it gets damaged. Not much about the effects on the body of removal or damage.
Good luck. Hopefully your original symptoms don’t come back.
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The paper linked by Dr. Towfigh is interesting in that it suggests that either there is no such thing as “mesh reaction” (it’s all just common foreign body response) or that all mesh implant patients suffer from mesh reaction, just to differing degrees of discomfort.
What is left out the “mesh reaction” discussion is the subject of what causes the reaction. Is it just the presence of the material itself? If the mesh was unraveled and implanted as a ball of fibers would it cause the same reaction? Or is it the movement or lack of movement of the mesh as the body moves around it. All Prolene sutures should cause a “mesh reaction”. The Shouldice procedure done with Prolene should have a line of mesh reaction. The depth of research in to the problem seems not deep at all. Observations and RCT’s but nobody, besides Bendavid, seems to be looking for root cause.
Good luck with recovery Herminius. Can you share more of the surgery notes? Any observations about nerves or vessels or the original indirect hernia would be interesting.
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I couldn’t say, I only know what I’ve seen on the internet. Is the Facebook group private? Post a link.
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SAGES recently, March 8 2023, created a document attempting to explain the different types of mesh to their members. Many authors. The document is a good general primer about mesh but doesn’t seem to offer much advice on how to choose one. It’s a good start though, and they do acknowledge that much is still unknown about the materials in general. They end with a hopeful statement about registries, similar to what Dr. Heniford was calling for about five years ago.
https://www.sages.org/publications/tavac/mesh-review-and-catalog/
“…
Considerations for the Future
Given the current wide use of products in many clinical situations by surgeons with differing expertise, it is critical that surgeons follow patients over time to determine the outcome of interventions. The implantation of a device with the intent of lifelong placement carries with it a responsibility to ensure safety and efficacy of the product over the long-term. This is especially true in the off-label use of these products. By combining the rich clinical data obtained through well-designed registries with administrative data linkages and patient reported outcomes, we can help ensure that innovations in our field ultimately benefit our patients while minimizing harm.…”
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Here is another mesh product from a company I had not heard of, Betatech. Based in Turkey.
It has on odd pattern, it looks like a combination of braided material with monofilament.
https://www.betatechmedical.com/en-US/Contact/Contact-Info
A forum member was looking for a surgeon to remove it recently.
https://herniatalk.com/forums/topic/inguinal-hernia-mesh-removal-stats/
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Jnomesh posted about a prosthetic made from a person’s own tissue.
https://herniatalk.com/forums/topic/new-personalized-hernia-patch-made-out-of-skin/
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So far I have not got back into the soccer scene. I was out for three years with the mesh before the mesh removal, and it’s been up and down since then as far as figuring out what my actual level of fitness is, and whether or not I could handle a game. In the last few months I’ve started doing more hard running and sprinting, similar to what I might do in a game and have had thoughts that I could be ready to play again. But, at this point, I’m just enjoying being healthy again. Plus I have moved to a different state so don’t have the connections anymore. Nobody looking for players.
Once you’ve been down that far you really don’t want to take a chance on being there again. I hope things are going well for you.
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This Topic reminded me of a recent (2021) article in Hernia about the flaws in the EHS Guidelines. I am not an expert in data analysis so can’t add much to what is shown in the abstract. Hopefully the EHS is doing a better job before they release their update.
The title of the article is telling.
https://link.springer.com/article/10.1007/s10029-021-02423-7
Original Article
Published: 13 May 2021
Mesh repair for lateral inguinal hernias: a non-evidence-based practice
D. E. Tripoloni, M. I. Canaro García, F. Cassani, M. Zanni & A. Sosa Mercado
Hernia volume 25, pages1183–1187 (2021)“…
Conclusion
The idea that mesh techniques reduce the recurrence rate in all PIHs is not supported by high level of evidence. The NNT for pure lateral hernias was very high and should be interpreted taking into account chronic pain rates and costs.” -
I think that he was saying that Dr. Belyansky does remove mesh that had been placed via open surgery. He does both.
” had my mesh removed by Dr. Igor Belyankski-Although he removed open placed mesh his expertise is definitely in robotic/laparoscopic removal of mesh placed this way.”
Here is one his older posts where he describes the 3DMax. There are others with more detail. He used the term “hard as a rock” often, as I recall.
“I really don’t want to worry you but wanted to chime in that I had the 3D maxx mesh implanted 6 years ago and had issues from day one. They weren’t debilitating but occasional flare ups were.
about 10 months ago I did experienced debilitating pain and after much exhausting journey found out that the mesh had folded. The only surgeon to see this on a cat scan was dr. Igor Belyanski in MD. I ended up having to have the mesh removed.”right laproscopic inguinal hernia surgery with numbness and pain on right leg
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Jnomesh was actually one of the first 3DMax patients on the forum, as I recall. He often described how his removal surgeon found it balled up and hard inside him.
I came across another lap mesh patient. Ian J. A new mesh, a product called Polymesh. He was on the forum about a year ago but stopped responding after Chuck asked him to “chat”. Not sure why.
https://herniatalk.com/members/ianj/
I searched for Jnomesh and came across another lap mesh patient looking for solutions. dmpain. Honestly, they are so common that you almost don’t notice them. On for a few posts, gone, back for a few more later.
https://herniatalk.com/members/jnomesh/
Long-term pain: bounced between sports hernia and complications from hernia repair
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Thanks William. I looked through some of the BHS pages and they are the typical “we do it best” marketing pages of almost all hernia repair facilities. They seem to be claiming credit for all of the “tension-free” mesh methods. Pretty proud of themselves.
But, without the numbers, it’s just more salesmanship. At this point, I barely look at work reported without the numbers. It’s just chest-beating and crowing without the long-term measurements of success, using the things like quality of life, chronic pain, and recurrence as measures. Their publications page is dated, the most recent is from 2009.
The patient stories page is full of the typical vague terms and words. One patient climbed Mt. Kilimanjaro. Woohoo? There are few dates on the patient blog site and there are only 146 reports. Sorry, but to me the BHS looks like a typical hernia repair mill.
This Topic is really about finding numbers that will allow a patient to eliminate the worst choices. Worst mesh product, worst procedure, even worst surgeons or clinics. The BHS site doesn’t have any numbers that help.
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And, of course, this circles back around to a registry. With a well-designed registry these numbers would fall right out. Which is, of course, a reason that the device companies would not want to have one. The less people know the better off they are.
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In short – just trying to find another tool to use for a “process of elimination”. A patient might not be able to find the best procedure but they can avoid the worst.
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David M I think that is a whole separate discussion, about the cause. At this point many surgeons are dismissing the problem as unreal or just the result of people in today’s world being weaker than people in the past. The problem has to be recognised first, as Dr. Campanelli did in his Editorial, so that professional researchers at the medical device companies and universities have a reason to work on solutions, and/or so that consumers can avoid the bad products. As long as the denial continues not many people will put effort in to working on it.
The point of my post here is about the relationship between the volumes. If more product is sued you would expect more problems to be reported. The ratio of problems to product used gives the probability of problems for specific products. A similar comparison, which the professionals should have figured out and which the medical device companies probably already know, is “what is the ratio of problems to the specific device?”. For example, plugs have been identified as “not a first choice” or “evil”. But, according to Dr. Towfigh’s past remark, and a past forum post, linked below, plugs are a very high volume product. So, are the bad plug cases actually a small percentage of overall plug usage? Or not.
If you get on to the MAUDE database you can find a huge number of reports about specific devices but there is no context with the total volume of their usage. This is what the FDA should be doing, identifying the probability of problems with a product. If I knew that 20% of people with plugs had problems, and only 10% of people with Lichtenstein had problems that would help me make a decision, along with other information about the work needed to fix the problems. But I don’t know if a database exists that would allow someone to define those percentages. The numbers have to be out there. Somebody should be drawing those correlations.
https://herniatalk.com/forums/topic/plug-and-patch-hernia-repair/
I had created a Topic about the MAUDE database in the past but Google and the forum’s search engine can’t find it. Here is a link to the database.
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm
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Thanks for following up Herminius. Your story is similar to mine, I was an active soccer player too, but my hernia was obvious, and the pain was after playing, over the following days after a game, while doing things like raking leaves in the yard. I also waited much longer before having the mesh removed.
I’ve written this before but I recommend keeping a log of your activities and of how you’re feeling. I found that the effects of certain activities did not manifest until a day or two later. Because the whole situation is so mentally traumatic it’s often difficult to remember exactly what you were doing in the days before some new soreness shows up. By keeping a log or diary you can look back and see the correlations. I found some unexpected correlations, like the fact that when I stretched my arms upward I would feel tightness/soreness at my pubic bone days later. This took years to resolve, I assume that the damage left down there after the mesh was peeled off took time to correct itself.
If you get the time and would like to share maybe you could tell us what Dr. Krpata found. Folded mesh, properly placed mesh, problems? Any reasons for the pain.
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Watchful is right for patients that give up and do not do any research. No research at all = the highest chance of a bad result.
alephy’s reference shows that not all publications can be trusted. But it does not show that all publications should be mistrusted. It just shows that people need to understand the sources of the information that they are seeing. The registry based studies seem most valuable. We need more of them.
Thanks for posting this alephy. It reminds of the reply to the “International Guidelines for Groin Hernia Management” by the EHS, from some experts in data analysis. They showed that the premise for reviewing the data used to create the Guidelines was flawed and that the recommendations were not valid. Maybe that’s why the updated Guidelines are so far behind schedule. Years behind.
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Doesn’t work. The Forum web site is starting to have major problems. We can’t paste old links in to a post. Pasting as “plain text” still pastes an embedded link.
These words might work – herniatalk.com/forums/topic/pintos-hernia-repairs-by-dr-kang/
It works. Highlight those words then, right click, choose “Go to …” and it will take you there.
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Let me try a different paste method. A person should be able to put this test in the address window of their browser to get to the page.
https://herniatalk.com/forums/topic/pintos-hernia-repairs-by-dr-kang/
Here is is in embedded link form –
https://herniatalk.com/forums/topic/pintos-hernia-repairs-by-dr-kang/
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There does seem to be something wrong with the site now. I pasted a link in the post above to a Topic with the title “Pinto’s hernia repairs by Dr. Kang” and it opens a completely different link. I also put the title in the site’s search box and it came up as –
“Search Results for ‘Pinto’s hernia repairs by Dr. Kang’
Hernia Discussion › Forums › Search › Search Results for ‘Pinto’s hernia repairs by Dr. Kang’Oh, bother! No search results were found here.