Good intentions
Forum Replies Created
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I’m not 100% sure, maybe sensei_305 or someone else knows, but I think that the owner of the web site has to jump through a few hoops to make their site’s content searchable on Google. Google is a profit-generating business. Nothing is free.
Dr. Towfigh is right that the posts are there, they just don’t get found by Google Search. If you type “site:herniatalk.com pinto” in to the search box you’ll see everything that Google finds on the site that has “pinto” in it. If you click the “Tool” word in the upper right of that results screen, you can set a date range to narrow things down. I did that and did not find the posts that I had found earlier, linked below, from 2021. Google doesn’t see them. But they are there.
I also see that some early posts were from Pinto2.
Edit – I clicked on the link below and something else came up. Not sure why. So it might not work, but it’s only a couple of weeks old, if you scroll back on the main list of posts.
https://herniatalk.com/forums/topic/pintos-hernia-repairs-by-dr-kang/
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Don’t forget to take a stool softener before surgery. Don’t test things too quickly, hopefully the original hernias will tighten up enough when the mesh is gone to avoid a recurrence. Healing takes time.
I put the link to your first post below. You didn’t post as much as many people do when they are looking for solutions. You didn’t even make it to one year after the initial repair, but several others on the forum have done the same. When you know, you know. I assume that you did a lot more reading and researching before settling on Dr. Krpata. Could you share a little bit about yourself and how you came to your choice? I think it helps people to see a logical rational path to a decision, especially when so many experts seem to have no opinion at all.
Good luck.
https://herniatalk.com/forums/topic/looking-for-advice/
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I read through your story again and, to be frank, it looks like your first surgery was not as “neat” as it should have been. You said “lesions” but I think that you meant adhesions. That is one of the big worries of all laparoscopy surgeons, adhesion of the intestines to the abdominal wall via a damaged peritoneum.
You didn’t say whether your surgeon used the TEP procedure or TAPP. The big advantage of TEP, apparently, is that the peritoneum is never opened, so the abdominal wall, the fascia, and the intestines never come in to contact with each other. The adhesion problem is dramatically reduced. But, a good TAPP surgeon is aware of these problems and will take extra care to close the peritoneum tightly after placing the mesh. In other words you really should not have any adhesions or colon problems. It’s not “normal” for mesh implantation. Scar tissue problems are not common for a simple mesh implantation.
The adhesions are probably why your surgeon used an open procedure to remove the mesh. Because the adhesions were blocking his entry points, or because he was worried about causing future incisional hernias at those points. The adhesion path seems to be one of those vicious cycles where attempts to remove the adhesions can cause more adhesions.
These are just thoughts from all of the reading I’ve done, I have no professional training in the area. As you probably realize all of these surgeries are really not healthy for you. Besides the multiple areas that have to heal you have all of the anesthesia to worry about.
To the points about getting a second opinion be aware that if the other experts were all from the same business group, or partnership, they have a vested interest in not finding fault with their partners’ work. It’s just one of those realities of business. You’re in a tough spot and you’ve already started down the “try something new” path. Be careful, and objective about what is going on. Your situation is more complex than most of the horror stories in this forum. Your surgeon might be trying very hard and honestly but he might be in over his head.
Good luck. Here are some articles that might help your thinking.
https://www.science.org/doi/abs/10.1126/science.abg5416
https://scholar.google.com/scholar?as_ylo=2019&q=surgery+adhesions&hl=en&as_sdt=0,48
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There seems to be something happening in the Bard 3D Max world. The volume of reports in the FDA MAUDE database has jumped dramatically since 2019.
Put 3D in the Brand Name box and leave the other boxes blank. The attorneys seem to be getting ready to identify 3D Max products as a problem. I searched for other products like SoftMesh that was used on me and nothing comes up. It’s a poor database but it might mean something. Maybe Bard (BD now) made a change in the product and it was a mistake. Make sure to change the date range, it starts with just a one month span.
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm
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Hello again Edward and welcome to the Forum.
Even though you trust your surgeon it would still be wise to get a copy of your medical records, for sharing and for long-term history. There is still a wide array of different opinions on how to best perform a mesh implantation. For example, prophylactic neurectomy is often performed. In other words the three main nerves in the groin area are cut, on the premise that this can avoid future pain, and the premise that they serve sensory functions only. There might be something in the procedure he performed that is a clue to someone with expertise, like Dr. Towfigh.
3D Max is a polypropylene mesh that that is very common in lap mesh repair. Nothing really notable there as far as immediate biological response, like an allergic reaction. But, who knows for sure.
How soon after the implantation did you feel the testicular pain and the left side pain? Obviously it was soon but was it immediate? What type of pain was the left side? Very localized and specific or diffuse?
Also odd that the surgeon performed open removal after laparoscopic implantation. Most lap surgeons would have removed it by the same method.
Finally, the involvement of the colon still seems odd. In both TAPP and TEP the body is placed in a position that lets the intestines drop away from the abdominal wall, where they are safe and out of the way.
These are just observations and questions. All surgeons sound confident in their work. I don’t think that a person can be a surgeon without a high level of self-confidence.
Anyway, the surgery notes might have some clues. A good surgeon will not be offended if a patient with problems wants to take a look at them. They are available to all patients just by asking. Most places can send them by internet or on a DVD.
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Thanks for clarifying. There’s a reason I don’t do complex things early in the morning. I felt compelled this time though.
So, rewording with more correct dates – bilateral implantation of the same 3D Max that Chuck had, late spring of last year, “revision”, whatever that means, 2 and 4 months later, (about one year ago), spinal stimulator 7 months later (no mention of what was happening in those 7 months), emergency surgery on the colon one month ago (although the colon is not involved at all in a mesh implantation), and the “exact same symptoms” remain, but those were not described.
Edward, if you are a real person, I apologize for making your post more complex. There is a forum member who has been creating new personas in order to make up stories, basically trolling the members of the forum. He had a bad mesh implantation experience and has been worried about the after-effects.
So, if you are real feel free to add to your story in a way that will make your legitimacy apparent. Sorry, but these alternate personas seem to be a new internet thing.
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The story has many similarities with “Chuck Taylor”‘s story. The writing style is similar also.
You went from 4/22 to 6/22 to 3/23 and then apparently had emergency surgery on 6/23 the day after revision surgery, then the last event was 8/22. The spinal stimulator trial was a month before the mesh implantation. Is a “spinal stimulator” a method of treating hernia pain? By the dates there was a spinal stimulator, mesh implantation, “revision” (unclear what that means) 2 months and 4 months later, emergency surgery the day after the first revision, and a MRSA infection. This all must have happened over a year ago since it’s only July. Very confusing story.
Could you retell your story in chronological order? It doesn’t really make sense. What were your initial symptoms and how did you end up getting spinal stimulator treatment? Good luck.
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Just a followup to point out something I missed – not all mesh repairs are the same. Sorry Watchful but you’ve kind of lost your rigor. Combining open Lichtenstein with laparoscopic TEP mesh. They are completely different methods of repair. The only commonality is the use of mesh. It’s the big trap that everyone falls in to – combining all procedures that involve mesh as “mesh repair” and all different types of mesh as “mesh”. Simplifying the whole complicated situation down to pure tissue versus mesh.
“I know 5 people who had mesh repair of inguinal hernias. 2 lap TEP, and 3 Lichtenstein.”
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Sorry Watchful, but I don’t believe that anyone actually has “zero” issues after any surgery. The other question that I didn’t ask (you didn’t answer the others) is, are they back to the same level of activity as before? “Fine” is not zero.
Besides the odds of problems, the magnitude of the corrective efforts is very important. Getting another pure tissue repair after a recurrence is orders of magnitude less significant than a mesh removal.
Personally, having gone through it, the damage that is possible from a mesh removal is barely comprehensible until it’s happened to you. To surgeons also. People need to consider what could happen if they get a poor result. Odds versus cost of failure.
We’re all just repeating ourselves now. Let’s get some details. I was finally able to fit into my old pants size, just last week. Soon after mesh implantation I had to go up two inches on waist size to reduce the pressure at the waistband, right below my navel. This did not change after mesh removal, my lower abdomen was like a plastic bowl. My pants have been getting looser and looser over the last few years and I finally pulled the trigger and bought a new pair of shorts. It feels so good to not have all of that extra fabric flopping around to actually feel like my pants fit correctly. It’s been over eight years.
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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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